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Asthma is the most common chronic inflammatory disease of childhood. It is caused by an inflammation (swelling) of the lining of the airways that makes them irritable, twitchy and hypersensitive to certain triggers or associated conditions. Asthma symptoms can occur as a result of the underlying inflammation but may worsen in reaction to triggers such as upper respiratory infections, cold weather, exercise, allergens and other conditions.
When the airways are provoked by a stimulus, what follows is breathing difficulty caused by:
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increased airway inflammation (when chemical substances are released from inflammatory cells) |
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tightening of the muscles around the airways (bronchospasm) |
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excess mucus production |
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All of this leads to airway obstruction (narrowing) and the development or worsening of asthma symptoms.
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Typical asthma symptoms include cough, shortness of breath, rapid breathing, chest tightness, chest pain, wheeze or any combination. Other symptoms to look for - especially in children who cannot explain themselves or are less self-aware - may include fatigue, irritability, poor exercise tolerance and sleeping difficulty.
There has been a tremendous, almost epidemic 150 % rise in the incidence of asthma in children over the past few decades (the rise in minority children in urban and inner city areas is even greater). It is estimated that almost 9 million children and teens in the U.S. - roughly 1 in 10 - have asthma, a number that may in reality be even higher since many children are undiagnosed or improperly diagnosed.
Annually among children, asthma is responsible for:
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800,000 emergency room visits |
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200,000 hospitalizations |
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12 million missed school days |
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A total healthcare cost of $3 billion |
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The good news is that while the incidence of asthma is increasing, mortality (death rate) from childhood asthma has leveled of, most likely due to increasing recognition and enhanced treatment.
Asthma often begins in early childhood. It is estimated that up to 80% of children develop symptoms before 6 years of age. There are several factors associated with an increased chance of developing the disease:
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A family history of asthma or allergy |
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Exposure to passive cigarette smoke during gestation (in womb) or in early childhood |
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Viral respiratory infections early in life |
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Male gender (until age 10) |
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Presence of atopic (allergic) symptoms such as eczema in the first year of life |
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The exact cause of asthma remains unknown It is most likely a combination of genetic predisposition and environmental factors.
GENETICS
The chance of a child's developing asthma is higher if one or both parents have the condition. If one parent has asthma, a child's chance of developing it is about 25%; with both parents, it rises to 50%.
But the rapid increase in asthma over the last few decades cannot be accounted for by genetics alone! It is more likely that environmental influences have triggered asthma in children who are genetically predisposed.
ENVIRONMENTAL FACTORS
Air Quality
There is evidence that increasing ozone concentrations and particles from diesel fuel exhaust in the environment increase airway sensitivity to triggers and may be responsible for more asthma episodes. Cigarette smoke exposure - first-hand, second- hand or in utero - significantly increases risk. Children of smokers are twice as likely to develop asthma than children of non-smokers.
Respiratory Infections
Infection with certain viruses during infancy and early childhood, such as rhinovirus and respiratory syncitial virus, significantly increases the chance of wheezing in the first 10 years of life. Other viruses have been associated with asthma, but the exact relationship as a cause of the disease remains controversial. It is more likely that a combination of a particular viral infection and a genetic tendency leads to asthma.
Hygiene Hypothesis
The rate of asthma's rise is lower in underdeveloped areas of the world than in the westernized, more hygienic regions with better healthcare. Why? One theory is that exposure to infections early in life primes the immune system to respond primarily to infections instead of to allergens and other triggers that worsen asthma. Infection early in life may actually protect one from developing asthma.
Lifestyle
As a society, we spend more and more time indoors. Children are increasingly playing video games, watching television or on the computer, and are thus exposed for greater periods of time to indoor irritants such as dust mites, mold, cockroaches, etc. - all potential asthma triggers.
Obesity
The greater incidence of childhood asthma during the last few decades parallels the increase in childhood obesity. A number of studies have seen a tie between higher body mass index and the development of asthma symptoms along with bronchial hyperresponsiveness in children.
There are many factors that can make asthma worse (triggers). It is important to understand that each child has his/her own individual triggers.
ASTHMA TRIGGERS CAN BE:
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Environmental irritants and allergens (pollen, dust, mold, cat dander, tobacco/smoke, wood smoke, fumes) |
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An upper respiratory infection (common cold, for example) |
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A sudden or extreme change in temperature or barometric pressure (snowstorm, extreme cold or humidity) |
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Exercise |
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Extremes of emotion (laughing, crying, stressful state) |
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Certain foods (rarely) and medications (non-steroidal anti-inflammatory medication such as aspirin and ibuprofen) |
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Untreated underlying medical conditions (sinusitis, gastroesophageal reflux) |
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TRIGGERS Click here for more detailed information on asthma triggers and the actions that can be taken to either avoid exposure to them or prevent them from worsening a child's asthma symptoms.
There is no known cure for asthma, but it can be controlled. It is a very manageable condition, and with the right treatment regimen and close monitoring, asthma will have a minimal impact on a child's lifestyle. Keys to successful control are:
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Seeking the appropriate diagnosis |
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Identifying individual triggers |
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Developing an individualized strategy and treatment plan with your physician |
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Adhering to the treatment plan |
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Becoming educated about asthma |
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Learning to be proactive |
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Please read about evaluation, treatment and prognosis in the Evaluation and Treatment section.
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