Croup occurs more frequently in allergic children than in others and may occur in children who are prone to have asthma. An episode of croup is easily differentiated from an asthma attack. In croup, the wheezing is heard when the child breathes in. The wheezing in asthma, as we know, comes with breathing out.
Since croup can occur in the asthmatic child, make sure to notice whether the wheezing comes with breathing in or with breathing out. This is very important because croup is more serous from the start and gets more severe more quickly than asthma. Treatment for croup and for asthma is somewhat the same, involving the use of humidified air, the adrenaline family of drugs, and steroids.
When these and other wheezing Conditions peculiar to childhood have been ruled out, asthma is the problem. Asthma usually is identified by wheezing, but in some children, the troublesome sign is a cough instead of wheezing. The cough is often a dry, hacking cough, usually worse at night. Such a cough is considered to be the equivalent of asthma and sometimes precedes wheezing by several hours. In this case, there is enough spasm of the bronchi to cause coughing but not enough to cause wheezing. Sometimes the wheezing is absent because the young child's respiratory muscles are too weak or too tired to provide the effort that is needed for wheezing. A mucus drip at the back of the throat (postnasal drip) can also cause a hacking cough.
Monday, August 31, 2009
Sunday, August 30, 2009
Asthma in Children
Asthma is a leading cause of chronic illness in childhood, and is responsible for a significant portion of school days lost because of chronic illness. It is also estimated that between 5 and 10% of children will at some time in their lives have signs and symptoms compatible with asthma. Before puberty, about twice as many boys are affected as girls; after puberty the numbers are equal.1 As in adults, the incidence of asthma and the death rate from childhood asthma are on the rise.2 There is no simple explanation for the increase in illness and death caused by childhood asthma, but delay in seeking treatment and increase in air pollution are two possible causes.
Despite the fact that both adult and childhood asthma are on the rise, there are some basic differences between asthma in adults and that in children. Allergy plays a more important role in childhood asthma than in adults. Most asthmatic children will have one or more other signs and symptoms of allergic disease and most children who will develop asthma have their first attack before age 2. Childhood asthma seems to be more prevalent in homes where the parents smoke, as are other respiratory diseases including the common cold, the result of air pollutants in cigarette smoke.
Despite the fact that both adult and childhood asthma are on the rise, there are some basic differences between asthma in adults and that in children. Allergy plays a more important role in childhood asthma than in adults. Most asthmatic children will have one or more other signs and symptoms of allergic disease and most children who will develop asthma have their first attack before age 2. Childhood asthma seems to be more prevalent in homes where the parents smoke, as are other respiratory diseases including the common cold, the result of air pollutants in cigarette smoke.
Asthma from Exercise- The Scourge of Olympians
Some people develop asthma simply from exercising, regardless of age. Within a few minutes after starting to run or beginning any other strenuous exercise, about 10 percent of all asthmatics develop full-blown asthma. Exercise-induced asthma is believed to be caused by the irritation and drying effect of large amounts of air, rapidly inhaled, especially cold, dry air.
Running is the usual cause of exercise-induced asthma. This is true not only for casual runners, but also for highly trained athletes. In a survey of the 1984 summer Olympians, 11% reported history or symptoms of exercised-induced bronchospasm (EIB),another term for asthma. Bicycling is a less common cause of EIB since the bent-at-the-hip position of the biker makes it easier to exhale. Swimmers are taught to control their breathing, to inhale quick and exhale completely in a controlled, rhythmic fashion. This appropriate breathing pattern makes swimming a rare cause of exercise-induced asthma. According to a 1996 study from the Sport Science Center at the University of Delaware, 30% of indoor figure-skating athletes develop EIB while exercising in the cold, damp, and sometimes moldy rink environment. None of this seems to handicap these athletes, especially since medicines that relieve bronchospasm are on the short list of medicines approved by Olympic authorities for use by competitors.
Running is the usual cause of exercise-induced asthma. This is true not only for casual runners, but also for highly trained athletes. In a survey of the 1984 summer Olympians, 11% reported history or symptoms of exercised-induced bronchospasm (EIB),another term for asthma. Bicycling is a less common cause of EIB since the bent-at-the-hip position of the biker makes it easier to exhale. Swimmers are taught to control their breathing, to inhale quick and exhale completely in a controlled, rhythmic fashion. This appropriate breathing pattern makes swimming a rare cause of exercise-induced asthma. According to a 1996 study from the Sport Science Center at the University of Delaware, 30% of indoor figure-skating athletes develop EIB while exercising in the cold, damp, and sometimes moldy rink environment. None of this seems to handicap these athletes, especially since medicines that relieve bronchospasm are on the short list of medicines approved by Olympic authorities for use by competitors.
Asthma - Antibody Tests
Allergy antibodies are members of the group of IgE antibodies. In this group can be found antibodies against the protein of trees and grasses, against animal hair and other inhaled substances, and against foods. Blood tests for IgE antibodies against plants and animals are very reliable, very helpful in diagnosing allergies. Testing for food antibodies is less satisfactory than testing for antibodies to the inhaled substances.
The technology used for determining these allergy antibodies is called RAST testing. Using RAST, it is possible to look for antibodies that react to allergy-causing substances. RAST can also be used to follow the progress of an allergic disease. As the condition lessens, the antibodies diminish, too. Tests for many allergy-causing substances (allergens) can be done on a single, small specimen of blood. This makes blood testing quicker and easier than skin testing, the traditional method of finding IgE antibodies. Skin testing is still the usual method of finding antibodies, however, because it detects smaller amounts of antibodies than RAST testing and is less expensive.
Testing of any type is best done on an individualized basis, the tests selected to correspond to information obtained from the medical history. There is no need to test for grass pollen in a patient whose symptoms are exclusively in the winter, no purpose to testing for foods such as lobster that the patient never eats. In any case, although the history is most significant in evaluation of an allergic patient, many tests are available to establish the diagnosis and observe progress with treatment.
The technology used for determining these allergy antibodies is called RAST testing. Using RAST, it is possible to look for antibodies that react to allergy-causing substances. RAST can also be used to follow the progress of an allergic disease. As the condition lessens, the antibodies diminish, too. Tests for many allergy-causing substances (allergens) can be done on a single, small specimen of blood. This makes blood testing quicker and easier than skin testing, the traditional method of finding IgE antibodies. Skin testing is still the usual method of finding antibodies, however, because it detects smaller amounts of antibodies than RAST testing and is less expensive.
Testing of any type is best done on an individualized basis, the tests selected to correspond to information obtained from the medical history. There is no need to test for grass pollen in a patient whose symptoms are exclusively in the winter, no purpose to testing for foods such as lobster that the patient never eats. In any case, although the history is most significant in evaluation of an allergic patient, many tests are available to establish the diagnosis and observe progress with treatment.
Alternative Asthma Treatments-Psychological Management
There is no doubt that the mental and emotional state of a person can influence health. In the 1940s through the 1970s, there was widespread interest in the mind-body relationship. Elaborate programs were designed to produce better adjustment of the patient to his or her social environment. The outcome sought was better understanding of the relationship of mind to body and how this was influenced by the social milieu. Some progress was made in management of some diseases in this manner.
In this period, it was fashionable to consider asthma as a psychosomatic illness and to offer psychological counseling or psychotherapy as a treatment. Some practitioners went so far as to liken wheezing to the cry of an infant for its mother. But with large-scale improvement in methods of managing physical health, interest in psychosomatics waned. These days, although it is understood that emotional state has an influence on asthma, there is much less acceptance of psychological problems as a cause for asthma. Although counseling is now considered important, it is only part of any management program.
In this period, it was fashionable to consider asthma as a psychosomatic illness and to offer psychological counseling or psychotherapy as a treatment. Some practitioners went so far as to liken wheezing to the cry of an infant for its mother. But with large-scale improvement in methods of managing physical health, interest in psychosomatics waned. These days, although it is understood that emotional state has an influence on asthma, there is much less acceptance of psychological problems as a cause for asthma. Although counseling is now considered important, it is only part of any management program.
Alternative Asthma Treatments-Homeopathy
The principles underlying homeopathy reach back to Hippocrates, the Greek physician of antiquity who is hailed as the father of medical practice. Hippocrates believed that certain substances caused disease and that taking the same substances, when diluted sharply down, would cure the disease. This theory was popular in the United States in the 1700s but fell out of favor when it failed to produce the results expected of it. Homeopathy is still recognized in Britain by the National Health Service as the only alternative form of healthcare.
There is little evidence that homeopathy works, but doses of all substances used are so low that they can't cause any trouble. For example, according to Dr. Oliver Wendell Holmes, writing in 1842, "Doctor Hahnemann, father of homeopathy, describes dilutions of a billionth, trillionth, quadrillionth ... and much higher" for treatment of actual patients.
There is little evidence that homeopathy works, but doses of all substances used are so low that they can't cause any trouble. For example, according to Dr. Oliver Wendell Holmes, writing in 1842, "Doctor Hahnemann, father of homeopathy, describes dilutions of a billionth, trillionth, quadrillionth ... and much higher" for treatment of actual patients.
Alternative Asthma Treatments-"Hands-On" Management
What about treating asthma by lying on of the hands? Chiropractic theory suggests that most diseases result from misalignment of the spinal column. The theory proposes that realignment by manual adjustment of the position of the vertebrae in the spinal column can offer relief. In practice, chiropractors use X rays of the spine to demonstrate misalignment of the bones. Then, using their hands to manipulate vertebrae of the spine, claim to correct the alignment and provide relief. There is no evidence that this is true. There is also no proof of effectiveness of various "ray" treatments, low-grade radiation that does not pass through the skin. It is likely that any improvement in asthma following chiropractic treatment is the result of relief of psychosocial stress or of improvement in breathing technique such as suggested elsewhere in this book.
Alternative Asthma Treatments-Acupuncture
As an example, there is acupuncture, a treatment developed in China about 5000 years ago and still widely used there but rarely in the United States. Asthma is one of the diseases described as treatable with acupuncture, a technique that involves inserting thin needles through the skin at certain sites. Acupuncture needles placed in exact positions definitely improve acute exercise-induced asthma in some patients. Improvement often occurs within one-half hour, but is not permanent and not all patients treated get better, but patients who improve once can be expected to improve again after additional treatment. The amount of improvement is also fairly constant, although bronchospasm improves only by about 50%. Acupuncture is helpful only in exercise-inducted asthma; it does not seem to benefit patients with asthma related to allergies or inflammation.
Most of the information about treatment by acupuncture comes from China, where that treatment is readily available and inexpensive. Publications such as the Journal of Traditional Chinese Medicine and the American Journal of Chinese Medicine publish well-conceived and implemented studies of the usefulness of acupuncture in treatment of asthma. Results are equivocal, some demonstrating usefulness of acupuncture, others not.
Although studies are readily available, in the United States experienced practitioners are hard to find and treatment is not nearly as convenient as and much more expensive than traditional therapies. This situation could change dramatically as and if acupuncture proves itself in the asthma-care marketplace.
Reflexology, sometimes called zone therapy, is a second cousin to acupuncture. It involves massaging specific points on the foot, or sometimes the hand, to treat asthma. From 1987 through June 1996, there were several articles in medical journals descriptive of reflexology but none of these concerned reflexology and asthma.
Most of the information about treatment by acupuncture comes from China, where that treatment is readily available and inexpensive. Publications such as the Journal of Traditional Chinese Medicine and the American Journal of Chinese Medicine publish well-conceived and implemented studies of the usefulness of acupuncture in treatment of asthma. Results are equivocal, some demonstrating usefulness of acupuncture, others not.
Although studies are readily available, in the United States experienced practitioners are hard to find and treatment is not nearly as convenient as and much more expensive than traditional therapies. This situation could change dramatically as and if acupuncture proves itself in the asthma-care marketplace.
Reflexology, sometimes called zone therapy, is a second cousin to acupuncture. It involves massaging specific points on the foot, or sometimes the hand, to treat asthma. From 1987 through June 1996, there were several articles in medical journals descriptive of reflexology but none of these concerned reflexology and asthma.
Asthma - Alpha, Antitrypsin Disease
Airflow obstruction arises also with alpha antitrypsin disease. In this disease, a protective antibody globulin (alpha antitrypsin) is missing or in short supply in the blood of the patient.
The antibody is needed to protect against enzymes produced by bacteria that normally inhabit the lungs. Without the protective antibody, lung tissue is digested by bacterial enzymes, resulting in destruction (fibrosis) of the lungs. In the process, coughing and wheezing are troublesome, depending on the severity of illness. The disease is transmitted genetically, and appears in a spectrum of severity from mild to very severe. Although the exact details of the disease process are unknown, causative genes have been identified. This is one of a number of genetics-based diseases that may ultimately be prevented or treated by genetic engineering. It is also possible to produce the missing protective antibody on a commercial scale, so specific treatment may be available some time in the future.
Also well known is the relationship between smoking and this genetic disease. Smoking and other harmful environmental exposures increase the severity of this disease. Until then, antitrypsin disease will persist as an unusual disease that causes wheezing.
The antibody is needed to protect against enzymes produced by bacteria that normally inhabit the lungs. Without the protective antibody, lung tissue is digested by bacterial enzymes, resulting in destruction (fibrosis) of the lungs. In the process, coughing and wheezing are troublesome, depending on the severity of illness. The disease is transmitted genetically, and appears in a spectrum of severity from mild to very severe. Although the exact details of the disease process are unknown, causative genes have been identified. This is one of a number of genetics-based diseases that may ultimately be prevented or treated by genetic engineering. It is also possible to produce the missing protective antibody on a commercial scale, so specific treatment may be available some time in the future.
Also well known is the relationship between smoking and this genetic disease. Smoking and other harmful environmental exposures increase the severity of this disease. Until then, antitrypsin disease will persist as an unusual disease that causes wheezing.
Asthma - Airborne Causes of Bronchospasm
Irritation produced in the lung by inhalation of chemicals like formaldehyde is still another known cause of asthma. These exposures usually occur at work, so the problem is called "occupational" asthma. About 250 agents can cause occupational asthma. Among the substances that may provoke occupational asthma are toxic gases including dry-cleaning fluids, metals such as solder, dusts (particularly grain dusts and seed dusts), organic chemicals, plasticizers, plant sprays, and toxic gases. For the most part, no allergic mechanism is associated with this type of asthma, but inflammation is a factor. Reaction to these exposures can cause severe asthma, which, when it occurs in the workplace, can lead to lawsuits.
Occupational asthma does not always happen on the job. I can vividly recall a whole family, including three small children, who developed coughing and wheezing only at home. Rather than use the municipal service, the family had their own well; testing the well water did not disclose a cause for the family's asthma. Next, the family was tested for possible allergies but nothing came up. On a visit to the home it became apparent that the problem had begun shortly after insulation had been blown into the walls. The culprit turned out to be formaldehyde, a plasticizer that continued to evaporate into the air for months as the insulation set The family was forced to move to a new home to solve the problem. This led to a lawsuit against the installer of the insulation, a suit in which the family prevailed.
Occupational asthma does not always happen on the job. I can vividly recall a whole family, including three small children, who developed coughing and wheezing only at home. Rather than use the municipal service, the family had their own well; testing the well water did not disclose a cause for the family's asthma. Next, the family was tested for possible allergies but nothing came up. On a visit to the home it became apparent that the problem had begun shortly after insulation had been blown into the walls. The culprit turned out to be formaldehyde, a plasticizer that continued to evaporate into the air for months as the insulation set The family was forced to move to a new home to solve the problem. This led to a lawsuit against the installer of the insulation, a suit in which the family prevailed.
Asthma: Use of Medicines in Pregnancy
Control of maternal asthma may require use of medicines. Happily, none of the medicines generally used to treat asthma are known to cause trouble for the developing baby in the womb. Adrenalinelike and theophylline medicines are okay. Drugs of the cortisone family have never been shown to cause problems to the developing baby.
The sickest asthmatics, those who need oral steroids continually to prevent asthma, are more likely to have their babies a little earlier than the expected date. The babies are early, but of normal birth weight and appearance. Doctors do not know whether this higher incidence of "preterm delivery" is the result of the asthma or of the medicines used to prevent it. No matter which, the problem is not severe enough to require any special management.
If you are considering having a child, your asthma need not discourage you. If your asthma is kept in check, there should be no problem for you or your baby Even if the asthma requires use of medicines, ifs still okay to get pregnant, since it has been shown in many studies that the commonly used asthma drugs are safe for the mother and safe for the fetus.
The sickest asthmatics, those who need oral steroids continually to prevent asthma, are more likely to have their babies a little earlier than the expected date. The babies are early, but of normal birth weight and appearance. Doctors do not know whether this higher incidence of "preterm delivery" is the result of the asthma or of the medicines used to prevent it. No matter which, the problem is not severe enough to require any special management.
If you are considering having a child, your asthma need not discourage you. If your asthma is kept in check, there should be no problem for you or your baby Even if the asthma requires use of medicines, ifs still okay to get pregnant, since it has been shown in many studies that the commonly used asthma drugs are safe for the mother and safe for the fetus.
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