Bronchial asthma is one of the most common chronic diseases of children and is the most common causes of school absenteeism. Although there is no cure for asthma, at this time, it can be successfully controlled. The diagnosis of asthma should not be a cause of shame. Many olympic athletes, famous leaders and others live successful lives with asthma. The incidence of childhood asthma appears to be increasing in Anguilla.

What is asthma?
Asthma is an inflammatory condition of the bronchial airways (the lungs). This inflammation causes the normal function of the airways to become excessive and over reactive, thus producing increased mucus, mucosal swelling and muscle contraction. These changes cause airway obstruction, coughing and wheezing. Childhood asthma is a disorder with genetic predispositions and has a strong allergic component.

Diagnosing childhood asthma
This can be an area of great difficulty for many health care providers. A history of wheezing has, over the years, become synonymous with the diagnosis of asthma, but there are other causes of wheezing in children besides asthma. Many children with asthma do not have wheezing. Asthma should be considered in any child presenting with any of the following:
• Persistent cough at nights, or with change of weather
• Bouts of cough, chest pain or ‘tight chest’ during or after play
• Shortness of breath or ‘tight chest’ with every cold or flu-like illness.

Common asthma triggers
Asthma triggers are conditions or things that bring on symptoms of asthma or make symptom worse. Although the triggers in children are similar to those for adults, there are certain areas that are more important to children. Common triggers in children include the following:

Infections - Children get more ‘colds’ in early life and these frequently serve to trigger an asthmatic attack.

Exercise - Exercise induced attacks are more common in children. This does not mean that children with asthma cannot do any form of exercise. Those children whose attacks are triggered by exercise should use asthma treatment prior to exercise and thus avoid an asthma attack.

Atopy - Many children are atopic and are prone to hypersensitivity to house dust mites, which live in blankets, cushions, pillows, mattresses and soft toys. Concrete homes with carpeting provide a good place for the house dust mites to live. Other triggers of childhood asthma include:
• Tobacco smoke
• Cockroaches
• Outdoor pollens and mold
• Allergens from animals with fur
• Medications-These include medications containing aspirin.
Efforts should be made to avoid or minimize exposure to these triggers of asthma.

Treatment
The key to effective childhood asthma management is the education of children and their parents about the disease. Doctors, nurses and other health care providers should be well trained about this common childhood condition and they should keep up to date on new advances in its management. Parents should be provided with correct information on asthma. Children and their parents should be taught how to use inhalers, spacers, peak-flow metres, symptoms diary and the self- management action plan.

All children with severe or moderate symptoms of asthma presenting at a health care facility should be seen immediately by a qualified health care professional. They should not be told to take a seat and wait! An acute asthmatic attack is a MEDICAL EMERGENCY and the patient should receive immediate treatment. Most medical facilities usually have a written protocol for the management of an acute asthma attack. This protocol should be known by all staff members and should be followed. A number of medications are now available for the control of bronchial asthma. Parents and children must be made aware of them.

Asthma in school
Many children frequently have asthma attacks at school. Teachers in Anguilla must be aware of all the symptoms of asthma and must know what to do if a child suddenly has an asthma attack.

Children with asthma should be permitted to use their inhalers so that they can get treatment if required at school. Children with asthma should not be stigmatized in any way. Having asthma should not interfere with a child’s performance at school. If the asthma is well managed, days lost from school would be kept at a minimum.

Prognosis
About 50-60% of children with asthma will outgrow it, and many others will notice a decrease in severity after puberty. Children whose asthma is well controlled should be able to attend school regularly and enjoy school activities. Good control also allows them to feel they are healthy like other children.

Conclusion
Asthma in children is increasing in many countries, including Anguilla. The causes of this increase are not fully known at this time. Many children are suffering with asthma and are not diagnosed accurately thus leading to poor control. Children with bronchial asthma who are diagnosed and properly managed can go on to have a successful life. New advances in the care of asthma, while not curing asthma, have allowed children to stay free of troublesome night and day symptoms and to keep physically active.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynecologist and family doctor who has over 20 years in clinical practice.

Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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