Childhood Asthma Expert FAQs
Good AdviceWe visit with Harold J. Farber, M.D., a pediatric pulmonary and asthma specialist at Texas Children's Hospital in Houston and coauthor of Control Your Child's Asthma
Q: Why has the incidence of pediatric asthma been going up?
Dr. Farber: While we don't fully understand why rates are increasing, we believe that it has a lot to do with the Western lifestyle. We know that a diet rich in processed foods isn't good. Children who eat a diet rich in oily fish, such as salmon, mackerel and herring, and lots of fresh fruits and vegetablesespecially those high in vitamin Chave fewer problems with asthma. Children do not get the same benefits as adults from supplements, so parents should focus on serving these nutritious whole foods.
Some data also suggest that not getting enough exposure to bacteria and viruses as young children may influence the development of childhood asthma. As parents, we work on trying to prevent kids from getting these infections when they are very young, but ironically, this could be adversely affecting the development of their immune systems.
Air quality also plays a role. Air pollution increases a child's chance of developing asthma. It can also trigger an attack. Studies show that there are higher rates of asthma in children who spend more time outside in high-ozone areas of Los Angeles and other polluted cities. And there are more breathing problems among kids who live or go to school near highways.
Q: What happens to a child during an asthma attack?
Dr. Farber: In asthma, the small breathing tubes in the lungs become more sensitive. When that occurs, muscles wrapped around the tubes squeeze and tighten. The breathing tubes get swollen and inflamed and make extra mucus. Twenty years ago, we thought the problem was that these muscles were tightening down, and we used medications to relax them. But now we realize that if we can use other medications to prevent the inflammation from occurring, we can prevent asthma flare-ups. That is why asthma treatment now focuses on long-term control of inflammation. Relaxing the muscles surrounding breathing tubes just gives temporary relief of symptoms.
Q: What symptoms should parents be aware of?
Dr. Farber: Pay attention to your child's breathing. A lot of people think that if they don't hear wheezing, there isn't a problem. But sometimes a child is not moving enough air to wheeze, and that could be more worrisome. Very hard or fast breathing, sucking in the stomach or ribs in order to breathe, or breathing so hard that walking or speaking is impossible signals a medical emergency. Call 911.
Also, if a child wakes up from sleep because of asthma, needs an inhaler to relieve symptoms more than twice a week or has asthma that limits exercise or activities, his asthma is not under good control. Talk to your child's doctor. Good asthma control can prevent severe attacks.
Q: What situations and substances may trigger attacks?
Dr. Farber: Parents need to pay careful attention to what their child is breathingboth inside the home and outdoors. Common triggers include allergens such as pet dander, pollen, mold and dust, but also weather changes (especially chilly temperatures) and viral infections (colds and flu). If their asthma is not well controlled, some children can have asthma attacks when they exercise or get overexcited.
Everyone knows, or should know, that cigarette smoke is a cause and trigger of pediatric asthma, but many parents don't realize how much smoke their children are exposed to. Parents may forget that smoke from the fireplace and from incense is smoke too. That smoke may not have nicotine, but it has many of the same irritants that can trigger asthma.
The chemicals in insecticides and household products can also trigger an attack. I have patients whose parents can't understand why their child is having problems, saying they keep their homes clean and allergen-free. Yet they do so by using antibacterial sprays, chemical air fresheners and harsh cleaners that could be triggering attacks. Keep your home as chemical-free as possible.
Q: Aside from processed foods, does diet play any role in aggravating asthma in kids?
Dr. Farber.: Typically, asthma is caused by what is inhaled, so if a child is eating a healthy diet, food is usually not a trigger. But if different organ systems are affectedfor instance, a child has asthma and also develops eczemathen in those cases, food-allergy suspects include milk, eggs, soy, peanuts and nuts.
Q: What type of doctor should you choose to treat pediatric asthma?
Dr. Farber: A good doctor will help a parent find the things that trigger their child's asthma. He or she will make sure that both parent and child understand what the medicines do and how to use them correctly. Most important, a good doctor will ensure that a child's asthma gets under control. That means no asthma symptomsno cough, no wheeze, no chest tightnessand no emergency room visits. The child can run and play as hard as he or she wants to. However, if your pediatrician is not meeting your child's needs, you should look for a specialist such as a pediatric pulmonologist or a pediatric allergist.
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Managing Pediatric Asthma: Take all the right steps!
The sooner you get medical treatment for your child's asthma, the better the chances of minimizing discomfort and controlling episodes. To help you start a productive dialogue with your child’s health care provider, here are some suggestions.
Get a Diagnosis
If you suspect your child may have respiratory or allergy problems:
- Pay attention to your child's symptoms. Don't dismiss chronic sniffles and coughing as simply a "kindergarten cold."
- Keep a wheeze and sneeze journal. Jot down times when your child coughs, wheezes and/or becomes fatigued for no apparent reason. Also note temperature, activities, location and date when those symptoms appear. List what you think may be triggers that cause breathing problems.
- Make an appointment with your pediatrician. When there, discuss the need to see an allergist or a pulmonologist (a lung specialist).
Make a plan
When you meet with your child's asthma doctor, you should create an Asthma Action Plan that outlines the medical and lifestyle routines your child needs to follow.
- Let your child help finalize the plan and put it into action. A child's involvement increases compliance and eases anxiety.
- Use the plan to explain asthma management to your child's caregivers and teachers.
- If the plan doesn't work well for you or your child, talk to the doctor immediately so you can adjust it as needed and still protect your child from asthma attacks.