Are these two the same?
Asthma and allergies are thought of by us scientists as two manifestations of the basic process of an over-sensitive respiratory system.
More precisely, allergy is a basic tendency of a person. Just as some people are fat or thin, there are people / children who have a basic, innate tendency to allergies. They themselves confess that they are Generally Allergic.
This basic tendency may manifest on any, more than one or all of the following parts / organs / systems of the body.
Skin as eczema (atopic dermatitis / atopic eczema /) or as Urticaria /Hives.
Eyes as allergic conjunctivitis ( frequent, red eyes/tearing/itching/muddy and stale looking sclera i.e. the white of the eye )
Nose Allergic rhinitis ( frequent runny and itchy nose / frequent colds / frequent episodes of sudden onset of runny nose and massive bouts of sneezing ).These people may go on to develop polyps in the nose ( small / medium non tumorous growths in the nostrils)
Lungs ( Chest ) : Asthma
In other words, the basic process of allergy has set the whole body as a triggered up and sensitive individual who fires off very easily.
You may call it a volcanic body system.
Allergic substances that trigger asthma:
Having understood this basic process, it is not hard to imagine a respiratory tree (respiratory tract / respiratory system) that is very sensitive and triggers off at trivial stimuli.
These stimuli may be any of the following irritants / allergens:
Dust
Pollens
Smoke
Pet danders
Perfumes
Foods
We have now made the ground for a respiratory tree that is reactive to stimuli!
So we may now call this asthmatic tendency in somewhat better terms: Reactive Airways Disease !
This is how we scientists prefer to re-label asthma. This is partly to be more descriptive and also to remove the fear tag from this condition.
When these stimuli attack the lungs, they cause BRONCHOSPASM.
Bronchospam is derived from: Broncho = Respiratory airways, spasm = going into a state of contraction.
Hence, central to the disease of asthma is the phenomenon called Bronchospasm.
No bronchospasm no asthma.
Bronchospasm the central figure in asthma
The villain of asthma:
This sudden squeezing of the airways lies at the root of all symptoms of asthma.
All our efforts at treatment and prevention shall circulate around this key phenomenon.
What are all these other confusing words used for asthma (Bronchitis, Reactive Airways Disease, Allergic Chest):
Asthma has a range of confusing words by which it is known and some are descriptive of the symptoms rather than being scientific names :
Bronchitis
Allergic Bronchitis
Reactive Airways Disease ( RAD )
Chest Allergy
Respiratory Allergy
Seasonal Cough
Sinus Problem
We prefer to call it Reactive Airways Disease since this describes the actual disease process best.
What are the symptoms of Asthma :
Any child who is showing an allergic tendency as outlined above and who is coughing either more long in time duration than usual or who is coughing more frequently compared to others is better addressed by your Pediatrician.
In a nutshell, the symptoms may be :
Cough that is lasting more time than expected
Cough that is coming up more frequently ( i.e. more times in
a month / year ) than expected
Cough that is spasmodic ( you have to hear it to know it a
severe cough that tends to make the face go red,may cause a
vomit at the end of the cough and comes in a burst )
Cough with wheezing ( a whistling sound heard at the chest
and more pronounced on the expiration of air i.e. upon
breathing out)
Cough getting worse on exertion ( Exercise Induced Asthma)
Cough with a fast moving chest
Cough starting with exposure to any of the allergens /
irritants outlined above
What you see as a common strain is COUGH.
Cough with wheezing is a hallmark of asthma.
Cough with any of these / more than one of these qualities is likely to be an asthmatic cough.
All that wheezes is asthma ?
Many younger children have some episodes of wheezing associated with the normal seasonal coughs and colds.
These have to be watched and not all may turn out to the actual asthmatics.
Please do not make your own judgment if you see cough and wheeze together.
Your Pediatrician may rather diagnose it as WALRI (Wheeze Associated Lower Respiratory Infection).These children eventually grow out of it by some 5-6 years of age and do not need long term or asthma-type of treatment.
Medical basis of asthma :
Asthma is now rather well understood by us.
We say that asthma is a state of hyper ( over ) reactive airways.In other words, it is a state of sensitive lungs.
This sensitiveness may also be called allergic lungs.
In the setting of a sensitive lung, the various irritating stimuli we have outlined above tend to cause an allergic reaction in the lungs and these cause the symptoms.
If you trace the lungs from the outside ( i.e. from the air entry level of the nose ) the first part is the nose.Here Allergic Rhinitis attacks and causes seasonal nose allergies.The symptoms are frequent and almost explosive onset of sneezing,watery fluid running from the nose, an itchy nose and frequently watery,red eyes.
The next level is the Bronchi ( the large air tubes in the chest that connect the nose to the lungs ).Here allergic Bronchitis attacks and causes the usual allergic cough of asthma.However, we now realize that asthma is more due to the involvement of the smaller airways ( alveoli and terminal bronchioles ) rather than the larger Bronchi.Hence the reason we discourage the use of the word Bronchitis.
Finally we come to the trouble area. At the very end of the respiratory tree ( from outside inwards ) we have the small Bronchioles the Terminal Bronchioles and then the Alveoli.These are really tiny tubes and collection of air sacs.
Inflammation ( swelling ) within the walls of these airways causes the manifestations of asthma.When these airways have walls that are swollen, the movement of air within and outside gets difficult. More markedly, it the outward push of air ( expiration) is what gets more difficult.
You may have noticed that in asthmatic people ( more easily appreciated in adults ) , the expiration ( breathing out ) is more difficult and causes the typical wheeze when the person strains to push out the air.
The swelling of the small airways is caused by these allergic stimuli.
The bad news is that this swelling is a permanent state of the small airways.
The symptoms may come up when the swelling gets suddenly increased by the allergic stimuli but a baseline swelling stays always.
Not to scare you, but to present medical evidence as it stands : We have to make all efforts in the direction of preventing further destruction of the airways by using medication and precautions.
Here comes the role of the concepts and words like :
1. Allergic precautions
2. Preventers
3. Rescuers
Please go on to the text further down what medicines : Inhalers / Syrups / Injections
When should I see my Pediatrician :
Quite naturally, whenever you see any of these above, please see your Pediatrician
Is it a life time disease ?
Essentially, asthma in childhood should be thought of as wheezing with cough and then to divide it into two age groups.
The first is the young child of say below 3-5 years who has a wheeze at some / many episodes of a seasonal cough.These children would most often outgrow their wheezing at a later age say some 6 years or latest by 12-14 years. The pubertal growth spurt causes rapid growth of the airways and this reduces the tendency for asthmatic attacks.
One thing we have to understand well is that Asthma, once diagnosed properly, is a permanent disease but controllable.
We do not make any claims of curing it. We help you in controlling it and allowing a nice life with minimal interruption in daily activities.
This is somewhat like Hypertension ( blood pressure problem ) or Diabetes. No one cures these. We rather help you live better with it.
Is there is any family disposition / genetic tendency :
It is believed that if one parent has asthma there is some 25 % higher risk of asthma in the child
If both parents have it, the risk goes up to 50 %
As they say , the only way is to choose your parents well !
We have a family tendency to allergies/asthma - can we do something to prevent asthma from developing in our child ?
There is little you may do to prevent this from happening.
The genetic code has been set and locked in place the moment conception has occurred. What has been zipped in can not now be unzipped.
What you may do ( and hope it works) is to avoid things that may irritate the lungs.
What is more important is to keep what we call is a high index of suspicion. This means that you need to be just more watchful.
The genetic baggage is already in place.
You need to see your Pediatrician more early in the course of a somewhat longer cough than some other family may do.
In other words, just be more alert.
Panic is not what you need.
Statistics can often be very unreliable.
Any preventive drugs ?
While we know medicines that prevent further destruction of the airways in established asthmatics, we do not have any drugs to prevent the tendency of asthma in an individual.
The tendency is genetic and is aggravated by several environmental factors ( mostly the irritant substances outlined above )
Any foods to avoid ?
Medical science is till date quite fuzzy about this.
What we know is that some children react very strongly to peanuts and dry fruits ( cashewnut / walnut / almond / pistachio / nuts used in butterscotch ice cream ).These are best avoided during the cough period.Whether we need to avoid them totally is not yet clear.
Undue cold juices/foods are anyway not a very nice thing to be doing.Avoid them.
What medicines for treatment inhalers / oral syrups / injections ?
This is the perennial area of controversy.
Generally speaking, the oral ( syrups/tablets) are used for control of short term control of cough and wheezing.When it comes to long term and systematic control , nothing works like Inhalers.This decision would best be made by your Pediatrician.
Despite adequate standardization in our field, there is still some disparity of advice given by Doctors to families of asthmatic children.Anyway, there is uniform agreement on the following :
What we know for sure is :
1 Some medicines are needed
2 For acute attacks ( i.e. when there is cough and wheezing ) we need medicines that act fast and reverse the bronchospasms
3 Preventors : will be needed permanently.
4 Rescuers / Relievers : will be needed on a need basis
Please note,Preventers do not mean drugs that prevent the development of asthma in a child .Instead they are drugs that prevent an acute attack in an asthmatic child.
These Preventers are essentially small doses of steroids that need to be delivered to the affected areas
( the smaller airways of the lungs ).
Steroids, if used orally ( as syrups or tablets ) have the potential for side effects.They will also be needed in larger doses so that after absorption from the stomach they circulate all over the body and ultimately reach the target area the lungs.
Hence, we have bought more dose with more side effects for getting a small and required fraction at the lungs.
If we imagine a method by which the required dose reaches the target area directly, this would be wonderful.
To do this, the pharmaceutical manufacturers have been able to get us Inhalational Devices.
They come as Dry Powder Inhalers ( DPI ) or as Metered Dose Inhalers ( MDI ).
These contain small doses of the required medicines and are breathed in for effect.
The choice is individual. We shall come to details of these below.
Hence, the preventers are almost universally Inhalers and the oral formulations are unacceptable because of side effects.
These days,we add a class of medicines called Leukotriene Inhibitors.These are add on preventers and are taken orally.These will usually be added onto a regime of inhaled medicine.
Other oral medications like Salbutamol and Terbutaline are used on a strict need base and are not as valuable for long term care as are the inhalational drugs.
These are very valuable for an acute episode of increased cough with associated bronchospasm.
Inhalers in general :
These come as two formulations either as Dry Powder Inhalers
( DPI ) or as Aerosols in Metered Dose Inhalers ( MDI ).
Inhalers β 2 Agonists Salbutamol : These are used for relief from acute ( sudden ) episodes of wheezing/breathlessness or increased, incessant cough.They may be advised a few days beyond this episode but are not to be used on a regular basis
Inhalers : Inhaled Costricosteroids :
These are used for prevention of asthma attacks.They act primarily as anti-inflammatory agents and reduce / control the inflammation/swelling within the airways.
They come as Budesonide,Beclomethasone or Fluticasone.
Their use is very specific for asthmatic children and is practically devoid of the serious side effects of orally taken steroids.This statement from us very important to reassure you and remove the fear of steroid usage.
Common parental concerns :
1 Dependence if I use Inhalers, my child will get hooked
to it
2 But this is the last step .I am worried that my child has
reached such a stage so young.
3 This is strong medicine .I do not want to use it.I prefer
oral medicines.
These concerns are clubbed under one heading since they address the most common issues that lead to non-compliance to properly advised treatment.
Believe us, and more so, feel empowered since you have already read about the basis of asthma and the use of inhaled medicines.
Nebulizers :
These are small machines that deliver a tiny mist if liquids.
The purpose is the same as in inhalers, i.e. to deliver target specific and area specific medication.
We use it to deliver moisture in dry airways by using normal saline.
You may use it to deliver the same drugs that come in Inhalers and deliver them through a Nebulizer for better effect.
Nebulizers as especially useful for treating severe acute attacks and are failry safe.
With improving technology, they are getting cheaper,smaller and less noisy.
Alternative Medicine homeopathy,ayurveda,yoga :
So long as your child is comfortable, his episodes of severe cough are less frequent, his attacks are reduced and he likes the formulation and timing of doses we are comfortable with any pathy.
Just be cautious about :
Un-informed administration of steroids
Use of heavy metals in formulations
Report and perceived ill effect to the concerned
practitioner.Do not believe that all other forms of practice
are altogether free of side effects.
Yogasana is a proven health elevator and directly influences prana vayu ( the essential air of life ) .Please start under a trained teacher and get periodic checks done for accuracy of practice.
Your Pediatricians role and goals in treating your child :
We understand your collective suffering and his personal discomfort.
What we aim at is :
1 allowing him a wheeze free childhood
2 allowing him to have normal activities
3 not having him miss school due to his problem
4 promoting positive health and self help so that visits to
Pediatrician are minimized
5 avoiding to the minimum his admission in an emergency
situation to a hospital
6 allowing him to sleep well at night and not have asthma
disturbing his sleep
7 helping him to do all this at the lowest levels of
medication and with the least medication and with medication
that may disturb his lifestyle the least
8 allowing him to have a normal body growth
9 minimizing side effects of medication to the least acceptable
Towards this goal we need : Towards this goal we need :
Your understanding of repeated coughs and wheezing so that
you may atleast visit a Pediatrician and have a firm
diagnosis made
Your continued visits to your Pediatrician till your
treatment plan is stabilized
Your cooperation in adhering to the suggested line of
treatment.
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