Asthma is a chronic inflammatory disease of the airways. This inflammation makes the airways very sensitive so they react strongly to things that are irritating. When they react, the muscles around the airways tighten, the inflammation increases, and the cells make more mucous. All three of these factors work together to make the airways more narrow, which causes an asthma attack.

There is no cure for asthma, however, if asthma is well controlled, patients can live a normal life with full participation in all activities.

Causes

There are 15 million Americans who have asthma, and 5 million of these are children. No one is for sure what causes asthma, and it is likely a combination of several factors. Some of the things we know contribute to asthma are family history of allergies, asthma, or eczema; exposures to irritants such as cigarette smoke early in life; and lower respiratory tract infection such as RSV and the flu in the first 2 years of life. Not all infants who wheeze when they get colds end up with asthma, but it definitely increases the likelihood they will.

Asthma exacerbations

Asthma exacerbations or "attacks" as they are commonly called can be brought on by a number of things. The most common cause of an exacerbation in children is a viral upper respiratory tract infection or URI. Others include respiratory irritants like smoke, allergens, exercise, cold air, weather change, and laughing or crying.

Symptoms of an exacerbation include:

• Cough- Cough may be the only symptom of asthma in children. The cough is often much worse at night and early in the morning, and with exercise. The cough can be a dry or wet cough.
• Wheezing- Wheezing is a high pitched whistling sound that is caused by narrowing of the airways.
• Chest tightness- Patients often describe this as feeling like someone is sitting on their chest, or like they are breathing through a straw.
• Shortness of breath-Patients may be breathing fast and may have retractions under and between their ribs.
• Colds that "go to the chest"- A child who frequently gets chest congestion with colds, or has a cough that lasts several days longer than their nasal symptoms with a cold is likely to have asthma.

Not all children have all of these symptoms, and symptoms vary from one exacerbation to the next. If your child has any of these symptoms, contact your child's physician for further evaluation.

Diagnosis

Unfortunately, there is not a test available to diagnose asthma in small children. Your doctor will use the patient's history (personal and family) along with an exam to make the diagnosis. Older children are usually able to perform PFTs or pulmonary function tests which aid in the diagnosis. A chest X-RAY and allergy testing may be indicated as well.

Medications

Medical treatment for asthma has come a long way, and the vast majority of patients can be symptom free most days.

• Short acting bronchodilators- also called "rescue" inhalers relax the muscles around the airways. All asthma patients should keep one with them at all times.
• Inhaled corticosteroids- preferred medication for control, decreases inflammation in airways
• Long acting bronchodilators- usually taken with corticosteroid for improved daily control
• Leukotriene modifiers- are sometimes used alone for mild asthma symptoms, but usually used with corticosteroids.

Signs asthma is not in control

• Increase in frequency or intensity of symptoms
• Worse at night or interrupting sleep
• Missing school or work
• Peak flow is low (if child is old enough to use a peak flow meter)
• ER visit or hospitalization
• Using rescue inhaler more than 2 times per week

Keeping asthma in control

• See your doctor for regular checkups.
• Get a flu shot every year.
• Have and use the asthma action plan given to you by your doctor.
• Teach your child and everyone who cares for him about his asthma.
• Protect your child from cigarette smoke. You will never find a better reason to quit smoking than the health of your child.
• Keep your child physically active.