Asthma is the most common chronic lung disease in the world. It affects the airways (conducting system) of the lungs and makes breathing difficult. Asthma, and other allergic conditions, is becoming more common in Kenya and other rapidly urban countries.
How does asthma manifest?
It manifests as recurrent episodes of cough, chest tightness, difficulty in breathing, and wheezing. Symptoms are usually worse at night or after exposure to different triggers including physical activity.
The airway of asthmatics has an abnormal response to proteins contained in animal dander, plant pollens, molds, and house dust mite, among others.
Detergents, perfumes, incense, and tobacco smoke also irritate their hyperactive airway.
Irritation of airways causes spasms, cough, thick mucus production, chest tightness, difficulty in breathing, and wheezing. If untreated, these signals will change the structure of the airway and result in reduced lung function as the child grows older.
Management of asthmatic children
Inhaled steroids are commonly used to treat asthma in children. The inhaled dose is a small proportion of the oral drug used during severe episodes. Daily use of these smaller safer doses helps decrease symptoms, improves control during exposure to known triggers, and preserves lung function in children thereby allowing them to live a fairly normal life. Acute episodes are treated with relievers; medications that reverse the spasms of the airway.
Unfortunately, parents are more receptive to using relievers compared to controllers, to the detriment of affected children. A child who regularly requires the use of a reliever is in danger of more severe asthmatic symptoms leading to decreased lung function.
It fails to address the underlying inflammatory process responsible for the symptoms. It is similar to a patient who takes paracetamol for a headache or fever caused by malaria without taking antimalarials.
Single-use of relievers or inadequate controller use results in poor baseline control with frequent hospital visits for nebulisation and oral doses of steroids.
Multiple doses of systemic steroids cause more side effects than those perceived with long term low dose inhaled medication.
Good baseline control requires regular use of whichever controller prescribed for a specific patient and avoidance of their asthma triggers, both allergens, and irritants.
Allergy testing helps identify the allergens that may affect your child. Controller therapy is needed for as long as the patient exhibits symptoms. Regular re-evaluations allow for dose changes to ensure the disease is managed well.
Why your child’s asthma may worsen during cold season
Infections especially viral ones, are more common during the cold season. Children are more likely to get infections due to their lower ability to fight them. The size of their airways are also smaller and more easily affected by both infections and the inflammation from asthma. The air is also much colder and drier may act as irritants to the hyperactive airway.
Tips on managing asthma in children during cold season
· Use their prescribed asthma controllers daily.
· Ensure that an age-appropriate spacer device is used for all inhalers. This helps the child inhale the medicine better.
· Use the nasal spray for nasal allergies daily; untreated rhinitis worsens asthma.
· Avoid all known triggers including tobacco smoke
· Keep your home dry and dust-free.
· Wash beddings at least once or twice a week. This decreases the burden of house dust mite or animal dander which may trigger allergies when the child is exposed during sleep.
· Take advantage of longer periods of sunshine to wash and dry blankets or duvets.
· Keep children warmly dressed but not enough to cause sweating under their clothes: cold inhaled air is the main trigger for attacks.
· If the asthma is worsening despite optimal use of your medications, consult your doctor.
· Always take the medications and spacer device with you during hospital visits for assessment of the spacer technique. This is a common cause of poor control that’s easily corrected without requiring higher treatment doses.
· Ask your doctor about the annual influenza vaccination.
Dr Kiragu is a paediatric allergy specialist at Aga Khan University Hospital, Nairobi