Asthma is a disorder which is characterized by inflammation of the airways – bronchi that lead to the lungs. This inflammation causes airways to become narrow, which blocks air from flowing freely into the lungs, thus causing difficulty in breathing. Symptoms include wheezing, breathlessness, chest tightness and cough, particularly at night or after exercise / activity. The inflammation may be reversed completely or partially with or without medicines.
Inflammation of the airways is linked to bronchial hyper – responsiveness, in which the airways leading to the lungs become narrow, whenever the persons are exposed to anything to which they are sensitive, thus making them hard to breathe. All children with Asthma have airways that are over sensitive or hyper reactive to certain Asthmatic triggers. The things that trigger Asthma differ from person to person. Some common triggers are exercise, allergies, viral infections and smoke. When a person with Asthma is exposed to a trigger, the sensitive airways get inflamed, swelled and filled with mucus. In addition, the muscles lining the swollen airways get tighten and constricted, making them even more narrowed and blocked (obstructed).
Thus, a flare of Asthma is caused by three important changes in the airways that make breathing difficult. These are:
· Inflammation of the airways
· Excessive mucus that results in congestion and formation of mucus “plugs” which get caught in the narrowed airways
· Bronchoconstriction; bands of muscles lining the airways tighten up
The disease may affect adults, children and even infants. The tendency to develop Asthma is often inherited. It can run in families. In most children, it develops before the age of 5 years and in more than half, it develops before the age of 3 years Many children can breathe normally for weeks or months between the flares. But the flares do occur, without any warning. A flare usually develops over time and involves a complicated process of increasing airway obstruction.
- Wheezing: It is a high pitched whistling sound heard when air flows into the lungs. Mild wheezing occurs at the end of a breath, when the child breathes out. Severe wheezing is heard during the whole exhaled breath. Children with severe Asthma can also have wheezing when they breathe in. However, during the most extreme Asthmatic attack, wheezing may be absent because no air passes through the airways. Asthma can occur without wheezing, so wheezing is not necessary for the diagnosis of Asthma. It can also be associated with other lung disorders such as cystic fibrosis.
- Cough: It may be the only symptom of Asthma, especially in case of exercise-induced or nocturnal Asthma. Cough due to nocturnal Asthma occurs usually around 1 to 4 am. The child does not cough anything up, so there is no phlegm or mucus. It may also occur along with wheezing.
- Chest tightness: The child feels that the chest is tight or does not expand when breathing in. The pain in the chest may be present with or without other symptoms of Asthma, especially in exercise-induced or nocturnal Asthma.
- Other symptoms: Infants or young children may have a history of coughs, bronchitis or lung infections like pneumonia. Children with Asthma may get coughs every time they get a cold. Most children with chronic or recurrent bronchitis suffer from Asthma.
Symptoms may be different depending on whether the Asthmatic episode is mild, moderate, or severe.
- Symptoms during a mild episode: Children may be out of the breath after a physical activity, such as walking. They can talk in sentences, lie down and may be restless. There may be an interruption with feeding; therefore, the infant takes longer time to finish the feed.
- Symptoms during a moderately severe episode: Children are out of breath while talking. Infants have a soft and short cry. Feeding is difficult. There is an interruption with feeding and the child may not be able to finish the usual quantity of feed.
- Symptoms during a severe episode: Children are out of breath while rest. They sit upright, talk in words (not sentences) and are usually restless. They do not take feed and are restless and out of breath. They may try to take feed but cannot sustain due to breathlessness.
- Symptoms indicating that breathing will stop: In addition to the symptoms already described, the child is sleepy and confused. However, the adolescents may not have these symptoms until they actually stop breathing. The infant may not be interested to take feed.
Diagnosis of Asthma is difficult and time consuming as different children may have a different pattern of symptoms. For example, some children cough at night but seem fine during the day, while others seem to get frequent chest congestion and colds that do not go away.
To establish a diagnosis of Asthma, a doctor rules out every other possible cause of the child’s symptoms. He asks questions about the family history of Asthma and history of any allergy. He performs a physical examination and suggests possible laboratory tests. Be sure that you should provide to the doctor, with as many details as possible, no matter how unrelated they might seem to you. In particular the following symptoms should be reported.
· How severe are the attacks?
· When and where do they occur?
· How often do they occur?
· How long do they last?
· How do they go away?
Does the child or anyone else in the family have any history of allergies?
· How often does the child get a cold?
· How severe are the colds?
· How long do they last?
- Has the child been exposed to irritants and allergens?
- Has the child experienced any recent life changes or stressful events?
- Do any other things seem to lead to a flare?
This information helps the doctor understand a child’s pattern of symptoms, which can then be compared to the characteristics of different categories of Asthma.The criteria for a diagnosis of Asthma are:
- Airflow into the lungs is reduced periodically (due to narrowed airways)
- The symptoms of reduced airflow are at least partially reversible
- Other diseases and conditions are ruled out
Categories of Asthma
The severity of Asthma is classified on the basis that how often the symptoms occur and how bad they are, including symptoms that occur at night, the characteristics of episodes and lung function. This classification does not always work well in children because the lung function is difficult to measure in younger children. Also, children often have Asthma that is triggered by infections and this kind of Asthma does not fit into any category. The child’s symptoms can be categorized into one of four main categories, each with different characteristics and require different treatment approaches.
· Mild Intermittent Asthma
Brief episodes of wheezing, coughing or shortness of breath that occur no more than twice a week are included in this category. Children rarely have symptoms between episodes (may be just one or two flare-ups per month and mild symptoms at night). Mild Asthma should never be ignored because, even in between the flares, the airways are inflamed.
· Mild Persistent Asthma
Episodes of wheezing, coughing or shortness of breath that occur more than twice a week but less than once a day are included I this category. Symptoms usually occur at least twice a month at night and may affect the normal physical activity.
· Moderate Persistent Asthma
Symptoms that occur every day and require medication everyday are included in this category. Nocturnal symptoms occur more than once a week. Episodes of wheezing, coughing or shortness of breath occur more than twice a week and may last for several days. These symptoms affect normal physical activity.
· Severe Persistent Asthma
Episodes of wheezing, coughing or shortness of breath are frequent, may require emergency treatment and even hospitalization. Many children with severe persistent asthma have frequent symptoms at night and can handle only limited physical activities.
Asthma in children usually has many causes or triggers. These triggers may change as the child ages. A child’s reaction to a trigger may also change with treatment. Viral infections can increase the likelihood of an attack of asthma.. Common triggers of Asthma include the following:
· Respiratory infections: These are usually viral infections. In some patients, other infections like fungi, bacteria or parasites might be responsible.
· Allergens: An allergen is anything in a child’s environment that causes an allergic reaction. Allergens can be foods, pet dander, molds, fungi, roach allergens or dust mites. Allergens can also be seasonal outdoor allergens e.g., mold spores, pollens, grass, trees etc.
· Irritants: When an irritating substance is inhaled, it may cause an asthmatic response. Tobacco smoke, cold air, chemicals, perfumes, paint odors, hair sprays and air pollutants are the irritants that may cause inflammation of the lungs and result in asthmatic symptoms.
· Weather changes: Asthma attacks may be related to changes in the weather or the quality of the air. Weather factors such as humidity and temperature are responsible for many allergens and irritants being carried in the air and inhaled by the child.
· Exercise: Exercise may also trigger an asthmatic attack. How exercise triggers asthmatic attack is still unclear, but it produces heat and water loss and change in temperature as the child heats up during exercise and cools down after exercise.
· Emotional factors: Asthmatic attacks can be made worse by emotional upsets.
· Gastro esophageal reflux (GER): It is commonly known as heartburn. GER is related to Asthma because the presence of small amounts of stomach acids outside the stomach (in the esophagus) may irritate the airways.
· Inflammation of the upper airways (including the nasal passages and sinuses): Inflammation of the upper airways, which can be caused by allergies, sinus infections or respiratory infections, may also induce an attack of asthma.
· Nocturnal Asthma: It is probably caused by multiple factors like breathing changes during sleep, exposure to allergens during and before sleep and body position during sleep.
Allergy Related Asthma
Although an estimated 75-85 percent of people with Asthma may have some type of allergy, but allergy is not always the primary cause of Asthma. Even if allergies may not be your child’s primary triggers for asthma, but they can still make the symptoms worse.
Children inherit the tendency to have allergies from their parents. These people produces allergic antibody which is called immunoglobulin E (IgE). The IgE antibody recognizes small quantities of allergens and causes allergic reactions to these usually harmless particles. Allergic reactions occur when IgE antibody triggers certain cells (called mast cells) to release a substance called histamine. Histamine occurs in the body naturally, but it is released inappropriately and in too high amount in people with allergies. The released histamine causes sneezing, running nose and watery eyes associated with some allergies. In a child with asthma, histamine may also trigger flares of asthma.
Once identified, the best treatment is to avoid exposure to allergens whenever possible. When avoidance is not possible, antihistamine medications are prescribed to block the release of histamine in the body and to stop the allergic symptoms. Nasal steroids are prescribed to block allergic inflammation in the nose. In some cases, an allergist may prescribe immunotherapy, which is a series of allergy shots that gradually make the body unresponsive to specific allergens.
Exercise Induced Asthma
Exercise-induced asthma develops after vigorous activity such as running, swimming or biking. For some children, exercise is the only thing that triggers asthma; for other children, exercise as well as other factors may trigger the symptoms. Young children with exercise-induced asthma may have subtle symptoms such as cough or undue breathlessness after physical activity. Not every type of exercise causes symptoms in children. With the right medicine, most children with exercise-induced asthma can play sports like other children. In fact, over 10 percent of Olympic athletes have exercise-induced have learned to control.
If exercise is the only trigger for asthma, the doctor may prescribe a medication that the child takes before exercise to prevent airways from getting tighten and constricted. Of course, asthma flares may still occur. Parents or the older children must carry the proper rescue medication, such as inhalers to games and activities and the child’s school nurse, coaches, scout leaders and teachers must be informed of the condition of child. Make sure that the child should be able to take the medication in school.
1. Arsenicum album: The person may feel exhausted, yet be very restless and anxious. Breathing become worse while lying down and better when sitting up. It may begin or be the most intense between midnight and around 2 a.m. Dry wheezing may progress to a cough that brings up frothy whitish fluid. The person is thirsty, taking frequent tiny sips. General chilliness is usually seen with burning pains in chest and heat in head. Warmth often brings improvement.
2. Carbo vegetabilis: This remedy is indicated when a person feels weak or faint with a hollow sensation in the chest. Cough jags may lead to gagging. The person may be very cold especially hands and feet, yet feels need for moving air, wants to sit beside a fan or open window. Acidity and digestive upsets are common. Sitting up and burping offers some relief. Feels worse in the evening and from talking, eating or lying down.
3. Ipecacuanha: Cough spasms that lead to retching or vomiting strongly indicate this remedy. Wheezing comes suddenly with a feeling of suffocation and heaviness in the chest. Mucus collects in breathing tubes, but the person has difficulty coughing it out. The person may sweat a lot and feel clammy or nauseous. He is worse from motion and warmth.
4. Natrum sulphuricum: Asthma attacks are brought on by exposure to mold and dampness. The person holds the chest while coughing as it feels so weak. Wheezing and breathing difficulties are aggravated by exertion and episodes tend to be worse in early morning.
5. Pulsatilla: Wheezing starts when the person gets too warm, especially in a stuffy room or after eating rich food. Cough brings up yellow colored mucus with gagging and choking. Tightness in the chest becomes worse in the evening and at night and is relieved by cool fresh air. The person is changeable and emotional, wants a lot of attention and comfort.
6. Spongia tosta: A hard or barking cough during an asthmatic attack is a strong indication for this remedy. Breathing may be labored with a sawing sound and there is not much mucus in the chest. The person may feel better when sitting up and tilting the head back or when leaning forward. Warm drinks ameliorate.
7. Kali bi: Patients who experience attacks at about 3 or 4 a.m., with a feeling as if there was no air in the chest. The patient is compelled to sit up to breathe. Bending forward while sitting brings some relief. The patient coughs up stringy yellow mucus.
8. Natrum Muriaticum: Asthma becomes worse when exposed to mold and dampness; attacks occur at about 4 to 5 a.m. and the patient sits up and holds the chest with the hands while coughing. Wheezing and breathing difficulties are aggravated by exertion. The patient usually has loose bowels after each attack.
9. Antimonium tartaricum: A remedy used by conventional medicine for Asthma. Presence of fine rattling or crackling sounds in the chest. Chest seems full of phlegm and the patient cannot cough it up. He must sit up at about 3 a.m. and has great difficulty breathing and feels suffocated. It is especially suited to young children and elderly people.
10. Blatta orientalis: A remedy for Asthma, especially when associated with bronchitis. It is indicated after Ars alb. when this is insufficient. Cough with dyspnoea in bronchitis and phthisis. Acts best in stout and corpulent patients. Much pus-like mucus.
11. Aralia Racemosa: This is a remedy for asthmatic conditions with cough aggravated on lying down. Drenching sweat during sleep. Extreme sensitiveness to draughts. Diarrhea with prolapse of rectum. Aching in rectum extending upwards; worse on the side lain upon.
12. Lobelia inflata: Asthma attacks with weakness felt in the pit of stomach and preceded with prickling all over. Feels as if heart would stop. Sensation of weight or pressure in chest, better by rapid walking.
13. Sambucus nigra: Paroxysmal suffocative cough comes on about midnight with crying and dyspnoea. Sniffles of infants. Nose dry and obstructed. Child awakes nearly suffocating, sits up and turns blue. Cannot expire. Millar’s Asthma. .
14. Causticum: Cough with rawness of chest. Expectoration scanty, must be swallowed. Cough with pain in hip better by drinking cold water. Cannot lie down at night. Voice re-echoes.