Coughing, wheezing and breathlessness may point to the chronic condition. SmartParents learns more about asthma from paediatrician Dr Terence Tan.

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Shirley Ng, a mum of two is no stranger to asthma. She had it as a child, and her two kids, Georgina, 5, and Dominic, 7, have it as well.

“I remember having asthma attacks as a child, and it was quite terrible ― I couldn’t sleep at night because I was wheezing, and I was always bothered by physical activities because I got breathless easily,” she shares. “As such, I always had my inhaler with me.”

Though she has mostly outgrown the condition, she says she felt “heart pain” when she learnt that both her kids have the condition, too. They have had sensitive airways since they were toddlers, and Georgina, in particular, had one pretty serious attack when she was 2.

“It started out like a flu virus, but when she started breathing heavily and wheezing, that’s when I suspected it was asthma,” she says.

Some children are predisposed to recurrent wheezing and asthma because they inherited it from one or both parents.

The condition is quite easily managed these days, but Ng says she has moments of guilt as her kids probably inherited the condition from her.

Dr Terence Tan, a consultant paediatrician with Kinder Clinic at Mount Alvernia Hospital, fills us in childhood asthma facts.

What are the signs and symptoms of asthma?
Asthma is characterised by a feeling of tightness in the chest, breathlessness, an audible wheeze and, when severe, turning blue because of adequate ventilation. Death can occur if the attack is severe.

How common is asthma among children in Singapore?
Asthma and recurrent wheezing in Singapore children is quite a common problem. A local study has suggested the current prevalence of asthma in Singapore children is about 10 per cent.

What are the main causes of asthma? Are there groups with a higher risk of getting it?
Asthma is a complex condition which does not have one underlying cause. Some children are predisposed to recurrent wheezing and asthma because they inherited it from one or both parents. Children of individuals with asthma or other allergic conditions such as allergic rhinitis ― what is commonly known as a “sensitive nose” ― eczema, or food allergies, are at greater risk of developing asthma. If a child has these allergic conditions themselves, then they are also at risk of developing asthma.

Also, certain viruses have been thought to increase the risk of asthma if the babies are infected at a very young age and have recurrent wheezing. Other risk factors for asthma are a premature birth, smoking in the household and being allergic to environmental agents such as dust mites.

Is asthma related to any other medical conditions?
Besides other allergic conditions in a child ― namely allergic rhinitis, eczema, food allergies and allergic conjunctivitis, asthma may often be triggered, or made worse, by concurrent respiratory infections.
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When do symptoms first appear?
Asthma can first appear in children of a wide range of ages. Some babies as young as several months of age may already have their first attacks of asthma when triggered by infections. At such a young age, however, it can be hard to distinguish the wheeze of asthma from wheezing due to other causes such as viral bronchiolitis, an infection-induced wheeze, and so on. Asthma can also first appear in older child, or in adulthood.

What triggers an asthma attack?
Asthma attacks (also known as exacerbations) in children can be triggered by many factors. The most common are infections, specific allergic triggers like dust-mite and pollen, and fluctuations in the environment like temperature changes. Even stress, sleep deprivation and exercise may trigger asthma.

What happens to the child during an asthma attack?
The symptoms of an asthmatic attack, or exacerbation, is due to the constriction or narrowing of the small airways in the lungs called bronchioles. Two main processes are occurring here. First, there is a constriction or contraction of the smooth muscles in the airways, which causes the airways to narrow. Very soon following the onset of the exacerbation, there is increasing inflammation in the lining of the small airways. This inflammation further causes the airway to narrow because the lining of the airways swell and produce thick mucus.

There are no foods known to cause asthma in a person who does not already have asthma.

Can diet affect the incidence of asthma attacks? Are there foods to eat more of, or foods to avoid?
Currently, there are no foods known to cause asthma in a person who does not already have asthma. However, if a child has a specific food allergy, the allergic reaction may include the triggering of the asthmatic exacerbation. What this food is varies with what the child is allergic to, but common examples are peanuts, bird’s nest, wheat, milk and eggs.

How long does an asthma attack last, and how frequently does it occur?
A very mild exacerbation of asthma may last only as long as the trigger is present, which may be a short duration as in exercise-induced asthma. Other triggers are more or less continuously in the child’s environment, like house dust mites. Very mild exacerbations may resolve without medication but often, some medication or treatment is required. The frequency of the attacks can vary from very infrequent like once a year, to frequent or even daily.
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How is asthma usually treated?
Asthma needs to be managed on two fronts. The immediate control and treatment of an attack, and long-term asthma control.

The attack is often controlled using a combination of a bronchodilator or “reliever” and an anti-inflammatory drug. Examples of bronchodilators are salbutamol (also known as albuterol in the US), formoterol and terbutaline. Drugs with an anti-inflammatory effect are often corticosteroids (or “steroids”) and are best given by inhalation to minimise side effects. Some examples commonly used in children are fluticasone and budesonide.

Long-term management of asthma in children will depend on the severity of the disease. It often requires the child’s parents to be aware of the triggers of their child’s asthma, and how to manage exacerbations. It may also require some lifestyle changes, though the ultimate goal in asthma management is for the child to have a normal and active childhood with no exacerbations. Long-term medication such as the daily use of inhaled corticosteroids or motelukast (a non-steroidal medication taken orally) may be necessary to achieve that goal.

Patients, parents and doctors need to work out an action plan for various scenarios ― a daily routine, what to do during sick days, how to manage mild exacerbations, and when to see the doctor or go to the emergency room.

When well, children should be encouraged to be active and exercise. Swimming is a particularly good activity for children with asthma.

How does a parent know they can manage the condition at home, and when their child needs to go to the hospital?
This should be part of the asthma action plan that is worked out between the patient, parents and doctors. Mild attacks are often managed at home but should be recorded, so that we have an idea of how frequently the attacks are occurring. A rough guide as to when to go to the hospital is when a child’s attack seems severe or does not seem to respond to the usual treatment.

Do kids usually outgrow asthma?
Some kids do indeed seem to outgrow their asthma, hence the term “childhood asthma”. These children have mild asthma and when older, minor exacerbations do not seem to cause them trouble ― or they might only cough and not wheeze. Some kids who seem to outgrow asthma perhaps never had asthma in the first place, and instead had virus-induced wheezing, which is a common condition in infants and toddlers.

Do you have any other tips for living with asthma?
Parents need to remember that the goal of treatment is to allow the child to have a normal and active childhood and to fully participate in all the activities they want for their child, even if that means being disciplined with the daily medication. When well, children should be encouraged to be active and exercise. Swimming is a particularly good activity for children with asthma.

Photos: iStock

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