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A Pathway to Better Pediatric Asthma Management

Author: Katherine Caldwell, MD

Specialty: Pediatric Hospitalist

Posted: June 2019

There are currently more than 6.2 million children who have pediatric or childhood asthma. Asthma is a chronic condition in which the airways in your lungs become swollen or inflamed and produce extra mucus, which affects your ability to move air in and out of your lungs. In children, it’s the leading cause of hospitalization and missed school days.

While pediatric asthma has no known cure, proper management can help control flare-ups as well as mitigate and reduce damage to your child’s growing lungs.

Signs and Symptoms

There’s no one way to experience asthma. The number and severity of symptoms may vary from child to child, or even from one attack to the next. Additionally, while asthma isn’t necessarily different in children versus adults, symptoms can get better or worse as your child ages. In fact, it’s not unheard of for asthmatic symptoms to completely disappear by adulthood.

Some typical signs of asthma in children include:

  • Chest tightness or pressure
  • Wheezing, particularly when exhaling
  • Shortness of breath
  • Coughing that worsens with a cold or the flu
  • Coughing or wheezing at night
  • Prolonged recovery from respiratory infection
  • Difficulty breathing when playing or exercising

Causes and Triggers

One of the key elements in managing your child’s asthma is knowing what triggers cause flare-ups and doing what you can to prevent or limit exposure to them.

Common asthma triggers include:

  • Viruses – colds, flu, etc.
  • Allergens – animal dander
  • Dust mites
  • Cockroaches
  • Indoor mold
  • Pollen and outdoor mold
  • Irritants – tobacco smoke
  • Irritants – smoke, strong odors, and sprays

Things that make asthma symptoms worse include:

  • Vacuum cleaning
  • Sulfites in foods and beverages
  • Cold air
  • Other medicines like cold medicines, aspirin, vitamins and other supplements as well as nonselective beta-blockers (including those in eye drops).
  • Stress

While incredibly common, the exact cause of asthma is still largely unknown. Some factors that are thought to affect one’s predisposition for the disease include having parents with asthma or allergies, a history of respiratory infections in infancy, and exposure to environmental triggers like air pollution and secondhand cigarette smoke. While the dense smoke of wildfires, such as the Camp Fire of 2018, affect those who already have asthma, it’s unknown how exposure will impact the instances of pediatric asthma in the long term.

When to Seek Medical Attention

In children, unmanaged asthma can quickly lead to a medical emergency. If you suspect asthma, it’s important to see your doctor to confirm a diagnosis and begin a management program. Some giveaways that may indicate your child has asthma include:

  • Chronic cough or coughing fits caused by physical activity
  • Episodes of bronchitis or pneumonia
  • Complaints of chest tightness or “feeling funny”
  • Wheezing or whistling sounds when breathing

Even with proper management, asthma attacks may be severe enough to warrant an emergency department visit. Regardless of diagnosis, seek immediate medical attention if your child experiences any of the following:

  • Has to stop to catch their breath while doing nonstrenuous activities like talking or coloring
  • Unable to breathe with their chest; using abdominal muscles to breathe
  • Visible difficulty breathing; flaring nostrils

Advances in Asthma Care

Because of its prevalence and potential for long-term lung damage, pediatric asthma is very much a public health issue. In fact, our most recent Community Needs Assessment identified it as one of the most pressing public health needs facing the Washington Township Health Care District.

Since 2018, Washington Hospital has taken part in the Pathways to Improve Pediatric Asthma Care (PIPA) study, a collaborative study between UCSF and the American Academy of Pediatrics. The goal of implementing this clinical pathway, or care roadmap, is to standardize processes, improve quality of care, and give our youngest asthma patients the best possible outcomes.

To achieve this, we created a multidisciplinary team that focused on improving our care of asthma patients ages 2 to 17. In addition to training hospital staff on asthma response protocols, the program seeks to educate patients, parents, and the public on pediatric asthma; proper asthma management; and limiting exposure to common triggers like secondhand smoke.

It’s our hope that greater public awareness of the dangers of asthma and continued evidence-based improvements to our own asthma protocols will lead to continued success in the treatment of our youngest asthma patients. If you suspect your child has asthma, I encourage you to speak to your primary care provider. With their guidance, you can learn to manage your child’s illness by identifying triggers, create a home and school response action plan, and reduce the impact of this illness on your child’s health and happiness.