Wheezing is a musical sound produced by the narrowing of the air passage inside the chest cavity (lower airways) from obstruction of outside of the wall, in the wall or inside the lumen.
There are multiple conditions that cause obstruction like:
By far, the most common causes for acute wheezing in children under 2 years for age is bronchilitis. In older children, asthma is responsible for most acute episodes.
No doubt, common diseases are more common. However your doctor is the right person to identify the most possible cause by good story from the parents(86%), detailed examination(6%) and specific investigations(8%). Depending on the suspicion of your doctor's advice, proper investigations and treatment is based on the diagnosis.
Asthma is a common condition. Children suffer more than adults and more common in boys than in girls. From various stimuli the wind pipes gets narrowed from construction of the muscles around the wind pipes(inflammation) and excess phelgm collection
Asthma occurs in people with sensitive wind pipes which may be inherited from symptom-free relatives
Emotional factors as a clause, is much less in children.
It is important that parents and child give the doctors as accurate an history as possible about the onset, progression, and sequence of events
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Examination
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Tests
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* In bigger children if
facilities are available
** When some complications or other diseases are
suspected
*** If planned for immunotherapy
70-75% of children experience mild episodic asthma. 20-25% experiences persistent asthma. 1-4% have persistent severe asthma. About 30% of children outgrow asthma attacks by age of 14 yrs.
Some families are more allergic than others. In such families there is greater frequency of eczema, hay fever and asthma. So the tendency to develop asthma, in part, is inherited and is mostly modified by the urbanisation, environment and pollution, and cigarette smoking etc.
Recurrent cough, cough which is more at night time or a cough lasting more than 10 days after a bout of cold, or coughing while crying, laughing can be a symptom of asthma. Indeed it may be the only symptom. Your doctor will arrange for a trial of bronchodilator medicines if facilities are available, accessible or affordable. He/she may arrange for pulmonary function tests.
In our country only 3-4% of houses in cities have pets. 90% of the time it is dog. So they are not the common cause of asthma. However children can develop allergy to the saliva, dander of pets, if the pets stay for longer periods with them. It is preferable not to acquire pets, if you do not have one. If you have already one, try to keep the pet outside and observe. Wash the pets once a week and it should be remembered that it takes 4-6 months of time after removing pets to find some improvement in asthma in truly allergic children.
The common of an asthma attack is a viral infection in children. Parents often observe that their child develops cold with or without fever which follows as cough and wheeze in few hours to days. Usually more common in July to October months, the virus infections stimulate the hyper sensitive airways to narrow and produce symptoms.
Usually no. Since viral infections are the common cause for asthma episodes in young children unlike older children when allergens are predominant factors for asthma attacks. None of these causes need antibiotics. However if your doctor suspects secondary infection in lungs, ears or sinuses he can choose specific antibiotics.
You should allow your child to participate in sports. Vigorous running will most likely induce wheezing in children with exercise induced asthma (ETA). Jogging cycling are less likely to do so. Swimming is the best tolerated exercise. Children with exercise induced asthma should have an inhalation from a puffer 15 minutes before competitive sports, or oral medicine (salbutamol, terbutaline) 1 hour before exercise.
Carpet is not preferred since it increases the population of dust mites and produces sensitivity for asthma in children after 2 years of age. If one want to have carpet, please cover it with a clean polythene sheet completely with skirting.font
Air conditioner helps people with allergy to pollens and molds but the humidity should be regulated between 250F to 500Filters should be cleaned frequently to avoid water borne infections from spray.
Usually antihistaminics are not needed in asthma treatment. If there is associated allergic rhinitis, hay fever then antihistaminics can be added with asthma medicines.
There are number of medications available to improve asthma. These drugs belong to two main types :
| Adrenaline injection | Chromolyn glycate inhaler |
| Aminophyline, salbutamol | Steroids-beclamethasone |
| Terbutaline, either oral | Budesonide (inhaler) |
| or inhalation | Prednisolone (oral) |
Your doctor would select drugs based on various factors including severity.
Your doctor is equipped to assess the severity by clinical features, lung function. Most of them are mild with occassional symptoms, in moderate asthma, children wakeup at night with cough or wheezing, which needs hospital visits often.
A peak flow meter is easy to use. Breathe in as deeply as you can, put the mouth piece in your mouth, close your lips tightly around it, and blow out as hard and as fast as you can. Watch the gauge is moving and record the reading three times and take the best possible reading and compare with normal values.
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Negative ion
generators are being suggested by some one. Can they be helpful ?
It is attractive to think that the air we breathe in our homes can be purified. At present there is no good evidence that negative ion generators are useful in the management of asthma. They are expensive however one can borrow or rent them for a while to see if it works before buying. |
Cigarette smoke is a common trigger factor for asthma attacks, including passive smoking. Smoking has many risks. It is strongly objectionable to smoke.
Many household odours can induce asthma, cooking odours, air fresheners, insect sprays, perfumes, soaps, smoke, moth balls including mosquito coil burning.
Nearly 20% of parents of asthmatic children attribute various foods as a cause for asthma. However it is very difficult to prove except by elimination of the diet which was suspected during asthma attacks like grapes, banana, guava, critus, ice cream, chocolate, fried food, tomato, etc.
Please avoid carpets in the bed room. Avoid stuffed toys, cover the bed and pillows with airtight polythene covers. Sun dry the mattress, blankets and pillows once a week.
During episodes of increased air pollution, avoid unnecessary physical activity and minimise outdoor exposure, temporary removal of the patients from the excessively polluted area is advisable.
This is unlikely. However, if one notices that your inhaler is having less effect, this may mean two things - one thing inhaler is getting empty, secondly that your asthma is getting worse & you should see your doctor.
A bowel is filled with water and the position the canister takes in the water indicates the amount remaining. Full canister-Sinks to the bottom horizontally, 3/4th canister-vertically sinks with the tip to the bottom of the bowel, 1/2 full canister-portion of the bottom of the canister out of the surface of water vertically, 1/4th canister-projects out of surface of water slantingly. Empty canister-floats on the surface of water horizontally.
Inhaled corticosteroids are quite safe since we are using only 10% of oral dose. However some time one can experience hoarseness, or fungal infection in the mouth which can be prevented by mouth washing after the use of metered dose inhaler or using a spacer. Using higher dose of inhaler in some cases may produce some delay in linear growth which can be quite minimal compared to the effect of severity of asthma and your doctor is the right person to guide you in that situation.
In most cases usualy this procedure is not needed. However if all the medicines fail in controlling asthma, despite environment control one can try for specific allergen under the guidance of specialists.
Skin testing is to define the cause of the patient's allergy (pollen,cat,dog,or house dust). These tests are not entirely reliable and do not always match up with the patients allergy. Occasionally one can get severe allergic reactions with currently available antigens. Skin tests are uncommonly done in children and should be restricted to very specific situations.
No, but patient has to be taught the correct method and often rectified and they do require a little practice.
Infants and young children often have difficulty in co-ordinating the use of inhalers. A spacer is a device which can ben attached to an inhaler. Often a face mask can also be attached to the spacer.
Age |
Recommended device |
| 0-2yrs | Nebuliser, spacer with mask,aerochamber with mask |
| 2-5yrs | Spacers, rotahaler |
| 5-8yrs | Rotahaler,spacer |
| >8 yrs | Metered dose inhaler |
Usually it does not help. Your child might develop an allergy to an newer allergens in a different cipy/place. It can add to the emotional and economic stress of the family.
It does seem to help in a number of ways in improving the muscle power and getting the child fitter, teaching the child to control his breathing in a relaxed way, and encouraging good posture to improve breathing.
Courtesy : Indian Academy of Pediatrics