Departments
Health Matters
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Week of 9 October 1998 |
Vol. II, No. 9 |
Health Matters
Childhood asthma: the most common chronic childhood disease
My five-year-old son suffers from asthma. What can I do to make our home as comfortable as possible for him?
Asthma is the most common chronic disease of childhood. According to the American Lung Association, an estimated 4.8 million children under the age of 18 have asthma, and many other children remain undiagnosed. It is a disease affecting people of all ages, but the steepest recent increases in asthma cases have been among the young.
In people with asthma, the normal airway functions designed to protect the lungs, including muscle contraction, mucosal swelling, and mucus formation, become overreactive to stimuli. The bundles of muscles surrounding the airway tighten, and the mucosa (the delicate cellular lining of the airway) begins to swell with inflammation, reducing the diameter of the airway. In addition, mucus production increases, often forming sticky plugs in the bronchial tubes. These reactions cause a variety of symptoms, including frequent coughing, chest tightness, and shortness of breath.
Most children with asthma are not born with it, but develop it as they grow older, says Suzanne Steinbach, M.D., director of the Pediatric Asthma Clinic at Boston Medical Center and an assistant professor of pediatrics at Boston University School of Medicine. "The risk for developing asthma, however, is based on genetic factors," she says, "including a family history of allergies and a condition called a hyper-reactive airway. If a child has both of these factors, the incidence of asthma increases."
Asthma can be diagnosed through the symptoms that are present or through a breathing test in which the child takes a big breath and blows into a tube connected to a spirometer, which measures airflow. This test can determine if the airway is behaving normally for a person of that age and size and is used for both diagnosing and monitoring the condition. Steinbach also says a peak-flow meter -- a $20 to $30 item -- will help parents measure their child's airflow at home.
Episodes of asthma, she says, are often triggered by environmental conditions or stimuli, among them allergies, infections, exercise, and other irritants. "Children develop asthma based on their exposure to common household allergens like dust mites, to pets, and to irritants like tobacco smoke," she says. In addition, the energy crisis in the late 1970s led homeowners to better insulate their homes, decreasing the air circulation in the home and trapping allergens inside.
Steinbach says the most common house allergen is the dust mite and that parents of children with asthma should focus on controlling that problem. She suggests using vinyl mattress covers, laundering bed linens frequently, minimizing dust and clutter, and keeping the humidity in the home at less than 50 percent. If there are pets in the home, she recommends that children avoid contact with them or that other homes be found for the pets.
Air pollution and other environmental irritants can also lead to episodes of asthma, but they are not the primary cause. As environmental concerns have led to decreased air pollution, the incidence of asthma has, in fact, increased. "Many parents tend to blame air pollution for their children's asthma and don't necessarily focus on indoor air quality, which is a mistake," says Steinbach.
The emphasis in treating asthma is on prevention, she says. That means working closely with the child's clinician to develop a comprehensive treatment plan that will enable the child to participate in physical activities, instead of being sidelined with asthma. Anti-inflammatory drugs (cromolyn, corticosteroids, and others) and bronchodilators (drugs that relax the airway) are effective in counterattacking the symptoms caused by asthma.
Asthma can cause discomfort, Steinbach says, but the disease can be controlled if parents and their children with asthma are diligent about reducing allergen levels in the home that trigger episodes and about using preventive therapy.
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on childhood asthma or other health matters, call 638-6767.