Asthma

Chronic asthma is a chronic inflammatory lung disease that causes airways to tighten and narrow, causing difficulty in breathing. It is an chronic allergic condition which often begins in early childhood.

When the airways become irritated, they become narrower obstructing air from moving in and out easily. Exposure to allergies, viral infections causing cough and cold, smoke, dust and pollution causes the mucous membranes in the small branches of the sensitive airways (bronchi) to swell and fill with mucus which makes breathing a struggle. Asthma attacks can also be triggered by hard physical exertion (exercise induced asthma) and can also be related to genetics. This can cause, coughing, chest tightness, shortness of breath and produces a wheezing sound when breathing out. 

The symptoms, frequency, severity and duration of an asthma episode vary from child to child. Severity of the attack depends of the extent to which bronchi are narrowed. In a severe attack, the child may be so breathless that he may not be able to speak and may show a bluish colour of the skin and mucus membranes due to lack of oxygen in the blood. In such cases emergency medical care is needed. 

Symptoms in children 

• Wheezing sound when breathing out
• Coughing, wheezing or breathlessness.
• Prolonged coughing, not because of a cold, especially at night.
• Generally feeling unwell.
• Recurrent colds from which it takes a long time to recover.
• Chest tightness
• Increase in pulse rate.

Diagnosis
If any of the symptoms persist, you should consult a medical practitioner whether your child has asthma. The diagnosis of asthma involves checking whether you have a family history of asthma, medical history of hay fever, eczema, itchy eyes, allergies, frequent colds, nasal stuffiness and persistent cough etc. Physical examination involves examination of the nasal passages and listening to the lungs. 

Several tests has to be done to find out the exact cause of asthma. A chest X-ray, blood test and sputum test are usually done along with a number of other tests for evaluating the airway responsiveness and allergies. The airway responsiveness tests include Spirometry, exercise challenge test and methacholine inhalation tests etc and allergy prick skin test to confirm the presence or absence of allergies.  Other possible causes of shortness of breath, wheeze, cough and chest tightness must be investigated in order to rule these out heart disease, other lung conditions etc.

Spirometry, a breathing test which measures the amount and rate at which air can pass through airways is a very dependable method of making a diagnosis. But with children under the age of five years, this test is not usually done because of the effort and cooperation required.

Treatment
If asthma is triggered by allergy to a particular substance, one should take measures to avoid such allergens. Treatment includes medications and drugs which are mostly inhaled. Drugs mainly belong to two groups (a) bronchodilators which are used to dilate the airways like Beta 2 agonists such as  salbutamol, terbutaline (short acting drugs) and longer acting drug like salmeterol etc. and Anticholinergics such as Theophylline, not commonly used in children. These drugs are quick acting and relieve the symptoms of wheezing, coughing and breathlessness (b) anti-inflammatory drugs such as Corticosteroids and sodium cromoglicate which is a good first-line preventative treatment in children.