Asthma is an inflammatory disease of the bronchi. Although triggers for symptoms (allergens, viruses, occupational/environmental factors, etc.) have been suggested, the cause is not known.
Can it be a genetic disease or is there a predisposition? Is it a chronic disease?
It is not a genetic disease, but there is a family predisposition. If both parents suffer from asthma, the probability of their children suffering from asthma is higher. If only one of them suffers from it, the probability decreases, but it is still higher than if neither the father nor the mother suffers from it.
Yes, it is a chronic disease. But 50% of children with asthma can grow out of it by the time they reach adolescence or young adulthood, regardless of the treatment they have undergone. In the past, allergists attributed the disappearance of symptoms to treatment with immunotherapy (vaccines), but this is not the case. In adulthood, only 2% or 3% may stop having symptoms, stop suffering from the disease.
What symptoms can make us suspect that our child is asthmatic?
Your child may have asthma and you may not know it. Asthma can present with severe symptoms and in that case it is easy to diagnose it, but it can also present with mild symptoms and in that case it is easy to confuse it with “bronchitis or recurrent colds”. The symptoms of asthma are:
- Cough, with or without expectoration
- Wheezing or “whistling” noises in the chest (thorax)
- Shortness of breath
A child with asthma may have a single symptom or any combination of these symptoms. Many children with asthma have only a cough. In this case it may be misdiagnosed as bronchitis or not diagnosed at all.
Asthma coughs are usually recurrent, serial and worse in the evening. If your child has a spasmodic cough that is worse at night and lasts longer than the usual cold cough, your son or daughter may have asthma. The same is true if the spasmodic cough is caused by exercise, after exposure to tobacco smoke, with cold or laughter.
Wheezing” is easier to identify. The specialists in Pneumology indicate that a sound will be heard when the child breathes, similar to a whistling sound, especially when expelling air. These, as with coughs, can appear after physical exertion, in the cold, when inhaling tobacco smoke or coinciding with a cold.
Breathing difficulty is usually accompanied by coughing or “wheezing” in the thorax and is noticed as chest tightness, which prevents normal breathing.
There is usually increased mucus production by the bronchial tubes – asthma is a bronchial inflammation – and the mucus may be whitish, thick and difficult to cough up. When the asthma begins to improve there may be more mucus, but it may be thinner and easier to cough up.
If the child starts with a cough as the only symptom and it becomes more and more frequent as the days go by, that is, if the cough worries you, it may be asthma. And if the cough occurs with every cold, and is spasmodic and worse at night, the cough may be due to asthma.
How should flare-ups be controlled, and how can this be taught to children?
Asthma flare-ups are often triggered by colds. When a child has a cold and coughs, you may think the cough is caused by that viral infection, but it may be an asthma symptom triggered by the cold. In respiratory distress crises, the first thing to use is inhaled bronchodilators, which can be repeated until improvement is noted or until they cause tremor or tachycardia. If there is no improvement, while the patient goes to the nearest emergency medical center, oral corticosteroids can be taken.
If the child is old enough, it should be explained to him that in case he notices breathing difficulty he should use the inhaled bronchodilator, and explain to him how to use it and the doses.
What is the most appropriate treatment for asthma?
The treatment for asthma is inhaled corticosteroids, which can be associated with long-acting bronchodilators depending on the severity of the asthma. In exacerbations we sometimes have to treat with oral or parenteral corticosteroids.
Short-acting bronchodilators should only be used “on demand”, when needed due to increased respiratory distress. Long-acting bronchodilators (formoterol, salmeterol, indacaterol, etc.) should never be used as the sole treatment for asthma; they should always be used in association with inhaled corticosteroids.
When asthma symptoms are controlled, every one to two months the doses of inhaled corticosteroids should be decreased until symptoms are controlled with the lower doses.
The patient with controlled asthma should be able to go about his or her normal life without daytime or nighttime symptoms. Cold (a viral respiratory infection) is the most frequent cause of asthma aggravation and does not require antibiotic treatment, only increasing the doses of inhaled corticosteroids, although sometimes it is not enough and the exacerbation must be treated with oral corticosteroids.