Coming Up for Air
Asthma is a common—and chronic—childhood disease, but with a proper diagnosis and successful management, it doesn't have to interfere with your child's life.

That coughing you hear from your child's bedroom at night—the sound that keeps you up wondering if you ought to call the pediatrician the next day—just might not be allergies or the lingering after-effects of a cold. As it turns out, it could be a sign of asthma, a chronic condition that inflames and narrows the airways of the lungs.

"When people think of asthma," says Arthur Atlas, MD, director of the Respiratory Center for Children at the Goryeb Children's Hospital at Overlook and Morristown Medical Centers, "the sign that most people refer to is wheezing. In children, however, a recurrent or chronic cough is more common. People can cough for lots of reasons, but in children it's frequently a sign of asthma. A cold typically lasts a week to ten days; if the signs and symptoms of a cold subside but a cough persists, this could be a sign of asthma." Other red flags, particularly in older children, include shortness of breath and exercise intolerance.

It is estimated that 8 to 12 percent of the pediatric population has some degree of the disease (figures are higher in urban areas). Children most at risk are those who were born prematurely, were exposed to cigarette smoke in utero or after birth, or who have a parent with asthma or allergies. Children with the skin condition eczema also tend to have a higher frequency of the disease. "If a child has eczema," Atlas explains, "that's a suggestion of an allergic tendency, and there is often an allergic component to asthma."

In Control

To diagnose asthma, Atlas suggests that parents turn to their child's pediatrician or family physician first. "From there," he says, "depending on the child's diagnosis and therapy, follow-up with a pulmonologist may be necessary, but for mild cases, many kids don't need a specialist."
What children do need, regardless of the severity of their asthma, is proper disease management. "The way I think about asthma is that it is an illness associated with increased sensitivity of the lungs, which does not always cause symptoms or need treatment," explains Atlas. "You treat the disease as it needs to be treated; the goal is to administer the least amount of medicine to achieve the best health. If a child has symptoms, it's usually because he or she is being undertreated.

"The way we treat asthma today is totally different than it was years ago," he continues. "Formerly, children were treated for acute exacerbations: They would go to the E.R., receive treatment, and be placed on medication for two weeks; then, when everything was better, the medication was stopped. Except in extreme cases, that was the standard. Now, the whole thinking has changed. We know that asthma is chronic, so rather than treat asthma acutely, we try to be as proactive as possible to prevent acute exacerbations of the disease. Now, it's more common for kids to be on a daily controller medication, at least during their higher-risk times of year, and have acute care—or "rescue" medications—added for an acute exacerbation. When risks are lower, we can back away from treatment and sometimes we don't have to treat at all."

Staying on Top of the Situation

It is essential to periodically reevaluate a child's condition, based on changes in age and lifestyle. "In young children, the most common trigger is a viral infection in the upper respiratory tract," he says. "As a child gets older, symptoms frequently change. Around second grade, the child usually has built up a better tolerance against these infections and new triggers need to be considered." It's at this time that allergic issues and exercise start to become greater factors.

It's also important to evaluate a child's ability to use their medications properly, especially in the case of inhaled medications. "A goal of therapy is to make sure the device that delivers medication is the right device for the child," Atlas says. "If the child is taking the medication but it's not getting into the lungs, it's not valuable. The medication needs to get down into the airways for it to be effective. This needs to be reviewed. As a child gets older and as his or her lifestyle changes, it's important to ask, 'Is there a more effective way to give adequate medication less frequently to manage results?' " Factors like a child's age, developmental maturity, and severity of illness, as well as parental involvement, all help to determine that child's medication regimen.

Atlas stresses that the key to managing a child with asthma is proper education about symptoms, triggers, and treatments. "Education is so important because asthma is a disease in flux," he says. "There are times when a child with asthma needs medicine daily or requires acute management; there may be times when that same child does not need any medicine at all. If a parent doesn't understand this, a child can be undertreated or over-treated, and that's never our goal. We want every child with asthma to be treated appropriately."

For a referral to a pediatric pulmonologist at the Respiratory Center for Children at Goryeb Children's Center, call (908) 522-5706.