Asthma in Children and Adolescents

Description

Managing Asthma

The more allergies a child has, the more severe the asthma. Making lifestyle changes to reduce allergy attacks and other triggers is extremely important.

Indoor Protection

House dust is a reservoir for pollen and dust mites.Some experts believe that reducing household allergens and pollutants in the home could reduce asthma in children by 40%. In addition, a 2002 study suggested that this approach might reduce the risk for asthma and allergies before it develops in small children.

Controlling Pets. People with asthma who already have pets and are not allergic to them probably have a low risk for developing such allergies later on. In fact, when children are exposed to more than one dog or cat during their first year, they have a much lower risk for allergies and asthma.

For children who have an existing allergy to pets, however, the pets should be given away or kept outside. If this isn't possible, they should at least be confined to carpet-free areas outside the bedroom. Cats harbor significant allergens, which can even be carried on clothing; dogs usually present fewer problems. Washing animals once a week can reduce allergens. Dry shampoos, such as Allerpet, are now available for both cats and dogs that remove allergens from skin and fur and are easier to administer than wet shampoos.

Many of the same substances that trigger allergies can also trigger asthma. Common allergens include pollen, dust mites, mold and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Asthma symptoms can be substantially reduced by avoiding exposure to known allergens and respiratory irritants.

Preventing Exposure to Cigarette and Cooking Smoke. Parents who smoke are strongly urged to make strenuous efforts to quit. Studies are finding that exposure to second-hand smoke in the home increases the risk for asthma and asthma-related emergency room visits in children. And, just smoky cooking can worsen asthma.

Parental smoking has been shown to increase the airway responsiveness of infants as early as the first two to 10 weeks of life. This extends even to the fetus of pregnant women who smoke. Such mothers tend to have babies born at a low birth weight, which affects lung function and increases babies' risks for asthma.

Sadly, the more heavily parents smoke, the less likely they are to seek treatment for their asthmatic children, according to a 2000 study. The authors of this study speculate that either the parents may have reduced awareness of their childrens symptoms, or else they may not want to be told to quit smoking by their childrens doctors.

Controlling for Dust. A 2002 study reported that simply using a spray furniture polish is very effective for reducing both dust and allergens. Air cleaners, filters for air conditioners, and vacuum cleaners with HEPA filters can help remove particles and small allergens found indoors. Neither vacuuming nor the use of anti-mite carpet shampoo, however, is effective in removing mites in house dust. In fact, vacuuming stirs up both mites and cat allergens. Carpets and rugs should be avoided, if possible.

Click the icon to see an image of a HEPA air filter.

Bedding and Curtains. Using semipermeable coverings to fully encase mattresses and pillows is the most proven effective step in reducing dust mite levels. (Vinyl mattress covers limit airflow and may also exacerbate, or even cause, asthma in children. Synthetic pillows may pose a significantly higher risk for severe asthma attacks in children than feather or no pillows, although well-conducted studies are needed to confirm this.) Curtains should be replaced with shades or blinds and bedding washed using the highest temperature setting.

Click the icon to see an image of dust mite prevention.

One 1999 study found that children sleeping in bottom bunk beds are significantly more likely to develop asthma than siblings occupying the upper bunks. Families with asthmatic or allergic children should avoid bunk beds or be sure that children with asthma sleep in the top bunk. Even with standard beds, it may be useful to have them sleep as high off the floor as possible.

Reducing Humidity in the House. Although warm, moist air from vaporizers can greatly ease and moderate asthma attacks, living in a damp house is counter productive. Dust mites thrive in humidity and damp houses increase the risk for mold. On-going humidifiers, then, can be counterproductive. If they are used, humidity levels should not exceed 40% and they should be cleaned daily with a vinegar solution.

Exterminating Pests (Cockroaches and Mice). Cockroaches should be eliminated by professional exterminators. (One study reported that ridding a home of cockroaches and cleaning the house using standard housecleaning techniques failed to eliminate the cockroach allergens themselves.) Mice should be eliminated, and attempts should be made to remove all dust, which might contain mouse urine and dander.

Disposable Diapers. Of concern was a 1999 study that reported lung irritation in mice exposed to chemical emissions from several brands of disposable diapers. Researchers in this study recommend that children with asthma or other respiratory diseases should use cloth diapers and avoid disposable diapers until more research has been conducted.

Outdoor Protection

Avoiding Outdoor Allergens. The following are some recommendations for avoiding allergens outside:

• Camping and hiking trips should not be scheduled during times of high pollen count (in the Northern states, May and June for grass pollen and mid-August to October for ragweed).
• Patients should avoid strenuous activity when ozone levels are highest, which usually occur in early afternoon, particularly on hot hazy summer days. Levels are lowest in early morning and at dusk.
• Asthma attacks are often higher during thunderstorms. Some evidence points to a build-up of ozone that accompanies such storms. Other evidence suggests that the changing airflow patterns bring a sudden downdraft of air containing concentrations of pollens, small particles and allergens.
• Patients who are allergic to mold should avoid barns, hay, raking leaves, and mowing grass.
• Exposure to automobile fumes may worsen asthma. Fungi in car air conditioners can also be a problem.

Reducing Exposure to Air Pollution. A number of studies have linked air pollution to asthma. Children breathe faster than adults, taking in more pollutants, and therefore appear to be particularly susceptible to soot and other small particles in the air. A 2001 study found an association between higher rates of asthma and other health problems in children who were exposed to high levels of specific pollutants (particularly sulfur dioxide and nitrogen dioxide). Diesel fuel exhaust has also been associated with worsened asthma in children.

Some experts point out that asthma rates in North America have increased over recent years while the prevalence of many common air pollutants have declined. So pollution is unlikely to be a primary cause of asthma. Regardless of whether pollution is an important cause of asthma, evidence strongly suggests that it can worsen existing asthma.

The effects of specific pollutants are unclear and conflicting. For example, some research indicates that nitrogen dioxide increases hospitalization in childhood asthma by precipitating upper respiratory infections. There are conflicting reports on the effects of ozone, however. Some studies indicate that high levels do not increase the risk for hospitalization from asthma attacks, although other studies indicate that such findings may apply to children.

Medications for Treating Seasonal Allergies

Patients with chronic allergic rhinitis may require daily medications. Patients with severe seasonal allergies may be advised to start medications a few weeks before the pollen season, and to continue it until the season is over. Effective medications include the following:

• Anti-inflammatory Agents. Nasal corticosteroids are now considered to be the most effective measure for preventing allergy attacks. Comparison studies are reporting that nasal steroid sprays are more effective than the second generation antihistamines loratidine (Claritin) and cetirizine (Zyrtec). One study also indicated that nasal steroid treatment was more effective than allergy shots. Leukotriene-antagonists and nasal cromolyn may be beneficial in specific cases of allergies.
• Antihistamines. A 2002 study reported that infants with allergies who were given the antihistamine cetirizine (Zyrtec) were much less likely to develop asthma later on. This encouraging research warrants more work.
• Allergen immunotherapy ("Allergy Shots"). Immunotherapy, commonly called allergy shots, is proving to reduce asthma symptoms and the use of asthma medications in patients with known allergies. It is not yet known if this approach is more effective or safer than other therapies. Although injections are the standard method of delivery, immunotherapy is also being delivered as tablets under the tongue (sublingual). They are safe but less effecting that the shots. Immunotherapy poses some risk for severe allergic reactions, particularly in people who are allergic to multiple allergens.

Dietary Factors

Weight Loss. Children who are both asthmatic and overweight may reduce asthma symptoms simply with weight loss.

Fruits, Vegetables, and Whole Grains. Healthy foods are important for lung function. Specific foods that may be important for healthy lungs are those that contain antioxidants (best obtained from fresh, deep green and yellow-orange fruits and vegetables), selenium (fish, red meat, grains, eggs, chicken, liver, garlic), plant chemicals called flavonoids (apples, onions), and magnesium (green leafy vegetables, nuts, whole grains, milk, and meats).

Fish Oil. Omega-3 fatty acids, found in cold water oily fish and in supplements (preferably DHA-EPA, which are the important compounds in fish oil) have anti-inflammatory effects. Some evidence suggests they may be helpful for people with asthma, although it is weak.

Caffeine. Caffeine has properties that are similar to theophylline, an agent used to treat asthma. A major analysis of studies reported that caffeine improved lung function for up to four hours after consumption. Although tea and coffee are the major sources of caffeine some sodas contain it and perhaps could tried when children have an asthma attack during the day. (People who are going to have their lung function tested should avoid drinking coffee, tea, or other caffeinated beverages for at least four hours beforehand.)

Food Allergies. Although 67% of asthmatics believe their symptoms are aggravated by food allergies, studies indicate that this belief may be true in only 5% of cases. If young children show signs of or test positive for food allergies, however, parents should be extra cautious in preventing exposure to any asthma trigger. Some physicians now counsel all children with asthma to avoid nuts entirely, and, of course, children who experience reactions to any foods should avoid them. Chemicals that may pose some risk for an allergic reaction are monosodium glutamate, or MSG (found in some canned soups, cheese, and certain vegetables), and sulfites (preservatives in foods, such as frozen potatoes and tuna). Contrary to what many believe, dairy products do not appear to exacerbate asthma symptoms in people who are not already allergic to them.

Exercise

Asthmatic children should be encouraged to swim and play sports, such as baseball, that will present less difficulty for them. Intense activities lasting less than two minutes, such as sprinting or competitive swimming, are less problematic than longer exercises.

It should be noted that asthma is no reason to avoid exercise. Historically, about 10% of US athletes who participated in the Olympics have been asthmatic. Some studies are indicating that long-term exercise may even help control asthma and reduce hospitalization.

Young people who enjoy running should probably choose an indoor track to avoid pollutants. Swimming is excellent for people with asthma. Yoga practice, which uses both stretching, breathing, and meditation techniques may have particular benefits. One study reported that two thirds of patients who practiced yoga regularly were able to reduce or stop taking their asthma medications.

Patients should consult their physicians before embarking on any exercise program. Exercise-induced asthma is a limited that has specific recommendations.

Preventing and Treating Respiratory Infections

People with asthma should try to minimize their risk for respiratory tract infections. Washing hands is a very simple but effective preventive measure.

There has been some question concerning influenza vaccinations because of some reports that vaccines may worsen asthma. Recent and major studies have been reporting, however, that the vaccination is safe for adults and children. It is also very important for patients to reduce their risk for respiratory diseases. Still, 90% of asthma patients remain unvaccinated.

Asthma patients should ask their physicians about the flu vaccine and also whether they should receive the vaccination against pneumococcal pneumonia.

Zanamivir, a new drug used for treating influenza, is now considered safe for asthma patients 12 years of age or older. And, in one study, asthma patients treated with zanamivir experienced fewer flu symptoms and their lung function improved.

Reducing Stress and Negative Moods

People with asthma have no higher rate of anxiety or depression than the general population. However, such emotions interact with the effects of asthma and its treatments in important ways:

• Negative emotions can discourage compliance with medication and the ability to cope.
• Poor control of asthma symptoms, in turn, increases the risk for negative emotions.
• Stress and depression have been associated with more severe symptoms and even an increased risk of fatal asthma attacks.