What Is Childhood Asthma
Childhood asthma is the same lung disease adults get, but kids often have different symptoms. Doctors also call this pediatric asthma.
If your child has asthma, their lungs and airways can easily get inflamed when they have a cold or are around things like pollen. The symptoms may make it hard for your child to do everyday activities or sleep. Sometimes, an asthma attack can result in a trip to the hospital.
Thereâs no cure for asthma in children, but you can work with your childâs doctor to treat it and prevent damage to their growing lungs.
What Makes A Child More Likely To Develop Asthma
There are many risk factors for developing childhood asthma. These include:
- Allergies.
- Family history of asthma, allergies and atopy .
- Frequent respiratory infections.
- Being African American.
- Being raised in a low-income environment.
In children who are under five years of age, the most common cause of asthma symptoms is upper respiratory viral infections such as the common cold.
What Can You Do If Your Child Has Been Diagnosed With Asthma
If your child has just been diagnosed with asthma, know that you are not alone. Asthma Canada and your healthcare team have many resources available to you.
- Start by learning as much as you can about the condition. Work closely with your childs healthcare provider to monitor your childs asthma symptoms. Ask questions and clarify any information you are unsure about.
- Reach out to Asthma Canadas FREE Asthma & Allergy HelpLine to speak with a Certified Respiratory Educator.
- Begin keeping a diary to keep track of what non-allergic triggers affect your childs asthma. This will help you identify your childs triggers, and develop strategies to avoid them.
- Learn all you can about your childs medications. This includes possible side effects of medication and the appropriate technique for administering medication.
- Ask you healthcare provider about developing a Kids Asthma Action Plan. And Asthma Action Plan monitors asthma symptoms and has a written plan to follow when symptoms change.
- Join Asthma Canadas membership alliance to connect with other Canadians living with asthma or impacted by asthma.
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What Are The Symptoms Of Asthma In Children
The symptoms of asthma in children include
- Chest tightness
- Wheezing, which causes a whistling sound when they breathe out
- Trouble eating or sucking
These symptoms can range from mild to severe. They may happen often or only once in a while.
When children have an asthma attack, their symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. Warning signs of a severe attack include severe coughing, serious breathing problems, and turning very pale or blue in the face, lips and/or fingernails. If your child has those symptoms, get medical help right away.
Severe Asthma In Adults And Children
Severe asthma represents a small subgroup of individuals who have a disproportionately high health burden. The European Respiratory Society /American Thoracic Society Task Force defines severe asthma as asthma which requires treatment with high dose of inhaled corticosteroids plus a second controller to prevent it from becoming uncontrolled, or which remains uncontrolled despite this therapy . This definition applies to both children and adults with asthma, and it is highly likely that the condition we refer to as severe asthma is the extreme end of the spectrum for several different asthma endotypes.
In the absence of linking data with national pharmaceutical schemes, capturing detailed information on medication use is challenging in epidemiological studies, although such information is critical when defining severe asthma. For example, in children the maximum treatment used to define severe asthma includes high doses of ICS or oral corticosteroids, often in combination with add-on therapy with long-acting -2 agonists and/or leukotriene-receptor antagonists . The limitation of the use of maximum treatment is that there may be different reasons for poor asthma control among patients on maximum treatment, such as the wrong diagnosis , non-adherence with medication , or therapy-resistant disease .
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Why Are Asthma Rates Higher Among Children Now Than In The Past
It is true that asthma prevalence has been rising in the United States and many other parts of the world. The reasons for this are not yet clear, although there are some hypotheses that are supported by at least some evidence. Understanding the increase in asthma, particularly in children, is terribly important. Preventing asthma in the first place is what we call primary prevention in public health. Until we understand why asthma is becoming more common, we are seriously limited in what we can do to prevent children from developing the disease.
Most people think that the rapid rise in asthma cannot be due to genetics, because genetic changes take many generations. This may be true, but I am not as certain. Imagine that infant deaths from pneumonia, which were common in the past, were dramatically reduced. It seems to me that you would then have a pool of children, rarely surviving in the past, now living through childhood, perhaps with weaker respiratory systems.
Another possibility is that doctors are simply diagnosing more asthma today than before. According to this line of thinking, milder cases of asthma, which would have been ignored a few decades ago, now get attention and treatment. While I suspect this may influence the rise in asthma prevalence, I am skeptical that it could account for most of the change. Many children with asthma today have moderate to severe asthma, which would have been readily apparent in the past.
Is There A Role For T Cell Mediated Immunity
Grifoni et al. measured SARS-CoV-2-specific CD4+ and CD8+ T cells responses in 20 COVID-19 cases and healthy control donors. CD4+ T cell and antibody responses were observed in all COVID-19 patients analyzed, and CD8+ T cell responses in most. In this same study, CD4+ T cell responses were also detected in 4060% of unexposed individuals. It has been suggested that SARS-CoV-2-specific T cells in unexposed individuals might originate from memory T cells to cross-reactive epitopes derived from exposure to common cold human coronaviruses, which widely circulate in the human population with mild self-limiting respiratory symptoms. Whether this previous immunity is relevant in influencing clinical outcomes in childhood is unknown, but it may be of value in herd immunity and vaccine development .
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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 Are The Costs Of Asthma To Society
More than $80 billion is spent in the United States each year on medical expenses related to asthma. The annual per person medical costs for asthma were $3,266.7
The number of doctors office visits due to asthma dropped between 2001 and 2016, from 409.7 visits per 10,000 population to 307.8 per 10,000 population. Rates of asthma-related emergency room visits did not change between 2001 and 2016. Rates of hospitalizations for asthma also declined by half during the same period.2
The number of children who missed one or more days of school decreased from 61.5 percent in 2003 to 49 percent in 2013. Missed school days did not change for age, gender, race, ethnicity or poverty level.6
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How Common Is Asthma In Minnesota
- Approximately one in 12 children 1and one in 12 adults 2 currently have asthma, adding up to around 582,100 Minnesotans who have asthma.3
- In 2018, there were 17,619 emergency department visits and 1,864 hospitalizations for asthma across Minnesota.2
- In 2018, there were 58 deaths due to asthma in Minnesota.
- 47% of those who died were age 65 or older when they died.
- 21% of those who died were 85 or older when they died.
- There were 10 deaths among residents under age 35.3
What Are The Signs And Symptoms Of Asthma In Children
Signs and symptoms of asthma in children include:
- Frequent coughing spells, which may occur while the child is playing, laughing, or at night or right after waking. Coughing may be the only symptom.
- Less energy during play.
- Complaint of chest tightness or the chest “hurting.”
- Whistling sound when the child is breathing in or out.
- Retractions in the chest from difficulty breathing.
- Shortness of breath or loss of breath.
- Tightened neck and chest muscles.
- Feelings of weakness or tiredness.
Not all children have the same asthma symptoms. Symptoms can vary from episode to episode in the same child. In addition, not all wheezing or coughing is caused by asthma.
If your child has problems breathing, take him or her to the pediatrician for an evaluation. Your child may be referred to a specialist, such as a pediatric pulmonary provider or a pediatric allergist.
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What Causes Asthma In Children
The exact cause of asthma is unknown. Genetics and environment likely play a role in which children get asthma.
An asthma attack can happen when your child is exposed to an asthma trigger. An asthma trigger is something that can set off or worsen asthma symptoms. Different triggers can cause different types of asthma:
- Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
- Dust mites
Asthma triggers may be different for each child and can change over time.
Nationally That Rate Is 38% What Are The Consequences For These Children
Editor’s note: This story is part of “Breathless,” EHN’s in-depth look at asthma in Pittsburgh and efforts to help children breathe easier.
PITTSBURGH Last fall, twelve-year-old Savaughn Williams was thrilled to start playing on the little league football team in Clairton, Pennsylvania, a town 15 miles south of Pittsburgh.
Savaughn’s mom, Collette Williams, was initially excited that he wanted to play, too. Football is a big deal in Clairton: The town’s high school team, the Bears, has won the state championship for its class four out of the last 10 years. In 2012 they set the state record for most consecutive wins after playing 60 straight games without a loss. “Go Bears” signs are plastered all over town.
But soon after the start of the season, Collette decided to pull her son off the team.
One chilly afternoon Savaughn had a severe asthma attack during practice. Collette managed to get it under control without a trip to the ER, but when he was little, she had to take him to the ER for asthma attacks nearly once a month. Cold air tended to exacerbate his breathing problems, and Colette feared that if he kept playing football, they’d fall back into that pattern.
She adds “I’m scared one day when he does finally get it, it might be too late if I’m not around.”
Collette and Savaughn Williams
Uncontrolled asthma is often the result of a lack of diagnosis and subsequent lack of treatment.
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Explore The Data: State
Asthma in Minnesota:Results From the 2017 Call-Back Survey The Asthma Call-Back Survey is a comprehensive survey of asthma in children and adults in Minnesota conducted annually since 2015. The telephone survey includes questions on asthma symptoms, work-related asthma, asthma management, asthma triggers in the home, asthma self-management education and access to care.
Asthma And Allergy Triggers
As the weather gets colder and more time is spent indoors, indoor asthma and allergy triggers are of growing concern. We also know that researchers have observed, in some studies, a link of seasonal and indoor allergies to the later development of asthma, added Dr. Bassett.
Indoor and outdoor trigger include: smoke pollution and strong odors, pet dander, mold, pollen, dust mites, exercise, pests like roaches and mice, colds and flus, certain foods, and changes in the weather.
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Asthma And Allergies On The Rise In The Us
There has been a steep rise in cases of asthma and allergies in the U.S. over the past few decades. Why?
According to the Centers for Disease Control and Prevention , about one in 12 people in the U.S. has asthma, or about 25 million people. And the rate appears to be on the rise. From 2001 to 2011, the CDC says the number of Americans with asthma grew by 28 percent .
Asthma affects people of all ages, but it most commonly starts in childhood. According to the CDC, the greatest rise in asthma rates was among black children from 2001 through 2009.
And new research presented at this years American College of Allergy, Asthma, and Immunology annual meeting shows that scientists are seeing a corresponding rise in allergy rates as well.
From 1976 to 1994, positive allergy skin tests in people with asthma increased significantly, said Leonard Bielory, M.D., an ACAAI fellow, in a press release. Not only have we found the number of asthma sufferers allergic to cats has more than doubled, but those with asthma are also 32 percent more likely to be allergic to cats than those without asthma.
A Protective Innate Immunity
As SARS-CoV-2 is a pathogen so far not recognized in humans, it would be expected that the triggering of an effective adaptive immune response to neutralize new antigens would operate around the second to third week of viral contact. This timing seems to indicate that infection control, in asymptomatic or mild patients, will probably be due to the innate or nonspecific first line immune response, whose activation does not depend on recognition by antibodies and/or T lymphocytes .
The innate immune system provides an early first line of defense, essential in defending against invading new pathogens, mainly cytopathic viruses. The interferon response is a first line viral defense andfor many respiratory viruses, including SARS-COV-1 and MERS-CoV, IFN types I and III appears to play a relevant role in limiting infection .
Still in this context, children may develop a more efficient production of neutralizing natural antibodies against SARS-CoV-2 at the beginning of the infection due to the greater number of activated B cells of IgM + memory . Moreover, they may have a larger thymic repertoire and more T- and B-regulatory lymphocytes, in addition to a more effectively trained and sustained innate immunity, due to increased natural exposure to viruses and vaccines . In this way, frequent infections and vaccines/adjuvants administered in early life may booster innate immunity in childhood , resulting in a more protective immune response in children.
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The Impact Of Asthma On Daily Life
Asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries.
People with under-treated asthma can suffer sleep disturbance, tiredness during the day, and poor concentration. Asthma sufferers and their families may miss school and work, with financial impact on the family and wider community. If symptoms are severe, people with asthma may need to receive emergency health care and they may be admitted to hospital for treatment and monitoring. In the most severe cases, asthma can lead to death.
Preparing For Your Childs Visit To Your Healthcare Provider
During your appointment, your healthcare providerwill conduct a physical exam and may order some tests, like x-ray, blood tests, allergy skin tests, and pulmonary function tests .
The physician will take a detailed history of:
- Family allergy/asthma, with emphasis on parents
- Childs allergy history e.g. eczema
- Childs history of illness to date e.g. frequency of colds
- Childs symptoms: Severity, frequency and duration of symptoms. What brings an end to the symptoms for example if the child has a cold, do the symptoms disappear when the cold is over?
- Childs triggers: what have the parents observed with respect to exposures to allergens or irritants, such as smoke, perfume, infection or emotions
This information will help your healthcare provider understand your childs pattern of symptoms.
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How Do I Know If My Infant Or Child Has Severe Asthma
If you are concerned that your infant or childs asthma may be severe, observe their behavior for the indicators below and speak to your healthcare provider right away.
Observe your infant for any of the following indicators of Severe Asthma:
- Sits up, refuses to lie down
- Stops feeding
- Pale or bluish-looking skin anywhere
- Irritable
- Rapid breathing
- Using accessory muscles of breathing-in, drawing of muscles at the neck when breathing it may look like the skin is being tugged in. If you see this, your child must be assessed by a healthcare provider.
Observe your child for any of the following indicators of Severe Asthma:
- Pale looking or bluish looking skin- anywhere
- Breathless
- Irritable
- Peak flow less than 50% of personal best
- Using accessory muscles of breathing-in, drawing of muscles at the neck when breathing it may look like the skin is being tugged in. If you see this, your child must be assessed by a healthcare provider.
Why The Increase In Asthma
What changes over the last several decades can account for the startling rise in asthma rates? It is unlikely that the dust mite and cockroach populations have changed significantly, nor can genetics explain this increase.
One dramatic change in recent decades is the variety of chemicals to which many children are exposed, especially in the indoor air they breathe. New materials are being used in building construction and maintenance. Energy-efficient buildings often have ventilation patterns that recycle the air which contains allergens and pollutants reducing indoor air quality. Consumer products such as furniture, particle board, and synthetic rugs can emit irritants such as formaldehyde. Some products, such as detergents, cleaning products, and deodorizers, can contain chemicals that irritate the respiratory system. Children from a very young age and in utero are exposed to many of these contaminants in different combinations on a daily basis. Public health experts are now raising questions about the impact of exposure to these pollutants.
Other scientists such as Dr. Peyton Eggelston of the Johns Hopkins University Center for Childrens Environmental Health Research believe that the important exposures occur after birth. This research has looked in particular at infectious bacterial and viral exposures that may contribute to onset of the disease.
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