Definition
Asthma is a chronic (longstanding) inflammatory disorder of the airways (breathing passages). This inflammation causes recurrent or persistent episodes of wheezing, breathlessness, coughing and chest tightness.  

What triggers an asthma attack?
The inflammation causes an increase in airway responsiveness (hyper-responsive) to various stimuli (triggers). Children with asthma therefore have extra-sensitive airways. An asthma attack is usually brought on by something that irritates the sensitive airways. These triggers can be different for each individual. 

 Common triggers:

  • Pet dander
  • Mold
  • Pollen
  • Dust mites
  • Cockroach droppings
  • Smoke or chemicals in the air (e.g., fumes or perfumes)
  • Cold or dry air
  • Viruses or infections
  • Anxiety or stress
  • Strong emotions (e.g., laughter or crying)
  • Exercise

How does asthma affects the lungs?

When the extra-sensitive airways of an asthmatic are exposed to stimuli (triggers)

  1. They become inflamed ( they become red and swollen)
  2. These red and swollen airways begin to make a lot of mucous which cause them to become clogged
  3. The inflamed airways cause the surrounding muscles to go into spasm and they squeeze together and tighten

The swelling and mucous along with the muscle spasm causes narrowing of the airways, this leaves less room for air to pass through thus making it hard to breathe. This is what makes/brings on the experience of asthma symptoms. Longstanding inflammation if left untreated can lead to permanent damage of the airways. Hence the importance of good asthma controls.

Symptoms and signs of asthma

  1. Wheezing defined as a high pitched whistling sound heard on “breathing out”
  2. Cough – A history of prolonged or recurrent episodes of cough may be the only symptom of asthma present.
  3. Recurrent difficulty breathing
  4. Chest tightness.
  5. Symptoms worse at nights.

The absence of a wheeze in a patient with a history suggestive of asthma does not prevent making the diagnosis.  

Types of asthma medication

There are two (2) main types of asthma medication

  1. Rescue medication
  2. Preventer or controller medication

Rescue inhalers are also known as fast acting inhalers, quick relief inhalers, short acting bronchodilators, or short acting β2 agonists. Rescue inhalers are used in the event of an asthmatic attack; they help provide quick relief by relaxing the tightened muscles around the airways making it easier to breathe. Rescue inhalers act quickly and last for a short time, they are taken only when needed, they treat the immediate symptoms and cannot control your asthma or prevent future attacks.

Examples of rescue medication are:
Salbutamol (Ventolin, Apo-salvent, Novo Salmol, Gen-salbutamol, Airomir)
Fenoterol hydrobromide (Berotec)
Terbutaline sulphate (Bricanyl)

Preventer (controller) medications are also known as anti-inflammatories, long-acting bronchodilators, or corticosteroids. Preventer medications prevent, reduce or reverse the redness, swelling and mucous in the lungs (corticosteroids) or they work long-term to keep your airways open (long-acting bronchodilators). When used regularly they help to prevent asthma symptoms and attacks. Over time these medications can help make your airways less sensitive to asthma triggers. Preventer medicines work slowly and over the long term, but they cannot replace a rescue inhaler for sudden attacks, but using them everyday can significantly reduce the number of attacks.

Examples of preventer (controller) medications are:
Inhaled corticosteroids (budesonide [Pulmicort], fluticasone [Flixotide], beclomethasone [Becotide]) 
Corticosteroid pills or liquids (prednisone, prednisolone, prelone, predcort)
Long-acting bronchodilators (serevent, fomoterol [Foradil])
Leukotriene receptor antagonist (zafirlukast [Accolate], montelukast [Singulair])

Inhaled corticosteroids are the most common types of asthma preventers, they are inhaled not swallowed, so they go straight to the lungs with fewer side effects than pills/liquid.

Sometimes the swelling in the airways is severe. In cases of severe swelling corticosteroid pills/liquids may be prescribed, they work the same way as inhaled corticosteroid, but are more powerful and are only used for a short while to get the swelling quickly under control. Patients with severe swelling should be maintained on daily inhaled corticosteroids.

NB 

CORTICOSTEROIDS FOR ASTHMA ARE NOT THE SAME AS MUSCLE BUILDING STEROIDS THAT SOME ATHLETES TAKE. SOME ATHLETES TAKE ANABOLIC STEROIDS, A TOTALLY DIFFERENT KIND OF STEROID. CORTICOSTEROIDS USED FOR ASTHMA ARE NOT THE SAME AND OD NOT HAVE THE SAME RISKS OR EFFECTS.  

Management of asthma

Reduce exposure to triggers, some useful tips are;

  • Avoid tobacco smoke
  • Avoid Dust mites- encase pillow and mattresses
  • Pets- remove from house, or at least from bedrooms
  • Cockroaches- remove garbage promptly.
  • Molds- reduce indoor humidity
  • Reduce airborne irritants- fumes, powders, perfumes.

Managing a sudden attack of asthma at home

Note symptoms: cough, difficulty breathing, wheeze, chest tightness. The degree of these symptoms does not necessarily relate to the severity of the attack. Accessory muscle use and retractions (sucking in of the chest and neck) suggest a severe attack.

Initial treatment

  1. Use rescue inhaler (short acting β2 agonist) - give 5-10 puffs every 20-30 mins. for three (3) times, preferably using a spacer device. OR
  2. Using a nebulizer if one is available, give one (1) nebulization every 20-30 mins for three (3) times.

If there is a good response to the above treatment continue using the rescue inhaler giving 2-4 puffs every four (4)hours for 24-48 hours. Children on inhaled corticosteroids should double the dose for about two (2) weeks (that is if you took 2 puffs twice daily then you should go up to 4 puffs twice daily), and then go back to normal doses when symptoms subside.

If child’s response to above treatment is poor, if there is severe distress or if symptoms persists beyond 24-48 hours then the child should be seen by a doctor as soon as possible. On the way to the doctor continue to use the rescue medication.  

If your child has asthma

  • Try to find common triggers
  • Make sure your child gets and follows good asthma treatment.
  • Learn proper use of asthma medicines and devices (inhalers, spacers) and ensure all caregivers do the same.
  • Keep the rescue inhaler with child at all times.
  • Have a written asthma plan to manage symptoms
  • Inform family, caregivers and school about child’s asthma and ensure that they all know what to do in an emergency.
  • Educate your child about asthma and its management.