Transcription:
Spotting and Treating Asthma in Children

Melanie Cole (Host): One in eleven children has asthma, according to the U.S. Centers for Disease Control. If your child is exhibiting certain symptoms, would you know what they are? Would you know the difference between seasonal allergies and asthma in your children? My guest is Dr. Lynn McDaniel, she is a board certified pediatrician at UVA Health System. Welcome to the show Dr. McDaniel. So, explain a little bit about asthma and what makes a child more likely to develop it.

Dr. Lynn McDaniel (Guest): Well, we’re not really sure what causes asthma. We do know that certainly genetics play a part. So, it can be inherited…if there is a family member that has asthma, it is more likely that a child will develop asthma. We know that the immune system plays a role. We know that environmental factors, like cigarette smoking in the home or air pollution. We also know that viral infections play a role in children developing asthma. Asthma is a disease of the airwave and the smaller airwaves of the lung can become very inflamed and clogged with mucus, making it very difficult for a child to breath.

Melanie: Let’s talk about some of the symptoms, because certainly at this time of the year, with the leaves falling and things, you know, kids develop all kinds of sniffles and coughs and little dry sounding coughs. How do we know what we are hearing, as parents, is something that we really need to take them to the doctor about and look into asthma?

Dr. McDaniel: You know, sometimes it can be very difficult to tell the difference when you’re a parent and your child has a cough and a sneeze and when they breath sometimes it does sound whistley or wheezy. I think if a parent is certainly concerned that it is something more than a cold, they should always take them to their pediatrician and have them evaluated. Some of the common signs children will have will be coughing, a lot of times, even in the evening at bedtime. Shortness of breath, they may complain that their chest feels tight, they may have trouble sleeping, because they cough. All of these things should trigger a parent worrying whether their child may have asthma or not. The other thing is a cold that seems to linger for a long period of time or a cough that seems it should have gone away if it were a typical cold – those are things a parent should look at and go “Perhaps I need to have a doctor evaluate them.”

Melanie: OK, if we take them to the doctor and they are diagnosed, this is something a little bit more chronic we’ve caught, that it kind of doesn’t go away, it’s not really the same as a cold, which comes and goes, maybe lasts a week or whatever and you’ve determined that it is asthma, what treatments are there? Because, people and parents, we are panickers of course and we worry about ongoing medications and what that’s going to do to our child at school and is it going to make them lethargic? Speak about treatments that are out there right now.

Dr. McDaniel: Absolutely. Asthma is the most common chronic disease of childhood. We see a lot of this. It’s responsible for so many office visits, so many missed days of school, so we do want to treat them appropriately. A lot of things that parents want to stay away from medications, is to eliminate any triggers. If they are allergic to dogs or they’re allergic to dust mites, do the kind of things in the household that’s important…try to eliminate the things that will trigger their asthma. Get a flu shot – great time of the year to think about that. Everybody in the household needs to be immunized because, influenza and colds can trigger them. But, when it comes to medication, it is incredibly important to understand that asthma is a chronic disease. It really does need to be treated. Your child will not become hooked or dependent on these medications, but they can help to calm down the inflammation in the lungs and allow them to be a normal kid and not be limited in their activities. One of the big things that we rely on is what we call “quick reliever medications” and those are medications like Albuterol. Generally, they are delivered in an inhaler or a puffer. They are inhaled medications. And those are important for relieving symptoms. Parents should know, that if their children are having to rely on those quick reliever medications really frequently during the week, several times during the week, then perhaps they need more…a medication that they take every day to keep their asthma symptoms down, so they don’t have to rely on that quick reliever medication. Some of those long term controller medications are things like Inhaled corticosteroids. A lot of times with parents and steroids they are like “oh no, that’s a bad thing.” But, inhaled steroids can be great. It is not the same kind of antibiotic steroids you hear about in sports, this is a medication that really calms down the inflammation of the lungs and really helps the children to be active and grow normally without being restricted by their asthma.

Melanie: So, if they are on these controller medications, the Inhaled corticosteroids and their at school, is there any restrictions? You know, back in the day, children with asthma would have to sit out from gym. We understand there is a difference between exercise induced asthma and asthma that is normal. Do they have to sit out? Is physical activity limited? Do these controller medications help them be able to partake in the physical activity at school?

Dr. McDaniel: Great question. The whole purpose of treating asthma is so it doesn’t limit them. We want them to be active, because, actually exercise in children with asthma is shown to be very helpful. We want to be able to manage their medications in such a way that they are not limited in their activities. We want them to play sports, we want them to be active in gym class. Certainly having those quick reliever medications available them at school or at play is important, so if they have an attack, but it should not limit their everyday activity.

Melanie: Dr. McDaniel, when do we turn over care of this kind of thing to our children themselves? When do we put them and say “you know what, you know what your symptoms when if you are about to have an attack and you keep that rescue inhaler with you, but, make sure you’re taking your meds when you are supposed to.” When do you begin to give them a little autonomy there?

Dr. McDaniel: A lot of it depends on the maturity of your child and whether they truly are able to sensor symptoms. Some children are much better able to go “I’m having trouble” and others are sitting there coughing and wheezing and saying “I’m fine.” A lot of it is knowing your child’s ability. Generally, we start talking about turning over some of their responsibility too them when they are around 10, 12 or 14 depending on your child. Schools will allow children, with a written note from their doctor, to carry their reliever medications with them in their backpack at school, which is really important, because getting to a nurse sometimes is difficult in larger schools. I think that teaching and coaching your children to know when and how to deliver their medications. Most children when they’re using puffers may need a spacer device attached to the puffer to help them deliver all of the medication. Some of them want to stop using that if they get to be older and teenagers, but they need to continue to use that spacer device to get all of the medication in.

Melanie: I’ve seen that spacer device and it does help the children. In the last minute and a half, tell us a little bit about the steps you’re taking at UVA to improve asthma care.

Dr. McDaniel: We have the joint commission, which is the governing body of hospitals has asked that children’s hospitals look closely at how they handle inpatient asthma. It’s very important that we do three things; that we give them reliever medications to relieve their symptoms, that we treat them with steroids and that we give them a very detailed plan when they’re discharged to help them manage that asthma at home, so they don’t need to come back. As a team of doctors and nurses and respiratory therapists, we’ve worked very hard to make sure that we are able to do those three things and for the past five quarters, UVA has been a top performer in what we call UHC, which is a university health system consortium of leading academic centers. We are very proud of all the work that everybody has done. But, more importantly, teaching our families what they need to do at home, what kinds of things they can do to stay away from triggers, to get their flu shots, so that they don’t need to come back to see us. That parents can manage and their doctors can manage their medication at home.

Melanie: That is very exciting. For you parents listening, you can work with your pediatrician at UVA to control your child’s asthma, maybe turn over just a little bit of it to your children, so they understand their symptoms, signs they might be having an asthma attack. Teach them how to use their meds properly, make sure they get all of the meds in. And work with your school system. You’re listening to UVA Health System Radio. For more information you can go to uvahealth.com, that’s uvahealth.com. This is Melanie Cole, thanks for listening…have a great day.