Living With Paediatric Asthma

A number of different management techniques can help in controlling asthma in children. The aim of these management techniques is to enable the child to have a “normal life”, free of asthma symptoms. This includes enabling the child to sleep without any asthmatic related disruptions, to attend their place of education, to grow and develop as “normal”, and to be able to participate in school activities (particularly sports). They also aim to prevent the number of acute asthma attacks (a sudden attack which can occur randomly), reduce the need for hospitalization and to avoid medication side effects [1].

Post-attack reviews are also crucial to prevent future asthmatic attacks from occurring. Post-attack reviews are used to check that treatment is working, to help understand causes of worsening asthma control and to prevent it from happening again [2]. Asthma attacks should be viewed as never event. A never event is defined by the NHS as “serious incidents that are wholly preventable” because suitable guidance and safety recommendations are already in place to remedy the problem. If postattack reviews are not practiced, or treatment has not been adjusted to fit the patient’s needs, there is an increased chance of a potentially life threatening attack occurring [3].

Smoking around children, whether they are asthmatic or non-asthmatic, is not advisable. Even exposure to light cigarette smoking (10 or less cigarettes per day) can cause asthmatic children to experience nocturnal symptoms [4]. Having asthmatic symptoms at night may cause the child to become chronically tired during the daytime, leading to emotional outbursts or decreased performance and concentration in their day-to-day life and at school.

What can trigger asthma symptoms?

A large proportion of children with asthma are sensitive to allergens, which is often referred to as atopic asthma. Those with severe asthma often experience sensitivity towards a wider range of allergens to a higher degree, compared to those with mild asthma [5]. Reducing exposure to the allergens to which a child reacts negatively will be highly beneficial for their health [6].

Asthma symptoms can also be triggered by viral upper respiratory infections (URI), physical activity, and changes in the weather [7].

If any child, asthmatic or non-asthmatic, is considered medically obese or overweight, it is advisable that they lose weight, to prevent other health problems from occurring, such as type 2 diabetes, sleep apnea, and heart disease [8]. This advice should be taken even more strictly if the child is diagnosed with asthma or showing asthmatic symptoms. An obese child has a heightened risk of an asthma diagnosis due to the increased weight on their chest wall, which can lead to breathing at lower lung volumes [9].

Is it possible to overuse an inhaler?

Due to the lack of education regarding how frequent asthma patients need to use their inhalers, inhaler overuse appears to be a common problem [10]. This is particularly noticeable with the reliever inhaler (blue), which is intended to be used when immediate relief is needed, such as in the event of an asthma attack [10]. Many patients tend to overuse their inhaler when an asthma attack is occuring because they are in a state of panic and are eager for their symptoms to disappear.

Evidence shows that patients who overuse albuterol, a common drug used in asthma inhalers, are twice as likely to develop depression, compared to those patients who take the medically advised dosage, when appropriate [4]. This evidence further highlights the risk of overusing an inhaler, and clinicians should consider depression in patients who overuse albuterol, particularly if they have mild asthma [11].

What is happening during an asthma attack?

During an asthma attack, the muscle wall contracts and the lining of the walls of the airway become swollen and inflamed [12]. This then causes narrowing on the airways, which is further aggravated by secretions from the mucus membrane, which block the smaller airways [12]. All these factors lead to an obstruction in airflow, which means that the child will have to put more effort into moving the air in and out of their lungs [12]. If the child is experiencing this, they will start to wheeze and feel breathlessness [12].

To prevent hospitalization, it is important that both the parents and child educate themselves on the condition, potential follow-up care, and the importance of identifying known disease triggers and avoiding/monitoring them as much as possible [13].

Emotional drain guilt

Parents/ caregivers should not feel guilty for feeling emotional or drained as a result of their child’s asthma. With symptoms of paediatric asthma leading to sleepless nights, there is no doubt that this could cause stress for both the patient and the parent/caregiver, leading to a lower quality of life, and higher workplace absences [8,9]. Learning how to better control asthma symptoms can help relieve these symptoms, leading to a higher quality of life for both the patient and the caregiver [14].

What are the next steps in terms of researching paediatric asthma?

The COVID-19 pandemic has accelerated technological innovation in healthcare. As a result, home monitoring of lung function, self-administration of biologic medication, and remote consultations have become more widely utilized. Remote physical examinations are also now possible with devices that enable a clinician to perform remote auscultation of the lungs [11]. This suggests that consultations from home for asthma management may become more prevalent in the future.

Advances in areas of smartphone technology can also help in improving the management of asthma. Smartphone applications can be used to provide medication reminders, help identify attack triggers, enable tracking of medication usage and monitor lung function [15]. Applications can also provide educational content which is important because the more educated a patient is about asthma, the more control they have over their symptoms and their disease.

References:

1. Potter PC. (2010). Current guidelines for the management of asthma in young children. Allergy Asthma Immunol Res.2(1):1–13.
2. Martin, J., Townshend, J., & Brodlie, M. (2022). Diagnosis and management of asthma in children. BMJ Paediatrics Open, 6(1).
3. Jones, H., Lawton, A., & Gupta, A. (2022). Asthma attacks in children — challenges and opportunities. Indian Journal of Pediatrics, 89(4), 373–377.
4. Stapleton, M., Howard-Thompson, A., George, C., Hoover, R. M., & Self, T. H. (2011). Smoking and asthma. The Journal of the American Board of Family Medicine, 24(3), 313–322.
5. Gelfand, E. W. (2009). Pediatric asthma: a different disease. Proceedings of the American Thoracic Society, 6(3), 278–282.
6. Potter, P. C. (2010). Current guidelines for the management of asthma in young children. Allergy, Asthma & Immunology Research, 2(1), 1–13.
7. Devonshire, A. L., & Kumar, R. (2019). Pediatric asthma: Principles and treatment. In Allergy & Asthma Proceedings, 40 . (6), 389–392.
8. Bray, G. A., Kim, K. K., Wilding, J. P. H., & World Obesity Federation. (2017). Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obesity reviews, 18(7), 715–723.
9. Ahmadizar, F., Vijverberg, S. J., Arets, H. G., de Boer, A., Lang, J. E., Kattan, M., … & Maitland-van der Zee, A. H. (2016). Childhood obesity in relation to poor asthma control and exacerbation: a meta-analysis. European Respiratory Journal, 48(4), 1063–1073.
10. Hadad R, Likhtenshtein D, Maimon N, Simon-Tuval T. (2020) Overuse of reliever inhalers and associated healthcare utilization of asthma patients. Sci Rep. 10(1).19155.
11. Gerald, J. K., Carr, T. F., Wei, C. Y., Holbrook, J. T., & Gerald, L. B. (2015). Albuterol overuse: a marker of psychological distress?. The Journal of Allergy and Clinical Immunology: In Practice, 3(6), 957–962.
12. Health and Safety Executive. Your lungs-an asthma attack. https://www.hse.gov.uk/asthma/lungs.htm
13. Flores, G., Abreu, M., Tomany-Korman, S., & Meurer, J. (2005). Keeping children with asthma out of hospitals: parents’ and physicians’ perspectives on how pediatric asthma hospitalizations can be prevented. Pediatrics, 116(4), 957–965.
14. McQuaid, E. L., Walders, N., Kopel, S. J., Fritz, G. K., & Klinnert, M. D. (2005). Pediatric asthma management in the family context: The family asthma management system scale. Journal of pediatric psychology, 30(6), 492–502.
15. Almarshad MA, Islam MS, Al-Ahmadi S, BaHammam AS. (2022). Diagnostic Features and Potential Applications of PPG Signal in Healthcare: A Systematic Review. Healthcare (Basel). 10(3):547.