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Baby and childhood respiratory disorders: asthma BABY AND CHILDHOOD RESPIRATORY DISORDERS: ASTHMA
Asthma is a fairly common lung disorder in which breathing becomes difficult, causing wheezing, coughing and respiratory distress. The airways become narrowed, because of fluid accumulating in their lining, and the muscle fibres in their walls go into spasm reducing their diameter. A wheezing noise occurs as the patient tries to force air from the lungs. Asthma comes on in bouts, frequently abruptly, and may persist for varying periods of time. In chronic sufferers, the chest tends to become barrel-shaped as the lungs overinflate.
Asthma is considered to be an allergic reaction. Numerous items (called allergens) have been incriminated for bringing on attacks. Once a person has become sensitized to a certain item, usually a foreign protein in the air, a reaction may occur in the future at any time he or she is again exposed to that allergen. Pollens from flowering grasses are an extremely common cause. But the range of offending items seems inexhaustible: hairs or material from the skin of domestic pets (dogs, cats, horses) are well-known causes, and so are feathers—hence problems in many sleeping quarters, from feathers, down and kapok in sleeping gear.
In recent years, household dust, a well-known troublemaker, has been tracked down to the house-dust mite, a potent and common cause for initiating attacks. It is almost impossible to escape exposure to this fellow which hides in the dust that accumulates in every home.
Many foods have been blamed, but the significance of this is in doubt. Attacks may be brought on after the ingestion of wheat products, eggs or milk, or many other products. Extremes in temperatures (heat or cold) may precipitate attacks in some sufferers; and often windy, dry, hot and dusty days may also cause trouble for others.
Emotional factors—tensions, stresses, being subject to situations that cause mental discontent—are also well known. In fact, if an attack is pending the psychological overlay may quickly bring on a fully blown attack and throw a child into great consternation and discomfort rapidly. The incredible value of medical hypnotherapy in treating certain patients testifies to the psychological overlay present in many individuals, and this is particularly so in youngsters.
Often an attack starts with a slight cough, a wheeze and general chest congestion. This may lead on slowly (or rapidly) to a more severe cough, to respiratory difficulty, and noisy wheezing respirations. If the attack becomes more severe, there may be perspiration, marked difficulty in breathing, blueness of the lips, a very tense and anxious expression on the face as the patient sits forwards in a valiant effort to get enough breath. It is a frightening sight when first seen, and a very exasperating and worrying situation for the patient. The thought of an impending attack is often enough to increase the speed with which symptoms occur.
Status asthmaticus is a severe form of prolonged asthma, in which breathing is particularly difficult and there is no let up. This may persist for hours, and unless proper treatment is readily available from the doctor or hospital it may be fatal. It is an emergency.
Treatment
In the past few years, enormous improvements have occurred in treatment. There is no simple do-it-yourself remedy, but as soon as a diagnosis has been made many routines are available for the patient to relieve the problem. Parents with asthmatic children should become well versed in the forms of treatment available, so they can carry these out whenever necessary.
Prevention of attacks is at present the mainstay of therapy. Avoiding contact with known troublemakers is the best advice. If there is an obvious or proven association with certain foods or other foreign proteins, every effort to avoid contact with these should be made.
Several forms of drug medication have now been available for several years which, when used regularly under the doctor's supervision, largely reduce the risk of attacks. Sodium cromoglycate (Intal) is a powder that is used in a device called a spinhaler and inhaled into the throat regularly. This reduces the risks of attacks in many cases.
A more recent one called beclamethasone dipropionate (Becotide and Aldecin) also gives excellent relief when inhaled daily according to the routine specifically worked out for the child. This is a fine spray, with a cortisone-type base which acts directly on the lung tissues. It can often greatly assist in preventing attacks. Neither of these drugs will give instant relief for an impending attack. They are used in a long-term manner, as a preventive.
In due course, other drugs along these lines will inevitably appear, and already others are under trial and may soon make their appearance. Each may offer benefits over existing ones when they are finally approved for commercial sale.
The aerosol inhalants represent a major improvement in therapy over the old-time method of injections of adrenaline. Salbutamol (Ventolin) is probably the most popular, but others are still being used, such as orciprenaline (Alupent) and isoprenoline (Isuprel). These come in cans containing 200-300 doses. The mouthpiece is held to the lips and the dose inhaled as the valve is released with a finger. These forms of therapy are extremely powerful and must always be given under proper medical supervision and instruction. Make certain that the instructions given are always followed carefully, for overdosing is a common problem. Although the spray routine is the most popular—and it is amazing how quickly children learn how to perform the routine—tablet and syrup forms of these medications are also available.
Other methods
Other methods of treatment are also used. Doctors still use the steroids, cortisone-like products but with fewer side effects than the original product. Prednisone and sometimes prednisolone are used. However, unwanted and occasionally disabling side effects in children are possible (stunting of growth, and fluid retention giving a full rounded facial appearance). In recent years many children on long-term steroid therapy have been successfully and easily switched to the aerosol forms, which seem devoid of these side effects.
Many other forms of therapy have been used in the past, and you may still hear of aminophylline, adrenaline, theophylline and ephedrine. They played their part in the past but have now been superseded by the newcomers in most cases. In certain cases, however, they still have a part to play and may be resorted to when other methods fail.
Some cases of asthma seem to be related to pollens, and these can be detected by allergy tests. Some doctors give the patient a course of injections aimed at desensitization. It consists of a long series of injections given once or twice a week. It is not popular with patients, especially with youngsters, but is still sometimes carried out. The results, in the main, are not considered to be good. Recent attempts to desensitize patients against the house-dust mite are similarly not very successful.
In recent years, some doctors have found excellent results with the use of medical hypnotherapy, a form of mental relaxation. Children often respond well, and often the frequency and severity of attacks may be reduced by this simple non-drug form of treatment. The Australian Society for Clinical and Experimental Hypnosis is the all-doctor group specializing in this form of treatment. Information will be supplied, on request, from the Honorary Secretary, A.S.C.E.H., P.O. Box 586, Chatswood, N.S.W. 2068 (for all Australian states).
General measures will always assist in reducing attacks and their intensity. Try to lessen the amount of house dust in the home. Try to avoid the child's contact with bedding containing known troublemakers such as kapok, feathers and down, and where necessary replace these with rubber types. Avoid winds and dusty days as much as possible. Try to keep the child in good health at all times, with sensible eating habits, regular meals and nutritious food. Breathing exercises practised regularly often help. Keep the child away from cigarette or any other smoke; ideally, nobody in the home should smoke. Attend to infections promptly, especially respiratory infections. Try to maintain happiness and harmony in the home—a happy, harmonious home is one in which problems will breed less often.
The future for a childhood sufferer from asthma is often very good. In many cases the asthma disappears entirely as the child becomes older. If the attacks are not complicated by respiratory infections, there is rarely any residual or serious lung impairment. However, at any given time the future course of the problem can be quite unpredictable, so it is worth following the medical advice carefully, treating every case seriously and taking all possible precautions.
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