Common asthma triggers
Asthma is a chronic condition affecting children as well as adults. It cannot be cured, only controlled. To understand what a severe asthma attack feels like, breathe in very deeply and hold for a second. Now, try to take another breath. This unpleasant sensation occurs when a trigger causes airways to the lungs narrow. Symptoms of asthma are wheezing, coughing, chest tightness, shortness of breath and mucous production.
Although struggling for air can be very frightening, asthma is not caused by anxiety. Never brush it off as ‘just nerves.’ Those who do not understand the condition may think someone with asthma is just puffing to get attention or avoid activity. However, asthma is very real and must be taken seriously.
Asthma is often inherited, affecting both adults and children. If both parents have asthma, the child’s risk of developing it is even higher. Mothers who smoke are more likely to have children with asthma. Although a diagnosis is rarely made before age one, roughly 10 per cent of children have asthma.
In Canada and across the world, more and more people are being diagnosed with asthma. Each decade, the number rises by 50 percent. Although we do not understand exactly why, increasing urban dwelling may be related. Modern medical treatment and medication have allowed the death rate from asthma in Canada to slowly drop since 1990. Still, around 20 children and 500 adults die of asthma each year. Whether you care for a child with asthma or have it yourself, the following information on managing the condition can help.
People with asthma have airways that are very sensitive to one or more triggers. Exposure makes airways begin to spasm, becoming red, swollen and narrow. Mucous is produced and gathers in the airways.
Next, small muscles around the airways go into spasm. As they become active, they shorten and tighten around the tubes in the lung. This narrows the airways and reduces airflow, much like wrapping your hand around a soft garden hose and squeezing to reduce the flow of water. During an asthma attack, both inflammation and resulting airway spasm cut the air flow. This causes shortness of breath, coughing, and often wheezing through the narrowed airway tubes.
The pulmonary (lung) function tests ordinarily used to diagnose asthma are usually impractical before six years of age. Instead, doctors use a good history, physical examination and follow-up of the child. Lab tests are usually done only to rule out other conditions that might cause similar symptoms. Response to bronchodilator medication can help confirm the diagnosis of asthma.
For some children, unrestricted play is just a dream. Others with asthma are able to control it so effectively that they are able to participate in world class sporting competitions.
As with most illnesses, the best treatment is prevention. Think about what irritates your child’s airways and triggers an attack. Then, reduce exposure to triggers (see sidebar).
ALLERGIC ASTHMA TRIGGERS
Children with allergies may be sensitive to certain foods or substances. Breathing in or eating these substances could cause an asthma attack.
Pollen - Trees, grass, ragweed
Dust Mites - Carpets, furniture, mattress, dirty filters, feather pillows, stuffed toys
Mould - Damp areas, such as sinks, bathroom, laundry areas, plants, garbage cans or humidifiers
Animals - Household pets, such as cats or dogs
Foods & Additives - Certain foods such as nuts, shellfish, eggs, milk or chocolate, additives or food colouring, sulphites in dried or preserved fruits, beer, wine or salads, monosodium glutamate (MSG)
NON-ALLERGIC ASTHMA TRIGGERS & IRRITANTS
Smoke, fumes and irritants - Cigarette smoke, fumes from bleach, paint, wood stoves, perfume or chemicals, high humidity or cold air
Exercise - Various sports and activities
Emotion - Excitement, laughing, crying, fear, anxiety or stress
Infection - Colds or chest infection
Medications - ASA, certain blood pressure pills (B-blockers), certain eye drops (beta blockers), anti-inflammatory (NSAIDS)
Some children only have symptoms of asthma when they exercise. They seem to experience more problems when exercising in cold dry air. Coughing after exercising may be the only symptom. Children may not mention breathing difficulties, but avoid physical activity because they cannot keep up with their friends. Stop-and-go sports such as baseball and volleyball may cause fewer problems than hockey and soccer. Water sports in an indoor pool and exercise in an indoor gym cause the least trouble because the air is warm and moist.
To prevent symptoms of exercise-induced asthma, make sure your child:
Take the 30 second asthma test to find out if your child’s asthma is under control.
If you answer yes to one or more questions, talk to your doctor about how you can better manage your asthma.
|Do you cough, wheeze or have a tight chest because of your asthma four or more days a week?
|Does coughing, wheezing, or chest tightness wake you at night once or more a week?
|Do you stop exercising because of your asthma?
|Have you missed school because of your asthma in the past
|Do you use your rescue medication four or more times a week? (except one dose per day for exercise)||Yes||No|
Asthma medications fall into two major groups: relievers (rescue) medications (bronchodilators) and preventor medications (anti-inflammatories). If you have any questions about your child’s asthma medication, or concerns about how your child feels while taking it, talk to your doctor or pharmacist.
Rescue medications (fast-acting bronchodilators) quickly relieve symptoms (see table below). They bring rapid relief by relaxing bronchial muscles. Only use a brochodilator when needed:
If your child is using rescue medication more than three times a week, other than once a day with exercise, the airways are likely swollen and need treatment. Follow your action plan or tell your doctor. You may need to increase asthma prevention medication or add another medication until the asthma is under control.
Trembling, nervousness, flushing, and increased heart rate are all common side effects of rescue medication.
If your child has asthma, your doctor is likely to prescribe an inhaled corticosteroid to keep it under control. These medications reduce swelling, redness and mucous in the airways. Inhaled corticosteroids are taken daily even if there are no symptoms to prevent swelling and mucous in the airways.
Inhaled corticosteroids do not have the same side effects as the performance enhancing anabolic steroids some athletes take illegally. Nevertheless, their use requires regular check-up as recommended by a family doctor. Oral yeast infections, hoarseness and sore throat are the most frequent problems. Remedy this by rinsing the mouth out with water after each dose.
For asthma attacks corticosteroids are sometimes taken systemically (by mouth or injection). Doctors often prescribe these pills for a short time to get swelling and mucous under control quickly. For prescriptions lasting three to seven days, side effects may include increased appetite, mood changes, water retention, and, in children, hyperactivity. When used for a few days, side effects are expected to be minimal compared to the benefits.
Long-acting bronchodilators help keep airways open and muscles relaxed, preventing asthma attacks for up to 12 hours. They are always prescribed with inhaled corticosteroids and should not be taken alone. Long acting bronchodilators may be used in children four years and older. Combination products containing inhaled corticosteroid and a long acting bronchodilator are available for children who need to be on both medications. Combinations make it easier to take medication on a regular basis.
Leukotriene receptor antagonists
Leukotriene receptor antagonists help reduce inflammation or swelling in the airways and keep airway muscles relaxed. Montelukast (Singulair) comes in pill form and is taken once daily. It can be used in children as young as two.
Zafirlukast (Accolate) is an oral tablet taken twice daily and used by children over 12. Leukotriene receptor antagonists are usually added to existing inhaled corticosteroid therapy when optimal asthma control has not been reached. They can be used in patients who cannot or will not take inhaled corticosteroids.
Theophylline is a bronchodilator in pill form. Today it is seldom used. It works directly on the airway muscle to relax it, making it easier to breathe. Theophylline has many side effects and needs to be closely monitored.
Antibody Neutralizers (Xolair)
Antibody neutralizers are used when moderate to severe asthma is triggered by allergies and inhaled steroids do not help. Xolair works by decreasing the amount of the antibody (the substance in the body that makes airways swell with an allergic reaction).
Asthma medications are often given through a metered dose inhaler (MDI). This system delivers a fine medication mist directly to the airway. A metered-dose inhaler can be used with an open or closed mouth technique. The preferred method for children is the closed–mouth version.
Helping your child to use a metered-dose inhaler
Once a week, remove the medication canister from the plastic casing and wash the casing in warm, soapy water. When the casing is dry, replace the medication canister and put the cap on the mouthpiece. Ensure the hole is clear.
A spacer device is an add-on that attaches to the mouthpiece of a metered-dose inhaler. Acting as a holding chamber for aerosol medication, a spacer makes it easier to take the medication.
It reduces the amount of medication deposited in the throat and increases the amount that reaches the lungs. A spacer is recommended for use with all metered dose inhalers.
Spacers are available with either a mouthpiece or a face mask. Spacers with face masks are used for young children. As soon as your child is able to use a spacer with a mouthpiece, make the switch. With face masks, as much as two-thirds of the drug may not be deposited in the lungs.
The turbuhaler is a multidose powder inhaler. Since the particle size and volume of powder is so small, your child may not taste or feel anything while inhaling it. Children three years and older can be taught to use a turbuhaler.
Helping your child to use a turbuhaler
Caring for the turbuhaler
Clean mouthpiece using a dry tissue or cloth, gently wiping away any particles which have collected inside the mouthpiece. Never wash the turbuhaler. Check the dose window counter - once a red mark appears in the window, there are approximately 20 doses left. Some turbuhalers use numbers to indicate doses left. Note that the sound heard when shaking a Turbuhaler is not the medication but an agent that keeps the medication dry. Hearing the sound does not mean that there is still medication in the container.
A diskus is a multi-dose (60) dry powder inhaler. Children as young as age three may be able to use a diskus.
Helping your child to use a diskus
Caring for the diskus inhaler
Store the device in a dry place, and close it when not in use. Never wash a diskus inhaler. Use a dry tissue or cloth to clean the mouth piece.
Nebulizers are usually reserved for hospital in-patients or out-patients who cannot use other inhalation devices. The amount of drug breathed in is the same as for metered-dose inhalers with spacers or breath-activated powdered inhalers. The same degree of bronchodilation occurs as with a properly used inhaler. As a result, it makes more sense for most people with asthma to use an inhaler.
An asthma action plan is a written set of instructions developed with your doctor or asthma educator. It explains what medication your child should take regularly when feeling well. It also discusses how to increase the medication if breathing problems occur. An asthma action plan can be used with or without a peak flow meter to help manage asthma.
ASTHMA ACTION PLAN FOR: ______________________________
PEAKFLOW ______________________ TO_____________________ (80% – 100% of personal best)
MEDICATION: (Avoid triggers):
PEAKFLOW _____________________ TO ______________________ (60% - 79% of personal best)
MEDICATION: (Avoid triggers)
Signs of Severe Asthma- Call 911 or go to nearest hospital One or more signs may be present:
A peak flow meter measures how fast air is blown out of the lungs. It can help you and your doctor determine peak lung capacity to get a sense of the pattern of your child’s asthma. Take readings one or two times a day, as recommended by your doctor. Record the reading in a diary and take it with you each time you visit the doctor. The reading can be used to find your child’s personal best. A peak flow meter is used in conjunction with a written action plan.
To use the peak flow meter properly
Every week in Canada, people die from asthma. Many are children. However, asthma can be controlled and treatment is better than ever. Take asthma seriously, learn about it and work closely with your doctor to keep the illness under control. If you need more information, contact your family doctor.
|RELIEVER (RESCUE) MEDICATION – used during an asthma attack, if your breathing gets bad, or before exercising|
|Inhaled bronchodilators (airway openers)||Bricanyl™ (terbutaline sulfate), Ventolin™ , ‘Airomir’ (salbutamol), Oxeze (Formoterol), Symbicort (Budesonide + formoterol)||Quick relief within five minutes, relaxing tight muscles around airways||Shakiness, fast heart rate when first taken|
|PREVENTER MEDICATION - used every day to prevent swelling and mucus in the airways even if you have no symptoms|
|Inhaled corticosteroids||Pulmicort™ (budesonide), Flovent (fluticasone), Qvar (Beclomethasone), Alvesco(Ciclesonide), Symbicort (Budesonide + Formoterol), Advair (Fluticasone + Salmeterol)||Works over time to prevent swelling, mucous build-up and reduce inflammation in airways||Hoarseness, mouth and throat infection (thrush) – after use, rinse out mouth and spit to avoid this effect. Alvesco does not have this side effect. May use with a spacing device (except Pulmicort™).|
|Corticosteroid pills||Prednisone, Prednisolone (PediaPred), Dexamethasone (Decadron)||Take effect over 4 to 6 hours to reduce swelling, inflammation and mucus secretions in airways; emergency control of asthma symptoms and severe asthma||Only use for 5 -7 days for asthma attack; may cause mood changes, water retention and increased blood sugar|
|Long-acting bronchodilators||Oxeze (Formoterol) Serevent (Salmeterol):must be used with an inhaled corticosteroid and come in combination: Symbicort (Formoterol + Budesonide) Advair (Fluticasone + Salmeterol)||Work over a 12 hour period to keep airways opened and muscles relaxed preventing asthma attacks||Tremors and palpitations|
|Leukotriene receptor antagonists||Accolate® (Zafirlukast)
|Slow action: prevent swelling and mucous build-up which cause narrowing of the airways, reduces twitchiness of airways, dosage adjusted according to age||Stomach upset, tiredness|
|Theophylline (seldom used)||Uniphyl™ (theophylline)
|Short or long lasting (8 to 12 hours) to open airways; not for quick relief, as it does not take effect immediately||Never increase the dose on your own, as it can be toxic if too much is taken. Take after meals or with food. Do not chew or crush tablets. May experience upset stomach, shakiness, headache, restlessness or sleep disturbance.|
|Antibody Neutralizers||Xolair (Omalizumab)||Lowers amount of antibody causing allergic reaction||For use in children over age 12|