What to watch for…
When it comes to asthma and kids — particularly infants and toddlers — the thinking among pediatricians has changed considerably in the past couple of decades, said Dr. Marc Chester, a pediatric pulmonologist with Novant Health Pediatric Pulmonology – Midtown.
For example, gone is the conventional wisdom that kids can’t be diagnosed with asthma before the age of 4 or 5. Today, diagnosing before the age of 5 — when lung-function testing is not an accurate option for diagnosis — is based on a careful history provided by the parents and by paying close attention to the number of wheezing episodes and other specific risk factors, Chester said. Those include family history, history of prematurity, prenatal and postnatal early exposure to smoking and particular viruses, along with a history of atopy, or allergies. Blood work may also be a part of the diagnosis for early ages.
While asthma can still be a tricky diagnosis in infants, pediatric pulmonologists have been using guidelines for more than 10 years now that allows them to make the correct call earlier. That increases young patients’ chances of having healthier lives.
“If an infant patient has wheezing, it’s important that we see them to determine if they have a predisposition to asthma or not,” Chester said. “There are established guidelines that allow us to diagnose asthma even in infants based on factors that include family history in the immediate family, which includes both parents and any siblings.”
Symptoms and treatment
Asthma symptoms for kids can show up for the first time at any age during childhood, Chester said. While the process for diagnosing asthma varies by age, here are the major signs of asthma Chester said parents should look for when it comes to children:
· Recurrent respiratory illnesses that linger.
· Persistent cough.
· Shortness of breath.
· Easy fatigue.
· Chest tightness (mostly for older children able to describe the symptom).
Treatment can vary, depending on the child’s age and severity of his or her condition, Chester said, but include nebulizers, inhalers, oral medications and sometimes injections. Chester said that although many associate younger children with nebulizers – which turn liquid medicine into a mist the patient inhales – often younger patients can use inhalers, as well.
Family history may be the big risk factor but environment can be a significant trigger as well, Chester said.
“There’s a large quotient of asthma that’s secondary to allergies and right now we’re in a high-pollen season, all the trees are blooming, so environment plays a big role,” Chester said. “There are lots of good studies that show asthma is worse for people living in moldy environments.”
For some parts of North Carolina, such as Charlotte, air quality should also be taken into account. “Pollution, fumes, gases, things like that, are what are called a trigger for asthma,” Chester said. “But the better controlled with your asthma medications, hopefully the less of an impact those will have on kids.”
Chester also listed secondhand smoke as a significant environmental trigger for asthma.
In the short and long run
Asthma can have both short and long-term consequences if left untreated or if the treatment comes too late for kids. “Immediate consequences could be that it affects their daily life — not being able to participate in activities, being sick more frequently, being hospitalized more frequently or requiring more courses of systemic steroids to treat later, which can have side effects for the body,” Chester said.
There are also long-term (chronic) consequences from poorly controlled asthma, including damage to the airways that can be irreversible.
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