As a parent, you can’t know if your child has asthma or not. You can suspect it. Johannesburg Specialist Paediatric Pulmonologist, Dr Keketso Mopeli ,of the Nelson Mandela’s Children’s Hospital helps break down the symptoms of the disease and the importance of a diagnosis.
Asthma is an airways disease of the respiratory system and the most common chronic condition of childhood. The causes are multifactorial; however, genetics play a big role. It is characterised by the narrowing of the airways which leads to inflammation, which is linked to a chronic cough and difficulty breathing. “Asthma is a reactive condition. This means symptoms can come and go,” Dr Mopeli says.
What to look out for
Asthma symptoms range. The most common one is a recurrent, dry cough. This is a chronic cough that usually occurs at night or early in the morning.
The cough could be triggered or aggravated by exposure to certain things. If the child is playing sports or running. Or if the child has allergies and they are exposed to those allergens – whether grass, pollen, or peanuts – that can start symptoms going. These are associated conditions of the disease.
“The reactive nature of the cough is what makes us suspect asthma as opposed to other conditions like an infection. If your child has an upper respiratory tract infection or pneumonia, they have fever as well. Whereas children with asthma just have this cough. They don’t appear ill otherwise,” notes Dr Mopeli.
Other symptoms include difficulty breathing; shortness of breath and your child may feel like their chest is tight.
“If it’s really bad – this is when they’re having an asthma attack or an exacerbation – you’ll hear a wheeze, when the airways are tight or narrow,” Dr Mopeli says.
Dr Mopeli believes it is vital to get diagnosed for a good quality of life.
“A cough is very disruptive to life and a chronic cough is uncomfortable. We want to relieve that discomfort and protect the child from having an exacerbation, commonly called an asthma attack. That is how we lose patients. If a person who is undiagnosed or who has been diagnosed but is not on the correct treatment or not on treatment, has a severe exacerbation, it may complicate things and they may end up losing their life,” she says.
Asthma diagnosis can be easy or hard depending on the age of the child and how it presents.
“We divide the children into two age groups: Under three or four years old and the ones above. The most important thing is what the parent tells you. Two main points of diagnosis are history and examination.”
“We take the child’s history and look at the cough holistically. We also look at the associated conditions of asthma. Are there any foods that the child is allergic to that give them a rash and aggravate the cough? Sometimes the child does not have an allergy at the time that you’re seeing them. Cow’s milk allergy and eczema are associated with asthma.”
Family history is also very important. If a close relative is an asthmatic, it increases the likelihood of a child developing asthma. There’s a genetic component as children inherit their immune system from their parents.
Dr Mopeli continues, “before examining the child’s lungs, I will examine the entire child for underlying conditions. There are co-morbid conditions that often go together with asthma. These are allergic rhinitis, eczema and allergic conjunctivitis.
“If asthma is confirmed, the child gets started on treatment for a month. We send the parent home with an asthma diary – a form taking note of the child’s progress every day. If the child comes back and is completely well, the parent can continue with the treatment and label the child as asthmatic until further notice. Or they can choose to stop the treatment. With asthma, the symptoms will come back and then we’ll start treatment again. This is for the young ones.”
For older kids, a lung function test is done where they blow into a machine and measure their lung volume. After that, they do a bit of exercise (walking or running on the treadmill) to find out what irritates them. They repeat the test, and if the test is much worse (there are criteria) then the doctor might get suspicious, if they’re reactive.
“We will then give the child treatment – an inhaler that will open up the lungs. And repeat the test again 20 minutes later. If when we repeat it again, there’s an impressive improvement, then we know that this is absolutely asthma. This shows us that these lungs are reactive,” says Dr Mopeli.
Asthma has no cure, but it is completely controllable and treatable. The gold standard treatment for asthma is inhaled corticosteroids. This is a pump or a steroid inhaler that is to be used every single day.
“The inhaled corticosteroid calms the inflammatory system down in the lungs. We call it a preventor or a controller. It treats the root cause of asthma – which is an immune system that has gone rogue. This is to be used daily whether the child is sick or not. Just like a person with high blood pressure must take their medication even if the blood pressure is normal, the same applies with asthma,” says Dr Mopeli.
“Medication for when the child is coughing, having an attack or when their chest is tight is called a Beta-agonist. This is an inhaler to open up the lungs. We also call it a reliever. If a clinician suspects that your child has asthma, they must start them on both the corticosteroid inhaler and the beta-agonist. That is what the guidelines say. Those are the primary medications.”
It is important to have the right treatment and medication doses, as well as the correct technique. A pharmacist or a clinician will teach the parents.
“For young children who can’t inhale or hold their breath, there are devices which are a combination of a mask covering the nose and mouth and a plastic chamber to release the medication into. All the child needs to do is breathe and inhale the medicine,” Dr Mopeli explains.
“Depending on anything else that the child has, we might add a nasal spray, if we believe the child has allergic rhinitis. You can add an antihistamine if you believe that the child has allergies. The child can be on some oral medication as well. These are usually add-on medications. And you need to save that add-on medication for when it is needed,” she advises.
If you know what asthma triggers are, avoid them. If parents aren’t sure, blood tests or skin prick tests can be done to give clear guidelines.
“Once your child is under treatment, monitor them. Figure out what the perfect medication dose and combination is for them, and if they stay controlled and they’re well, overtime we can cut it down. Maybe one day you can even stop the treatment. Some children do outgrow asthma. Some children don’t,” says Dr Mopeli.
Read more here on managing asthma https://www.babyyumyum.co.za/manage-asthma/