Transcription:
Ways to Control Asthma in Children

Evo Terra (Host):  Richmond has been designated as the most challenging place in the US to live with asthma for a number of years. But Children’s Hospital of Richmond is on a mission to help empower children and families through the You Can Control Asthma Now Program. As the CDC tells us that roughly one in twelve children in America suffer from asthma, I’ll ask Dr. Michael Schechter, Professor and Chief of the Division of Pulmonary Medicine at Children’s Hospital of Richmond at VCU about some ways to control asthma in children.

This is Healthy with VCU Health. I’m Evo Terra. Dr. Schechter, let’s start with the basics. What is asthma?

Michael Schechter, MD, MPH (Guest):  Well asthma is a condition in which there is inflammation in the bronchial tubes and because of that inflammation, there’s a tendency for the bronchial tubes to squeeze shut when exposed to certain triggers. 

Host:  I’m curious, are children at risk differently than adults? Are there certain triggers for asthma that affect children and don’t affect us adults?

Dr. Schechter:  No, the triggers are really all the same between children and adults. Viral infections are more common in children and are probably a little bit more common as a trigger to asthma, but these sorts of colds and virus infections are probably the most common triggers for asthma in adults as well as children.

Host:  So clearly you want to manage the symptoms of asthma when an attack happens but is there something, we can do beyond that, beyond just managing the symptom control?

Dr. Schechter:  Well if symptoms are only occurring once in a while, which is really the most common situation in most children with asthma; then treatment of the symptoms when they come up is usually adequate. If it only occurs for a few days every couple of months related to a cold, if the symptoms are well-controlled with medication that we call a quick relief medication or a rescue medicine which is albuterol; then the use of these medicines as needed is really all that is necessary. In children who have symptoms that are present more frequently, particularly when they don’t have colds or in children who have symptoms that are very severe when they do get sick; then there are other things that are appropriate to do to try and get better control. 

On the one hand, that involves the use of medications on a regular basis to help to reduce the airway inflammation. And on the other hand, there are some environmental sorts of precautions that people can take. Certainly avoiding any contact with cigarette smoke or any other airway irritants like that is a good idea. And for people who have a lot of allergies; then trying to reduce exposure to the things that they are allergic to is also going to be helpful. 

Host:  Earlier you mentioned some medications and my wife has asthma and I have a grandson with asthma as well and I know they both carry rescue inhalers with them. But that’s not all we can do these days, right?

Dr. Schechter:  Right so as I said, the rescue inhalers are there for when you have problems and for those who only need to use them once in a while, once a week or less frequently than that; then that’s probably all they need. But for people who need to use them frequently or as I said, for those who may have more severe attacks when they do get sick; then there are some other medications that we call controller medicines that reduce the inflammation in the bronchial tubes and those are very effective. Those medications for people who are having frequent symptoms are a really good way of controlling them. I think that this is really an important point because there are a lot of people who think that for their children who tend to have difficulty whenever they run around; that their only recourse is to just keep them quietly sitting in the corner and not letting them run around. 

These medications that we are talking about would really allow the vast majority of people with even fairly severe asthma to be able to live normal lives as long as they are taking their medication regularly. 

Host:  So, with these controller medications people can lead active and healthy lives. Would you go so far as to say they will cure asthma?

Dr. Schechter:  The medications don’t cure asthma; they control it and that’s an important distinction. There are many children who do outgrow asthma as they get older. That’s not something that we can promise but certainly not uncommon for children who have difficulty say in elementary school to have lesser problems as they get into middle school and high school. There are some of course, who do continue to have problems as they get into adulthood and some people don’t have asthma during their childhood but develop it in their adulthood. So, there’s a lot of different variations in the course of the disease. 

Host:  In a moment, I want to ask you about your You Can Program but before I do that, maybe you could give us three tips for kids, children that have asthma. What top three tips would you give to caregivers of kids with asthma?

Dr. Schechter:  Well I think that the number one tip is to have expectations that your child will be able to do whatever his or her friends are doing and if that’s not the case, then it’s important to seek out medical care from somebody who has expertise in asthma and who can provide you with the treatments that are necessary. I think that’s really the most important thing to keep in mind. The use of these chronic medications if they are prescribed, is important. They work most effectively if they are used on a regular basis and so for many children the medicines will start to work, people will then get a little bit lax in making sure that their children are taking them and then the symptoms start to come back. So, that’s really important also. 

And then finally, the avoidance of obvious triggers is really an important component of asthma care. You can’t really avoid getting colds and we don’t want to put our children in a bubble just to make sure that they never catch a cold. But certainly cigarette smoke exposure is an important thing to avoid. It’s important to avoid dust and mold in particular. These are very common things that children will be allergic to and they are present inside the house. So, being aware of that is an important part. If there are pets in the house, children aren’t always allergic to them but having some knowledge about what they are allergic to again is important. 

Host:  Very helpful. Let’s transition and talk about your You Can Program. What is it that makes it so unique?

Dr. Schechter:  Well the You Can Program is something that we put together in response to the difficulties that many minority children in the city of Richmond have with asthma. And this is something that is a problem throughout the US that there are many intercity minority children in particular, who have very difficult times with asthma. And it’s related to housing conditions, it’s related to a number of what we call the social determinants of health and these things all combine to cause these children to have much higher likelihood of hospitalizations, emergency department use and really severe disease. 

And so this a program that was put together with support from the Children’s Hospital Foundation to enable us to bring in social workers, to bring in a nurse program coordinator that would allow us to focus on providing good medical care to these children but also do that in the context of these social determinants and help them with some of the other stressors that the families are dealing with that make it more difficult for them to control their asthma. 

So, we’ve been fairly successful in this program in terms of reductions in the emergency room and hospital use, reduction in missing school days and work days on the part of the parents and overall improving quality of life for the children. 

Host:  And I think that last part is the most important one. Thank you for your information doctor. That’s Dr. Michael Schechter, Professor and Chief of the Division of Pulmonary Medicine at Children’s Hospital of Richmond at VCU. To listen to other episodes of VCU Health, visit www.vcuhealth.org/podcasts. This has been Healthy with VCU Health. And I am Evo Terra. Thanks for listening.