#ChildhoodAsthma and wheezing a 🧵
Childhood atopic asthma (cough, wheezing, breathlessness) is all too common
Stigma attached is doubly so, myths associated with inhalers and spacers is strongly ingrained, perpetuated acquiesced even by a proportion of paediatricians
What happens in asthma?
Due to a viral or environmental trigger (pollen etc) the child develops reaction in his airways: smaller breathing tubes (bronchioles)in lungs constrict (muscle around them tighten) + smooth lining of these tubes become swollen and produce sticky mucus
What are the symptoms of #asthma in a child?
Tightness of chest, fast breathing, shortness of breath, severe fatigue with cough when severe
Milder symptoms could be troublesome cough in sleep, on running around or a cough that follows common cold and doesn’t get better easily
How is asthma diagnosed?
Diagnosis is by a good history, examination and sometimes tests : history reveals pattern, examination tells us if there is wheeze (squeaky noises on listening to chest) In older kids we do lung function tests to quantify/monitor response to treatment
What are the common concerns?
Oh! He will get addicted to inhalers
My friend says it is very bad for kids
Can you treat without inhalers doctor?
I don’t want to give my child steroid medication
He’s taking homeopathy/ Ayurvedic meds, exercising - I don’t want to use inhalers
Why is it important to treat adequately?
Most children who wheeze in early childhood eventually stop, some don’t.
But when they have symptoms it is very important to treat. It is also important to use preventer medications (which are steroid inhalers) to reduce these episodes.
Why so? Why be concerned about a bit of cough? Why use the inhaler?
You remember the two changes : muscles tightening and smooth mucosa becoming swollen - these two keep happening, in reversible way then in less reversible ways. Ultimately ‘remodelling’ these breathing tubes.
Poorly treated = costly price to pay later
We now know repeated mild and severe symptoms less than optimally treated in a growing child affects his future health
The child as a young adult is left with less than 100% efficient lungs because of remodelling
Are steroid inhalers safe?
They are, when used in correct way, in the right dose for the right duration. Long term high doses may affect height but are not prescribed in those quantities. Suboptimal control on the other hand definitely affects child’s growth and future health
Aren’t nebulisers better?
Nebulisers are great when you are very unwell and maybe need oxygen. Inhalers use a fraction of the dose, most of it delivered right into lungs, are completely portable. So no, nebulisers are not so great. But somehow they have ducked the stigma!
Aren’t levolin salbutamol, terbutaline syrups better?
No where but in India we use this,against all guidelines
Same medications via inhalers in a small dose, directly act on the lungs Syrups pack x10 more, and have major side effects like fast heart rate, tremors and anxiety
#childhoodAsthma is wished away, stigmatised, poorly diagnosed, inadequately managed - all because of a spasm of stigma, unfounded anxiety and failure on our part to educate parents.
A child with Asthma can lead a fully healthy and normal life with proper treatment.
*End*
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