Presentation Of Asthma: Adolescence
Puberty has an interesting impact on childhood asthma, specifically relating to sex. Prior to puberty, asthma risk is higher among male children. At the time of puberty, the risk of asthma is approximately equal between males and females, and after puberty, girls have a higher risk of asthma . Some of these differences could be explained by the differences in airway development between the sexes. The fetal lung is less developed in boys from 16 to 26 weeks, measured by mouth movements that reflect fetal breathing, a critical determinant of lung development. In the last 4 weeks of gestation, airway resistance is higher in males . Boys up to 10 years old appear to have smaller airways in relation to lung size as compared with girls of the same age, height, and weight . After puberty, smaller airway caliber is then observed in the female sex . The known sex differences in asthma may also be due to other factors such as hormonal effects, genetic susceptibility, immunologic response, and differences in consultation practices and health-seeking behaviors by sex .
Remission is common in adolescence, with remission rates reported at 1660% . Factors that have been implicated in an increased probability of asthma remission include mild disease and minor airway inflammation before adolescence, male sex, and the absence of allergic sensitization .
Remission And Mortality In Childhood Asthma
Asthma remission occurs most commonly between the ages of 1421 years . However, large longitudinal studies have also shown that, among children who wheezed before age 3 years, more than 50% had stopped wheezing either by 6 years of age or by 12 years of age, depending on the study. Remission rates of childhood asthma have been reported between 16 and 60% by early adulthood, according to prior longitudinal studies . The wide variation in reported remission rates is likely due to diverse study designs, varying follow-up periods, and different study populations. In longitudinal studies, children with the following characteristics had higher remission rates: episodic asthma , milder initial asthma severity, less allergic sensitization, less allergic rhinitis, less atopic dermatitis, and male sex .
While the morbidity of childhood asthma is significant, fortunately, mortality from childhood asthma is rare with an estimated 28 deaths per million children with asthma . As with childhood asthma morbidity, there are grave racial disparities in childhood asthma mortality, and black, and Hispanic children suffer disproportionately from the highest mortality rates .
What Are Signs And Symptoms Of Adult Onset Asthma
Regardless of age, asthma symptoms can include:
Dry cough, especially at night or in response to specific triggers
Tightness or pressure in the chest
Wheezing a whistling sound when exhaling
Shortness of breath after exercise or physical exertion
Difficulty breathing
Colds that go to the chest or hang on for 10 days or more
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Asthma In Children And Adultswhat Are The Differences And What Can They Tell Us About Asthma
- 1Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
- 2Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- 3Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
- 4Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.
Aspirin And Paracetamol Intake
Among individuals with existing asthma, aspirin can acutely precipitate bronchospasm in the subset of patients with aspirin-intolerant asthma. In contrast, long-term intake of 100 mg aspirin has been shown to reduce the relative risk of a newly reported diagnosis of asthma in healthy females . Thus, in individuals without asthma, aspirin might reduce the risk of developing asthma via cyclo-oxygenase -dependent and COX-independent pathways.
On the contrary, the use of paracetamol represents a putative risk factor for the development of asthma . Glutathione depletion in the airways and increased oxidative stress may be the mechanism underlying the link between paracetamol use and asthma development.
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Everyday Treatment For Asthma In Children
The main aims of day-to-day asthma treatment are to:
- keep symptoms under control
- keep lungs as healthy as possible
- stop asthma from interfering with school or play
- help your child enjoy a full and active life.
Your doctor will help you to develop a plan to manage your childs asthma which will include an asthma action plan , and will prescribe the correct medication to help you do so.
What Should You Do If Your Child Has An Asthma Attack
If your child is showing symptoms of an asthma attack:
- Give your child their reliever medicine according to the asthma action plan.
- Wait 15 minutes. If the symptoms go away, your child should be able to resume whatever activity they were doing. If symptoms persist, follow the Asthma Action Plan for further therapy.
- If your child fails to improve, or if you aren’t sure what action to take, call your care provider.
The danger signs of an asthma attack are:
- Severe wheezing.
- Trouble walking and/or talking,
- Blue lips and/or fingernails.
If your child has any of these danger signs/symptoms, go to the nearest emergency department or call 911.
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Severe Difficult To Control Asthma Steroid
Children that do not seem to respond to standard treatment are referred to as severe or difficult to control asthma, and these children experience substantial morbidity from asthma symptoms. To classify a child into this phenotype, the first step is to exclude an incorrect diagnosis, poor adherence to treatment, or incorrect technique with an inhaler and spacer . Supervised asthma therapy programs can be extremely useful in managing asthma symptoms and reducing healthcare utilization for children with poor medication adherence and inhaler and spacer technique . It is important to differentiate between severe therapy-resistant asthma and difficult-to-treat asthma due to comorbidities Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities, such as allergic rhinitis and chronic exposure to asthma triggers, are directly targeted. Home visiting programs and assessment of the school environment are important features of the evaluation for children with concern for chronic exposure to asthma triggers . Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard asthma therapy should be referred to an asthma specialist to consider more potent biologic therapies such as anti-IgE, anti-IL-5, or anti-IL-13 therapies and further evaluation .
Why Do People Get Asthma
Research has yet to show a definitive cause of asthma. However, researchers have determined several risk factors that can lead to asthma development.
Family History and Genetics
Children of mothers with asthma are three times more likely to suffer from asthma, and 2.5 times more likely if the father has asthma. More than 30 genes have been linked to asthma so far, and gene-gene interactions, gene-environment interactions and epigenetic modifications also play a part. Genetic differences also play a role in differences in response to treatment.
Allergies
People are more likely to have asthma if they have certain types of allergies, such ones which can affect the eyes and nose. However, not everyone who has allergies will get asthma and not everyone who has asthma is affected by allergies. Respiratory allergies and some types of asthma are related to an antibody called immunoglobulin E , which the immune system produces in response to allergens. To protect the body, the IgE causes allergic reactions that can affect the eyes, nose, throat, lungs and skin.
Premature Birth
Children born before 37 weeks are at increased risk of developing asthma later in life.
Lung Infections
Babies or small children may be at risk of developing asthma later in life if they had certain lung infections at a very early age.
Occupational Exposures
Hormones
Women can develop adult-onset asthma during or after menopause.
Environment Air Quality
Obesity
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How Is Asthma Diagnosed In Infants And Toddlers
It is hard to diagnose asthma in infants and toddlers. Since they are not able to talk well, they cannot describe how they are feeling. A fussy baby could mean many things. Toddlers and preschoolers are often active, even with chest tightness or trouble breathing.Parents should give the following information to their childs doctor:
- Family history of asthma or allergies
- The childs behavior
- Breathing symptom patterns
- Potential triggers and responses to foods or possible allergy triggers
Lung function tests often used to make a complete asthma diagnosis are hard to do with young children. Instead, the doctor may see how the child responds to medications to improve breathing. The doctor may order blood tests, allergy testing and X-rays to get more information.Using this information, the doctor can make the best diagnosis. Parents may need to take their child to a pediatric allergist or pulmonologist for special testing or treatment.
How Is Asthma Diagnosed
To diagnose asthma, doctors will ask questions about a childs health, problems with breathing, and family medical history. Theyll also ask about any allergies, illnesses, and exposure to things that may make breathing worse.
Kids will have a physical exam and may have a lung function test. This usually involves testing breathing with a spirometer, a machine that analyzes airflow through the airways.
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Can Asthma Reappear In Adults After Disappearing Years Ago
Asthma is usually diagnosed in childhood. In many patients however, the symptoms will disappear or are significantly reduced after puberty. After age 20, symptoms may begin to reappear.
Researchers have tracked this tendency for reappearing asthma and found that people with childhood asthma tend to experience reappearing symptoms through their 30s and 40s at various levels of severity.
Regardless of whether your asthma is active, you should continue to avoid your known triggers and keep your rescue medications or prescriptions up-to-date and handy in case you need them.
Diagnosis Of Asthma In Children
Diagnosing asthma in children younger than 5 years can be difficult because children cough or wheeze for many different reasons. Take your child to the doctor if:
- the wheezing happens more than once with or without an illness
- constant coughing or bouts of coughing become worse at night
- you are concerned about any breathing problems in your child.
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What Is The Best Way To Live With Asthma
The key to good living with asthma is developing a strong partnership between patients, caregivers, and physicians. Practical steps include the following:
Make an asthma care management plan with your physician. An asthma management plan helps you understand what to do when specific situations arise. Each time you visit the physician, talk about your plan, and make any necessary changes.
Educate yourself. Stay informed about the latest developments in asthma and allergy care and treatment. Ask your physician about new medications or research findings that may relate to your care.
Get regular medical care. If you have asthma, you should see your physician at least once a year, even if your symptoms are under control. When you become sick, or if you have significant changes in your health, you should also talk with your physician about how your asthma could be affected.
Take your medicine. Your asthma medications will make you feel better and sometimes people think thats the time to stop. Its not! Use your medications as prescribed.
With good management, asthma symptoms can be controlled. Most people who develop adult onset asthma are able to lead normal lives. Expect success!
Signs And Symptoms Of Childhood Asthma
Not all children have the same asthma symptoms. A child may even have different symptoms from one episode to the next. Signs and symptoms of asthma in children include:
- A cough that doesnât go away
- Coughing spells that happen often, especially during play or exercise, at night, in cold air, or while laughing or crying
- A cough that gets worse after a viral infection
- Less energy during play, and stopping to catch their breath during activities
- Avoiding sports or social activities
- Tight neck and chest muscles
- Feeling weak or tired
- Trouble eating, or grunting while eating
Your child’s doctor should check out any illness that makes it hard for them to breathe.
Experts sometimes use the terms âreactive airways diseaseâ and âbronchiolitisâ when talking about wheezing with shortness of breath or coughing in infants and toddlers. Tests may not be able to confirm asthma in children younger than 5.
When to get emergency care
A severe asthma attack needs medical care right away. Watch for these signs:
- Stopping in the middle of a sentence to catch a breath
- Using stomach muscles to breathe
- A belly that sinks in under their ribs when they try to get air
- Chest and sides that pull in as they breathe
- Severe wheezing
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Epidemiology Of Asthma: An Overview
The recent substantial increase in the reported prevalence of asthma worldwide has led to numerous studies of the prevalence and characteristics of this condition. Foremost among these are 2 major international initiatives that have collected data using validated questionnaires, one among children, the International Study of Asthma and Allergies in Childhood, and the other among young adults, the European Community Respiratory Health Survey. Follow-up investigations for both of these studies, have examined temporal trends within and across populations. During a mean of 7 years following phase I of the International Study of Asthma and Allergies in Childhood, which in most participating countries was conducted between 1991 and 1993, the prevalence of asthma was stable or decreased in some areas of the world but increased substantially in many other areas, especially among children 1314 years of age .
Changes in prevalence of diagnosed asthma and asthma symptoms over time among children and young adults. Reproduced, with permission, from Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med 2006 355:222635. Copyright 2006 Massachusetts Medical Society.
Preparing For Your Gp Appointment
A little bit of preparation can help you to get the most of your first GP appointment. It may even speed up the process so you can get diagnosed more quickly.
Have answers at the ready
Think about your family history.
- Does anyone in your family have asthma?
- Does anyone in your family have allergies?
- Do you have any allergies, including eczema or hay fever?
Your answers to these questions could help your GP work out if asthma is more likely.
Keep a diary of your symptoms
Note down how often and when you have symptoms. For example, are your symptoms worse at night, early in the morning, or when youre at work?
You could also make a note of what you think sets them off. Things that set off your asthma symptoms are called triggers. Common asthma triggers include dust mites, cigarette smoke, and exercise.
Keeping a diary or a chart of your symptoms and triggers can help your GP or asthma nurse see the pattern of your symptoms. Seeing how your symptoms are over time helps your GP to know if asthma is more likely.
Film symptoms on your phone
Asthma can come and go, so you could have no symptoms when you go and see your GP.
Try filming yourself on your phone – or ask someone else to when youre having symptoms. Then you can show the GP or asthma nurse exactly what it was like, without having to try and describe it with words.
But dont delay getting help if symptoms are getting worse though!
Jot down your questions
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Why Are More Children Getting Asthma
No one really knows why more and more children are developing asthma. Suggestions include the following:
- Children are being exposed to more and more allergens such as dust, air pollution and second-hand smoke.
- Children aren’t exposed to enough childhood illnesses to build up their immune systems.
- Lower rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.
What Causes Adults To Develop Asthma
At least 30% of adult asthma cases are triggered by allergies. People who are allergic to cats may have an increased risk for developing adult onset asthma. Exposure to allergens or irritants such as cigarette smoke, chemicals, mold, dust, or other substances commonly found in the persons environment might trigger the first asthma symptoms in an adult.
Prolonged exposure to certain workplace materials may set off asthma symptoms in adults.
Hormonal fluctuations in women may play a role in adult onset asthma. Some women first develop asthma symptoms during or after a pregnancy. Women going through menopause can develop asthma symptoms for the first time.
Different illnesses, viruses, or infections can be a factor in adult onset asthma. A bad cold or a bout with the flu is often a factor in adult onset asthma.
Smoking does not cause adult onset asthma however, if you smoke or if you are exposed to cigarette smoke , it may provoke asthma symptoms.
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