Asthma is the leading respiratory disease in children. According to the World Health Organisation, it is actually the most common chronic condition in childhood. Many of us would know of people with asthma and for some of us our child or our own selves may be afflicted with this condition. So it is important for us to understand a little bit more about asthma. At Marabella Paediatric Services, we want to empower parents to take control of their child's condition through knowledge and education.
So how exactly does one deal with an asthma attack?
Before answering this condition we need to understand a little bit about what asthma is.
Asthma is:
a chronic (meaning lasting over a long period) disease of the lungs.
characterized by increased inflammation within the airways.
also characterized by narrowing of the bronchial (small airway tubes inside the lung).
usually triggered by cigarette smoke, dust, environmental smoke, pets and pollen.
The best way to deal with an asthma attack is by avoiding one in the first place.
What does this mean? To avoid an attack one would need to avoid the triggers- as mentioned above. One of those triggers which is extremely important and needs to be stressed is cigarette smoke.
Children living in homes with people who smoke cigarettes can have more asthma attacks due to second hand smoke. It is advisable that parents or relatives, who are smokers, should seek help with their General Practitioner to quit smoking. If this is difficult, then as a last resort, the smoker should wear a jacket, hat and gloves go some distance outside the home to smoke and on returning he/she should hang their hat and jacket outside the house to keep cigarette smoke particles from entering the home.
For those who are asthmatics, then they would be provided with some inhalers. These would usually be a rescue inhaler like salbutamol and a preventer inhaler like beclometasone or fluticasone. These inhalers are very important in the management of asthma and once used properly can be very effective.
For the new parent of a child with asthma, it is important to have an asthma action plan so you know what to do in times of an attack. The main drug that should always be readily available is the salbuatamol. Which means that you may need to keep one for school and home. This drug is important in opening up the narrowed airways in asthma- as was mentioned in number 3 above.
The number of salbutamol puffs varies based on the size and age of the individual. At least two puffs should be administered. In some instances the number of puffs of salbutamol can go up to 8 puffs in severe attacks. This medication is a life saving and can help to immediately abort an acute attack. Having said that, the main objective in asthmatics would be to limit the number of times this drug has to be used.
As a result, the inhaled steroid (preventer) enters the picture. This drug will help keep the inflammation down (as mentioned in number 2 above) and thereby helps to reduce the need for the rescue drug. Now one of the things you need to know about this, is that it is a daily medication that must be used for several weeks regardless of any wheezing or cough symptoms. I must emphasize that inhaled steroids are not effective in acute attacks and should not be used only when attacks come.
It is a common mistake for many patients to use the preventer inhalers only during an acute attack of wheezing.
Once the preventer inhaler (either beclometasone or fluticasone) is used daily for weeks then this would also prevent getting an attack and thus avoid a serious asthma attack.
Now one of the other medication that you may have heard about that is used in an asthma attack is oral steroids. This is commonly known as prednisolone or prednisone. This can be in liquid or tablet forms and the dose must be established by your paediatrician or physician. This helps with acute inflammation in the lungs and is usually prescribed for three to five days.
Many parents and physicians alike share concerns about the side effects of oral steroids. One dose is usually fine with minimal side effects. However, with multiple doses of oral steroids over a short space of time, then there may be some cumulative side effects. If a child has to take multiple doses over a few months, then this implies that the asthma is poorly controlled. To minimize oral steroid use, then the preventer inhaler are needed on a regular basis over months.
As a side note, inhaled corticosteroids are generally much safer than oral steroids because it reaches the lung with minimal absorption systemically and as such there is less fear with long term use.
In some cases the medications just don't seem to work, or so the parents would think. This is where technique of administration is important.
Many times children are prescribed inhalers together with a spacer device and facemask. These devices need to be used appropriately for the medication to reach the lungs. A proper seal must be made with the facemask whilst administering the drug. Moreover, a spacer should be replaced at least every 6 months to cater for static and cracks which can inhibit the drug from reaching the lung.
In conclusion, to treat asthma the first thing is to avoid triggers, especially cigarette smoking. Relatives should avoid smoking around children with asthma. Salbutamol is a life saving rescue medication and should be used in acute wheezing. Beclometasone and fluticasone are preventer inhalers and need to be used daily and NOT only during a wheezing attack. Oral steroids may have to be used in the acute attack. Frequent use of oral steroids imply poor control of asthma and can cause side effects. Inhaled steroids are safer than oral steroids and technique is the key to ensure that the drug is delivered to the area of lungs that needs it the most.
Dr. Zafir Latchan
BMedsSci.(Hons), MBBS, PGDip. Paediatric Emergency Medicine (Dist), MRCPCH (Lon)
This information is meant only for educational purposes only. If you or your child is wheezing then seek help from your physician or the physician of your child for an appropriate diagnosis and treatment.
Comments