Treatment of childhood asthma

MBBS(Ceylon), DCH(Ceylon), DCH(England), MD(Paediatrics), FRCP(Edinburgh), FRCP(London), FRCPCH(United Kingdom), FSLCPaed, FCCP, FCGP(Sri Lanka) Consultant Paediatrician

Asthma is an inflammatory disorder of the airways characterised by narrowing of the air tubes brought on by swelling of the lining of the airway, contraction of the muscles of the airways and increased secretion of mucus or "phlegm". In the case of children, asthma is such a variable disorder that there are many considerations that need to be gauged when one looks at the treatment options that could be used. There is a very wide spectrum of clinical presentation of asthma ranging from mild infrequent attacks through moderately severe and frequent episodes to acute severe life-threatening events. Careful assessment is essential before tangible decisions are made regarding further management and the use of certain medications.

One component of treatment is the management of an acute attack. There are several drugs which are so very useful in controlling an acute episode but judicious decisions have to be made regarding their use. Initial assessment of the severity of the attack is the determining factor for the selection of drugs. This initial evaluation is used to classify the episode as a mild attack, a moderately severe attack or an acute severe attack. The last could be so severe that the presence of certain features would further categorise it as a life-threatening attack. This is a harbinger of death and urgent intensive treatment is absolutely essential to save life. All these assessments need to be done by an experienced doctor using features of the history of the illness, its progression, past history and the findings on clinical examination.

The first requirement for a moderately severe or an acute severe attack is the provision of added oxygen through either a mask or through nasal prongs. The airway narrowing leads to marked interference with ventilation of the lungs that the necessary amounts of life-giving oxygen are not allowed to be provided to the blood and thereby to the tissues of the body. The only initial solution to this problem, at least till one could take steps to correct the narrowing of the airways is to provide an additional increased amount of oxygen into the lungs. Parents often get frightened by medical staff starting a child on oxygen but it is more or less a precautionary measure. Most people believe that added oxygen is given only to a dying patient. This is not true and there are several other instances where added oxygen may be used. Steps must be taken to explain this to the parents or care-givers, allay their anxiety and provide reassurance.

Then there are the drugs that are so useful to treat the acute episode and relieve the airway narrowing. Their action is centred around dilatation of the narrowed airways. These drugs are therefore known by the collective term "relievers". There are several different groups of medications that fall into this category. Some of them need to be given by inhalation, either by using a nebuliser or via a spacer device attached to a metered dose inhaler which is commonly known by the name of "puffer". The advantage of these methods is that only tiny doses need to be used as the drug is directly provided to the lung where its primary effect is required. Some of these drugs could also be given by mouth but then much larger doses need to be used. The oral use is generally employed only for very mild attacks. Many people also believe that these children who are once nebulised will always need nebulisation. This too is not true and there is no scientific basis for this belief. Nebulisation and other forms of inhalation therapy is used for the moderately severe and severe attacks as it is so very effective and the observable clinical effect comes on within minutes. The other advantage is that inhalation therapy could be repeated at very frequent intervals as and when necessary. The general side effects that are seen when the same drug is given by mouth are generally not seen as frequently with inhalation therapy. Inhaled therapy is quite safe in the acute phase of the attack and this is so even when the procedure has to be repeated at frequent intervals. It certainly has no adverse effects on the heart.

There are other reliever drugs that are used through the intravenous route. These are generally used when inhaled therapy fails to control the acute attack. Some of these drugs, just like those used for inhalation therapy, act quite quickly but prolonged treatment in the form of intravenous infusions may be necessary to maintain the achieved dilatation of the airways. There are several drugs that fall into this category and some newer drugs are being increasingly used. All these drugs work by different mechanisms of action, the effects are generally complementary when more than one drug needs to be used and the end results are quite good. It is however imperative that proper doses are used to obtain the best effect.

In markedly severe cases, drugs belonging to the corticosteroid group may need to be used. However, it must be remembered that these medicines take about 4 to 6 hours to produce optimal effect. They could be given orally or through the intravenous route. In severe cases, the latter route of administration is preferred. They act by suppressing the inflammatory response of the airways and this process necessarily takes time. Steroids may need to be continued for up to a week in certain instances. Such short courses of steroids are safe and do not have long-lasting undesirable side effects on the child.

In most acute episodes, ancillary treatment measures are also quite important. If the child is hospitalised, good nursing, attention to good quality nutrition and adequate hydration are essential. The latter is of marked significance as rapid breathing induced by the attack leads to a loss of water from the body via exhaled breath. If it is not possible for the child to drink because of the severity of the episode of asthma, replenishment of the fluid losses should be by the intravenous route. In the case of suspected bacterial infections precipitating the acute attack of asthma, it may be necessary to use antibiotics but it must be stressed that this is perhaps uncommon and the use of antibiotics is certainly not a panacea for all ills in asthma.

Once the acute episode has been brought under control, it is time to assess the need for further long-term treatment. There are several drugs available today which, when used prudently, help to prevent recurrences of asthma. These drugs are therefore known as "preventers". However, these decisions are not to be made lightly as preventive treatment is a protracted form of therapy and needs to be continued for quite some time. There are certain features that suggest that the child may benefit from these forms of treatment. Children with what is known as persistent asthma with some degree of airway narrowing virtually every day, those who get very frequent attacks that interfere with normal life, children with acquired chest deformities as a result of asthma, those with marked exercise induced asthma, those who have growth retardation as a result of asthma, those who have significant disturbance of schooling as a result of asthma, those who are prone to get acute severe episodes of asthma and those who suffer from troublesome nocturnal asthma and persistent night cough that interferes with sleep are the ones in whom preventive therapy may be considered. In addition, those who have poor access to medical care, especially at night too, may be considered for primarily social reasons. The rationale for this is that severe attacks at night may cause a lot of problems and perhaps may even cause death.

There are some oral drugs that may be used for preventive therapy but these are effective only in some cases and are not quite useful in severe forms of the disease. However, some of them may be quite useful in combinations with other forms of preventive therapy, especially in severe and difficult to control cases. In today’s context, the "gold standard" for preventive therapy is the use of inhaled corticosteroids. Only very small doses of these steroids need to be used as the drug is delivered directly to the lungs and as such general effects on the rest of the body are not of any significant consequence. In the recommended doses, even long-term treatment with inhaled corticosteroids is safe. The effectiveness of these drugs depends on their anti-inflammatory action as it counteracts the very basic disturbance in childhood asthma which is inflammation of the airways. All preventive medications have to be given even when the child is quite well as they work purely for prevention and most of them are not useful during acute attacks.

There are several different formulations of inhaled corticosteroids and different inhaler devises that could be used in children. There are some dry powder inhalers that could be usefully employed in older children. The child has to inhale the very fine powder into the lungs. However, the most useful form if inhaler in children is the metered dose inhaler or "puffer". When each dose is actuated, a jet of gas containing the effective dose of the drug is ejected. The only problem is that the speed of ejection is very high, around 70 miles per hour and most children, and for that matter, even adults, find it impossible to synchronise their intake of the breath with the actuation of the device to ensure that the drug is inhaled properly. To get over this problem a holding chamber or "spacer" needs to be used. This device is connected to the puffd the child breathes in and out normally at the other end of the spacer after the puffer is actuated and the dose of medicine is put into the spacer. One-way valve systems ensure that the breaths that are put out do not get into the spacer. In the case of children, they need to be trained under direct medical supervision on the proper technique of the use of all these devices. The parents too must observe and learn all necessary details of these forms of treatment. All inhalers have a finite number of doses and it is useful to write down the date of starting a fresh inhaler on the inhaler device label itself so that a new inhaler could be purchased when all the contained doses have been used up. Many parents wait till the inhaler device completely finishes and is no longer able to eject, before purchasing a new one. This is a mistake as, beyond the total number of doses that are specified in the device, there is only the propellant gas that is emitted. The active drug is available only for the total specified number of ejections.

Whatever the device, it is best to rinse the mouth with water and throw out this water each time inhaled steroids are used. This is to ensure that some of the drug that is deposited in the mouth is not swallowed. All spacer devices need cleaning from time to time and there are special ways in which these need to be cleaned. Vigorous rubbing of the inside of the spacers should be avoided as this interferes with the normal working of the device. Proper advice regarding the use of all inhaler devices should be given by the prescribing doctor and time taken to explain the different aspects of inhalation therapy is time well spent to guarantee proper utilisation of the drug and ensuring optimal effectiveness of these forms of treatment.

Preventive therapy has to be carried out under medical supervision. These children need regular assessment by the prescribing doctors from time to time. The dosage may be reduced by the doctor once control of the disease has been obtained and the child remains well for a reasonable period of time. The dosages may also need to be increased to deal with special situations and when the disease appears to be getting out of control. These are not drugs that could be continued by the parents without regular medical direction. Haphazard changes in dosage, keeping off doses from time to time and abrupt stoppage of treatment should be scrupulously avoided. It must be remembered that the disease is being kept under control by these drugs and the child may develop an unprotected acute severe attack if the drugs are suddenly withdrawn. There is no truth whatsoever in the commonly held belief that patients tend to get addicted to these inhalers. These drugs are used simply because the asthmatic state is of considerable concern which requires their use and there is no risk of addiction to them.

P.S. Boost your immunity against asthma by eating Vitamin C and Vitamin D rich foods and fruits.

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Smoke a testing time for asthmatics

THE National Asthma Council Australia is urging people with asthma in bush fire zones, or those planning summer holidays in the country, to ensure they have considered their asthma as part of their total summer survival plan.

“People with asthma are at particular risk from bush fire smoke, especially the very young and older people,” National Asthma Council Australia Director,Associate Professor Peter Wark.

“The best protection, where possible, is avoiding exposure to high levels of smoke and ensuring your asthma is well controlled from day-to-day.

“This means seeing your doctor to make sure you have an appropriate written asthma action plan to help you manage your asthma over summer as well as making sure you regularly take your preventer puffer,” Professor Wark said.

“If you live in a high risk fire zone, you should also ask for a prescription for a second emergency inhaler, which you should have ready to take with you if you evacuate.

“Keep your back-up medication with your most precious papers or photographs to ensure it goes with you if you decide to leave.”

The National Asthma Council Australia also stressed the need to follow the manufacturer’s storage recommendations for medications during the hotter summer months.

“Keeping a back up inhaler in your glove box may seem like a good idea, but the extreme heat may render your medication ineffective, or worse still, some medication canisters could explode under the intense heat conditions that will occur in cars this summer.”

People who live in built up areas also need to plan for days of smoke haze as winds can move bush fire smoke and harmful airborne particles over great distances.

Bushfire smoke contains particles of different sizes, water vapour and gases, including carbon monoxide, carbon dioxide and nitrogen oxides, which can trigger asthma symptoms, such as wheezing, coughing or chest tightness

Larger sized air-borne particles, containing burning debris, contribute to the visible haze when a fire is burning.

They are generally too large to be breathed into the lungs, but they can cause irritation to the lungs, throat and nose.

Finer particles and gases, however, are small enough to be breathed into the lungs.

“This is why we are cautioning people with asthma across Australia to be vigilant about their health as the 2009/10 bushfire season unfolds and Australia heats up.”

P.S. Boost your immunity against asthma by eating Vitamin C and Vitamin D rich foods and fruits.

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Just breathe - Buteyko Method

"When a person gets short of breath, intuitively the right thing to do seems to be to inhale deeply," says Margalit Noam. "But amazingly, if asthma patients are asked whether a deep breath helped them during an attack, the answer is unequivocally no. This is because people with breathing problems do not suffer from a lack of air, but from too much ventilation. They inhale too much air and the body has a hard time coping with that."

To anyone who's ever witnessed an asthmatic struggling to get air into his lung, this approach sounds contrary to logic. However Noam, a therapist who treats asthma using the Buteyko method, explains, "When you inhale too much, the concentration of carbon dioxide in the body dwindles and not enough oxygen reaches the tissues. Inhaling more air in order to provide more oxygen to the tissues not only does not help, it actually worsens the situation."


Professor Konstantin Buteyko, a Ukrainian doctor, derived this understanding from the findings of the physiologist Christian Bohr in the early 20th century. Bohr found that a decline in carbon dioxide levels in the body reduces the blood's ability to release oxygen to tissues and vice versa. Based on this phenomenon, known as the Bohr effect, Buteyko concluded that while in a state of shortness of breath, the body will benefit more from a reduction in the volume of air that enters the body. In the mid-20th century, Buteyko developed a unique method for treating patients suffering from asthma and other breathing passage problems, and patients of this method learn to slow the pace of their breathing.


Restoring balance

A shortage of oxygen is not the only problem related to over-breathing. "When there is too much air, the acidity level of the body drops [the PH level increases] and the body is not balanced," adds Noam. "In order to restore its acidity level, the body begins to secrete more lactic acid. This does not improve the situation and only causes fatigue. The breathing system enables the balancing of the acidity level in the body much more quickly than the body's other systems."

"For the sake of comparison," he continues, "the metabolism, the digestive system and kidney tract require several hours and sometimes even several days to restore the body's acidity levels to normal levels, whereas the breathing system can do so in minutes. Slowing the pace of breathing and sometimes even a brief halt in breathing reverses the process, and with a normal breathing pace the body returns to its desired acidity levels."

The treatment is sought primarily by asthmatics, but also helps people with allergies, anoxia, snoring, chronic runny noses, stuffed noses and sinusitis. The treatment is also sought by those with a tendency to suffer from anxiety and unease, high blood pressure and migraines. The direct connection between breathing and the improved conditions is explained by the following: after the breathing is relaxed, oxygen is released to the tissues, the blood vessels expand, pressure from them decreases and pain is reduced.


Learning to relax

Noam's patients attend six two-hour sessions, during which they improve their awareness of breathing difficulties, learn to identify situations where they over-breathe and learn how to relax the pace of breathing.

The Buteyko method is one of the most effective ways of treating asthma patients. In studies conducted in Canada and Australia, patients report a substantial reduction in the use of extenders, inhalers and inhalation machines (up to 96 percent after just 12 weeks) and in asthma prevention medications (49 percent). The reduction in the use of inhalers and medications is of greater significance for asthmatics who have become used to living alongside the inhaler and in many cases become anxious if they can't remember where they put it. Noam also reports improvements for those suffering from sleep disturbances such as apnea or snoring.

In Russia, the method is widespread and has been studied for over 50 years. In the West it is also starting to gain institutional recognition. In Australia, medical insurance covers some of the expenses of attending a Buteyko workshop, given the knowledge that it will save on other insurance costs. In England, a family doctor is authorized to recommend the method for treating breathing problems.

Dr. Avner Goren, a pediatrician and allergy, clinical immunology and asthma expert, as well as the director of the Maccabi health maintenance organization branch in Ramat Hasharon, says he frequently recommends the treatment, based on "the research results that indicate a substantial reduction in the use of medications and also because of the fact that I know for certain that they do not interfere in any stage of the patient's drug treatment."


P.S. Boost your asthma immunity by eating Vitamin C and Vitamin D foods and fruits.



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Smart Inhalers Help Fight Asthma

Developing and deploying smarter wireless medical devices to manage chronic conditions is a high growth area, and with good reason.

According to the CDC, 70 percent of deaths among Americans are due to a chronic illness. One of the keys to controlling chronic disease is adhering to proper medication dosage and schedules. Yet many patients seem to have difficulty following their doctor’s recommendations. We recently came across a couple of smart, connected medical devices designed to help asthma patients be more compliant and achieve better control over their disease – which may in turn help them lead longer lives.

Asthma is a widespread chronic disease that often strikes in childhood, making it a prime area for smarter treatment solutions that help patients to manage their symptoms. One avenue for such devices is to deliver medication through inhalers. Computer controlled inhalers with embedded intelligence can precisely measure the amount of the drug that gets to the patient. Increasingly, doctors are moving from pills to inhalers as a way to administer drugs, but it can be difficult determining how much actually was inhaled into the lungs. This is the challenge that smart inhalers help to solve.

One such smart inhaler system prototype is being developed by Clement Kleinstreuer, a mechanical engineering professor at North Carolina State University in Raleigh, in collaboration with a departmental colleague, Dr. Stefan Seelecke.


According to Kleinstreuer, the inhaler system (pictured left) “modulates the patient’s inhalation waveform and then releases a controlled drug-air stream which targets specific lung sites.” This stream could also be targeted at sites like a tumor or some other predetermined lung area, giving the smart device even wider applicability. Kleinstreuer adds that this “optimal targeting methodology” has been successfully tested in both virtual reality and in the lab, and components of a smart inhaler system prototype are now being built and tested.

“Clearly,” he says, “clinical trials will be necessary to convincingly document the amazing capabilities and wide-range applicability of the invention.”

In the long run, medical devices that use embedded intelligence to deliver precise amounts of medication to patients will help not only asthma patients, but also address other chronic and acute diseases that need targeted and specific medications.

Asthma patients can look for more immediate relief from a smart inhaler that is already available in New Zealand. This device comes from Nexus6, Ltd, a New Zealand company. New Zealand has one of the highest incidences of asthma in the world so it’s not surprising that they are leading the efforts in this area. According to COO Garth Sutherland, “New Zealand has the second-highest per capital incidence of asthma in the world; over a half a million of the 4 million people have the disease. Fortunately, we have a good public health care system so there is a good chance that asthma will be diagnosed and treated.”

Sutherland started the company in order to help chronic asthma patients better manage their own care. The Nexus6 Smartinhaler device (pictured right) helpspatients adhere to the prescribed amount and frequency of medicine. It connects to the patient’s computer via a docking station and the data is uploaded and sent to their email system. The patient can then print a report to provide to their doctor and health care team. A wireless version, which has a cell phone chip imbedded in the device, is currently in clinical trials. Also in trials is a ringtone reminder that is designed with kids in mind. Preventing asthma attacks is important, and keeping to the prescribed routine is crucial in those prevention efforts. “Kids really like the ring tones and it keep them on a schedule.”

The need for smarter management of asthma treatment is certainly not unique to New Zealand. In the United States, it’s estimated that more than 34 million Americans suffer from asthma. Smart inhalers are one example of how connected health technology can help those with chronic illness get the most benefit from prescription drugs and give them tools to better manage their own care.


P.S. boost your asthma immunity by eating Vitamin C and Vitamin D rich foods and fruits.



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What is Chronic Obstructive Pulmonary Disease

COPD (Chronic Obstructive Pulmonary Disease) is a chronic disease of the lung that covers several conditions including Chronic Bronchitis or Emphysema.

Chronic Bronchitis results from an inflammation of the airways of the lung. The term chronic refers to the fact that the condition is present for a long time and bronchitis means inflammation of the bronchi or air passages of the lung. You can find the anatomy of the lung on any well-researched website, but I will give a brief summary here.

The air passages begin with the trachea in the neck which branches into the left and right main stem bronchi. These bronchi continue to branch into smaller bronchi or bronchioles until they end up in the microscopic air sacs or alveoli. It is the alveoli that oxygen and carbon dioxide are exchanged with a rich network of small blood vessels or capillaries. The bronchioles and bronchi are responsible for delivering the oxygen to the alveoli and for carrying the carbon dioxide from the alveoli to the outside. These air passages are more than just tubes — the linings are composed of cells and structures that serve many functions for lubricating the airways and removing debris from the airways. These cells can be damaged by infections or toxins like inhaled poisons or smoking. When these cells are irritated by various stimuli, they form mucus which can plug up the airways and make air movement difficult. In addition, the airways have muscles in the walls and these muscles will contract or dilate the airway depending on what kind of pressure is placed on them.

When we breathe in, our diaphragmas act like an accordion and pull air into the airways. When we breathe out, we squeeze our chests and the airways by pushing our diaphragms up to force the air out. This pressure to force the air out causes the bronchi to become narrow and slows down the speed of the air escaping from the lungs. If the airways are already partially blocked by mucus, or if the muscles are contracting due to irritation, the air cannot escape from the lungs as well, and we feel short of breath or you will hear a wheezing sound as the air tries to escape through narrow tubes.

Emphysema, on the other hand is a disease of the alveoli or air sacs, where the lining of the sacs become destroyed by specific enzymes or infections, and the small air sacs become larger and larger as the walls or membranes between them become destroyed. They tend to lose their elasticity and are unable to squeeze the air out of them as effectively. In addition, the walls or membranes contain the capillaries or small blood vessels that carry the oxygen to the tissues and remove the carbon dioxide from the tissues, so air exchange becomes compromised and we feel short of breath, because not enough oxygen is being delivered to our tissues. In severe cases we can actually see our fingernails turn blue from lack of sufficient oxygen. When there is not enough oxygen in the blood, the blood becomes dark or blue, like in our veins. When there is enough oxygen in the blood the blood becomes a bright red, like in the arteries.

Chronic Obstructive Pulmonary Disease or COPD is a combination of Chronic Bronchitis and Emphysema. The treatment is therefore three fold.

* Remove the toxins from the lungs. This is done by avoiding irritants like smoke, perfumes, dust, or allergens from the environment. In addition, direct toxins like cigarette, cigar or pipe tobacco smoke should be immediately discontinued.

* Treat the constriction of the airways with medicines that can open up the airways. These are called bronchodilators and are usually in inhalers or nebulizers, but can also be in cough medicine, or pills.

* Treat the inflammation of the airways with inhaled anti-inflammatory medications, or by pills or injections. These medications are derivatives of cortisone. Frequently in severe episodes you will be treated with doses of Prednisone tablets for short period of time, or injections of cortisone.

The treatment of COPD is therefore a combination of bronchodilators and cortisone as well as discontinuing smoking, treating any infections and avoiding an environment of smoke.

The prognosis varies depending on the severity of the condition, and this can be determined by doing pulmonary function tests to see how well you can breathe. A simple test that can be done in the office is the PEFR (Peak Expiratory Flow Rate). This is a simple flow meter that patients with COPD can obtain from the pharmacy to test the amount of airway restriction that is present. A more detailed test can be done by a pulmonary specialist, which we do have here in Nassau.

If caught early enough, like any other disease, the prognosis is excellent. I have seen patients with severe COPD who require oxygen all the time, still smoke even with the oxygen being administered. Those are extreme cases but, as you can see, the prognosis can vary widely depending on the severity of the disease and the compliance of the patient with prescribed treatment.

P.S. boost your asthma immunity by eating Vitamin C and Vitamin D rich foods and fruits.

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Users Complain About New Asthma Inhalers

A year ago the government ordered a big change in asthma inhalers.

The propellant used to force the medication out of the inhaler was changed to a more environmentally safe chemical.

The old albuterol inhalers used chlorofluorocarbon (CFC), but it’s believed the CFC damages the ozone.

As of the first of the year, CFC inhalers were banned and hydroflouroalkane (HFA) was used as a propellant instead.

While the HFA may be better for the environment, some patients and doctors say the inhalers may be dangerous for patients.

Katie Mitchell of Pittsburgh suffers from severe asthma.

She described what an asthma attack feels like. “My chest gets tight, feels like an elephant on my chest, then your airways constrict and you kind of gasp for air.”

Mitchell, a junior at Slippery Rock University, relies on an albuterol inhaler to control her symptoms. Like all asthma patients, her inhaler now contains the environmentally friendly propellant HFA.

She said the new inhaler put her in a life-and-death situation.

“I went to use it and nothing came out and I started panicking because I didn't know what to do. I was shaking it and I had to prime the inhaler six times before I could actually use it, which is dangerous for someone with asthma,” Mitchell said.

Mitchell isn’t the only asthma sufferer who has had problems with the new inhalers.

The FDA told Channel 11 it has gotten many similar complaints about the new inhalers.

Dr. David Skoner, an asthma and allergy specialist at Allegheny General Hospital, said he’s also had patients complain about the inhalers.

Skoner said, “These have a tendency to plug up the little holes where the drug comes out. That can cause a life hyphen threatening situation.”

The medication is stickier, so it can clog the hole it comes out of and can reduce the amount of medication delivered.

Many patients don’t realize they must now take the inhaler apart and clean it at least once a week, which they didn’t have to do with the old inhalers.

Mitchell now cleans her inhaler after every use to make sure it will work the next time she needs it.

“If you're having an asthma attack and you use your inhaler and it's clogged, you can't go over to the sink and wash it out,” Mitchell said.

Skoner said the drug manufacturers recommend taking the inhaler mouthpiece apart and running warm water through it for 30 seconds. Then flip it over and run warm water through the other end for another 30 seconds. Then shake it off and let it air dry overnight before putting it back together.

Clogging isn’t the only complaint the FDA is getting.

The old propellant pushed the medication out with a lot of force, but the new propellant sends the medication out in a gentle plume.

Because it feels and tastes different, many of Skoner’s patients don't think it's working.

“The taste and feel are very different. The CFC felt cold in the back of the throat. This one doesn’t. They knew what the old one felt like . When they use the new one, they don’t feel that, so they don’t feel they are getting the drug and may take more puffs of it,” Skoner said.

Skoner and the FDA said tests show the new propellant still delivers the right amount of medication.

Another drawback of the new inhalers is the cost. The new inhalers are two to three times the price of the old generic inhalers.


P.S. prevent asthma attacks by eating Vitamin C and Vitamin D rich foods and fruits.



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Dr. Andy: Used correctly, inhaler effective

The metered dose inhaler, also known as the pump inhaler, has been the main treatment for lung problems such as asthma since it was first sold in the 1950s. For most it is a convenient and cost-effective way to get medications such as Albuterol into the lungs. Earlier this year a major change in these devices occurred, a change which several of my patients are convinced has made their inhalers less effective.

In the past, the propellant in inhalers was a chlorofluorocarbon (CFC) such as freon. However, as freon has disappeared from our air conditioners, so it did from pump inhalers. In fact CFCs have been banned internationally. Today, the inhaler propellant is a hydrofluoroalkanes (HFA).

In the older CFC inhalers, up to 80 percent of the aerosol one breathed in from the inhaler was the propellant. The CFC also caused the cold sensation that many patients associate with their old inhaler medications. The newer HFA inhalers don't have the same cold sensation, and also do not propel the medication at as high a speed. This results in more medicine actually being delivered into the lungs.

Discussions of pump inhalers would also not be complete without mentioning spacers, or holding chambers. These are usually plastic tubes with the inhaler plugged into one end, and the other end in the patient's mouth. Using a spacer dramatically increases the effectiveness of pump inhaler medications.

Using a spacer with a pump inhaler has been shown in repeat studies to help kids with asthma improve faster than when treated with an inhaler without a spacer attached. There is also no need to coordinate the inhalation with the pumping of the inhaler.

The spacer allows more medication to get to the lungs by allowing it to slow down in the chamber, and may reduce some common complications with inhaled steroids, such as oral thrush. For younger children, a mask can even be fitted to the mouth end of the chamber.

Be sure to clean your spacer chamber prior to using it with a mild dishwashing detergent, and repeat that cleaning process occasionally. This will reduce the electrostatic charge that can build up on the plastic, which attracts the medication particles, reducing the amount available for inhaling into the lungs.

In regard to nebulizer machines vs. the pump inhalers with a spacing chamber, numerous repeat studies have shown that a correctly used pump inhaler with a spacing chamber is as effective, if not more effective, than a nebulizer treatment. The significantly lower cost of inhaler medication, ease of portability and lack of reliance upon electrical equipment are just added benefits of inhalers over nebulizer machines.

So if you, or your child, use an inhaled medicine, be sure to talk with your doctor to verify you are using it correctly. Don't be afraid to ask questions, and remember - we work for you.


P.S. prevent asthma attacks by eating Vitamin C and Vitamin D rich foods and fruits.



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How to Use Your Albuterol in Asthma Treatment

Albuterol, also commonly called salbutamol, is one of the most common medications that you would be given if you have asthma. Albuterol is a bronchodilator, and as such its main purpose is to relax the muscles in your airways to allow more air to pass through. It is one of the most effective weapons against asthma attacks and is important to have with you at all times. Call your doctor or get one from the nearest pharmacy if you think that you are running out. Having two inhalers just in case one gets lost is also a good idea. If you feel that you medication is not working as is used to, or if you are reacting negatively to the medication, inform your doctor right away.

Knowing the proper procedures when taking your inhaler can prove crucial and even life-saving. Here’s the list of the things that you need to take note of when using your Albuterol inhaler:

Make sure the inhaler canister is properly inserted. If you encounter difficulties inserting the canister refer to the manufacturer leaflets or diagrams that can be found either on the packaging or inside the box of medicine.

Shake the inhaler for about ten seconds and actuate the device at least once to test. Shaking ensures effectiveness of the medication while test spraying can help get rid of any foreign object that may be in the nozzle.

When having an asthma attack, lying down makes you feel worse. So to avoid rendering your inhaler useless, use it while sitting in an upright position. Using the inhaler while sitting or standing increases the rate at which the medicine can reach your lungs.

Place in inhaler about an inch away from your mouth, if you are having difficulty estimating you can also use a spacer to help you out. Remember to forcefully inhale every time you puff. Inhaling forcefully will ensure that the medicine goes directly into your lungs and not end up at the back of your throat or just circulate inside your mouth.

After inhaling the medication, hold your breath for five to ten seconds. This allows the medication to travel further into the air passages. If you need additional puffs, wait about thirty seconds before doing so again.

Replace the cap after use. Rinse your mouth with water to clear any residue of the medicine.

Depending on your asthma severity and advice taken from your doctor, you may be required to take more puffs. It is important that you adhere strictly to the instructions given to you. Bronchodilators can have side effects. Not using them to be as efficient as they should leads you to use them for a longer term. Your albuterol treatment effectivity is directly proportional to how well you use it.

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Asthmatics shun prevention

Asthmatics are endangering their lives and draining the health system of millions of dirhams annually by over-relying on “rescue” medications instead of preventive treatments, according to the region’s largest study of the disease.

The Asthma Insights and Reality in the Gulf and the Near East study found that only 5.5 per cent of the 200 asthmatics surveyed across the Emirates used preventive treatments such as inhaled steroids.

That figure is “shockingly low”, according to Dr Zouhair Harb, a lung specialist working in Abu Dhabi.

The report, released last month, interviewed 1,000 asthmatics in the UAE, Jordan, Kuwait, Lebanon and Oman between January 2007 and March 2008.

The study showed that more than 31 per cent of asthma sufferers surveyed had been hospitalised or sent to emergency rooms during the period, although most of the admissions had been preventable. Another 48 per cent fell back on emergency bronchodilators to bail themselves out of asthma attacks.

It concluded: “[Regional] asthma morbidity is high, with an unacceptably high reliance on the use of emergency or rescue care.”

Ignorance about the respiratory disorder, which constricts the airways, “places a great burden on the healthcare system and society as a whole, with substantial loss of time from work and school”, it added.

Patient denial is also to blame, the researchers said.

Dr Bassam Mahboub, who led the UAE surveys at the University of Sharjah, said most asthma-related fatalities occurred because patients “don’t perceive themselves as having a disease, so they stop medication”.

He is now studying the economic impact that poorly managed asthma has on the health sector, which he estimates to be in the “hundreds of millions” of dirhams.

“We actually need a majority of our asthmatic patients to be on the controlled medications,” said Dr Mahboub, a member of the Emirates Respiratory Society. “So 5.5 per cent is way too low.”

The findings are particularly grim given that the UAE has one of the highest rates of asthma in the world; doctors estimate that 15 per cent of the population suffers from the condition.

The European average is about seven per cent, based on 2004 figures from the Global Initiative for Asthma.

And in 2005, the prevalence of asthma in the US was just under eight per cent, according to the American Academy of Allergy, Asthma and Immunology.

“But it’s especially hard [in the UAE], where you have a lot of dust and dependence on airconditioning,” said Dr Harb, of the Advanced Cure Diagnostic Centre in Al Bateen. “That’s a lot of wear and tear on the airways.”

The Lebanese-American lung specialist was dismayed by the study’s finding that fewer asthmatics in the UAE than in any of the countries surveyed were proactively treating their illness.

“In a perfect world, I would be expecting 100 per cent of asthmatics [to use preventive inhalers],” he said. “Really 5.5 per cent in the UAE is quite low. Shockingly low.”

Dr Harb estimated that 30 to 50 per cent of asthmatics in the most developed countries use the recommended steroid therapies.

According to the report, nearly 30 per cent of Lebanese patients use preventive inhalers. Roughly 19 per cent of Kuwaitis are also on controlled treatments.

Quick-relief medications such as bronchodilator puffers reopen clogged airways during bouts of breathlessness. But daily steroid therapy prevents the attacks from happening in the first place.

“[The patients] have a choice between two medicines,” Dr Harb said. “A rescue medication will work within five minutes and the maintenance one will work maybe over a week. They’re going for the quick gratification, the immediate remedy, which isn’t the right remedy.”

Overusing the emergency devices can stress the lungs and cause long-term problems.

Fixed doses of preventive steroids control inflammation in the lungs, said Dr Asif Sattar, a pulmonologist at City Hospital in Dubai.

“It seems people in Dubai tend to use emergency departments more and tend not to follow up with their physicians regularly,” he said. “Well-controlled asthmatics shouldn’t need to use their reliever at all.”

Dr Sattar said patients might dismiss preventive treatments because they might not realise they have a chronic disease.

There may also be negative connotations associated with the idea of taking steroids, although the inhaled steroids are safe, he said.

Dr Ashraf al Zaabi, the head of the respiratory division at Zayed Military Hospital, hoped the study would better inform physicians and patients about the importance of preventive therapies.

“This low compliance with the controlled medication is not surprising,” he said. “But there are explanations.”

For one, he said “especially younger patients tend to get fed up with taking medicines” over a long period of time.

Dr al Zaabi also noted that half of the UAE respondents in the study were Emiratis, while the remainder were mostly other Arabs and South Asians.

“A lot of those guys can’t afford the Dh200 or Dh300 medications, so that might explain the low percentage, with those non-nationals perhaps not having health insurance.”

Unlike in the UK, many asthma medications in the UAE can be purchased over the counter. In some cases, patients who self-medicate might buy only rescue puffers.

“We know that asthmatics tend to have poor perception of the control over their condition, so patients sometimes delay seeking medical advice until they are really bad,” he said.



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CAFFEINE CAN REDUCE ASTHMA SYMPTOMS

A study presented at a conference at the American College of Sports Medicine found that those who ingested caffeine within an hour of exercise reduced their symptoms of exercise-induced asthma (EIA), which is characterised as a shortness of breath during sustained aerobic activity.

The randomised, double-blind, double-dummy crossover study was led by University of Utah researcher Timothy A. VanHaitsma and fellow researchers at Indiana University and involved ten asthmatic people who had also had EIA. Each took either three, six, or nine milligrams of caffeine per kilogram of body weight or a placebo, an hour before exercising on a treadmill. Tests of pulmonary function were taken 15 minutes before exercise commenced, then again 1, 5, 10, 15 and 30 minutes after the exercise stopped.

At nine milligrams of caffeine per kilogram of body weight, considered a large dose, the effects were comparable to using an albuterol inhaler, something commonly used to prevent or treat EIA. This would be the equivalent of about six cups of coffee. Smaller amounts of caffeine, such as three and 6 milligrams per kilogram of body weight, were also found to be useful, reducing coughing, wheezing and other EIA symptoms.

All participants received all doses, including the placebo, at one point or another during the experiment.

Associate professor in the Department of Kinesiology and a co-investigator of the study, Timothy Mickleborough, said that no additional benefit was found when caffeine was combined with an albuterol inhaler.

For someone who weighs 150 pounds, for example, 3 to 9 milligrams of caffeine per kilogram of body weight equals from about 205 to 610 milligrams of caffeine. This study adds to earlier work that found caffeine can reduce the symptoms of EIA and is the first to examine any synergistic effect of caffeine use along with an albuterol inhaler.

Mickleborough and his fellow researchers have also investigated the efficacy of a number of nutritional factors on EIA, with research to date showing that a diet high in fish oil and antioxidants and low in salt has the potential to reduce the severity of EIA and perhaps reduce the reliance on pharmacotherapy. With growing concern about the potential side effects of inhaled corticosteroid use, this is especially important. Also, prolonged usage of daily medications can result in their reduced effectiveness.



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What You Should Know About Asthma Pediatric Cases

What You Should Know About Asthma Pediatric Cases

Asthma in children is one of the most trying experiences that parents may have while their children are still very small. Asthma pediatric cases are very common nowadays because of the many triggers in the environment, as well as in the food that our children eat everyday. More often than not, children who are living in the city are often the hardest affected by asthma pediatrics due to the smoke emitted from vehicles and other pollutants in the air.

Common Symptoms in Asthma Pediatric Cases

If you are a parent with very young children who have asthma, taking note of the common symptoms of asthma pediatric cases is very important. Unlike adolescence and adults, very young children often cannot express what they feel very well. In most cases, they will just appear to be irritable and cry a lot, and it is really hard to tell what is wrong with them. Since your child could not aptly express what he or she is feeling at the moment, you will need to be very perceptive.

To determine the first signs and symptoms of asthma pediatric attack in you child, you should note the common signs and symptoms of the disease. Note that most asthma pediatric cases have different signs and symptoms. To determine what are the early signs and symptoms of pediatric asthma in your child, you will need to take notes of what happened during the last time your child had an attack.

Is There Such a Thing as a Pattern for Asthma Pediatric Episodes?

Technically, each child may have some unique experiences with asthma pediatric episodes. However, if you are a very keen observer, in most cases, asthma pediatric attacks on very young children follow a pattern. For instance, every time your child is exposed to smoke, he or she will start sneezing followed by coughing. After a few hours of coughing, he or she will start wheezing and getting out of breath. If you have noticed this pattern in your child, chances are this will happen every time he or she is exposed to smoke.

Preventing Asthma Pediatric Episodes

Recognizing the triggers of your child’s asthma is very important. Knowing what triggers asthma in your child would help you prevent such attack. For instance, if you observe that your child would react strongly towards smoke, then, make sure that he or she is not exposed to smoke to prevent an attack. Knowing what to prevent can mean everything in the case of asthma.


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The Link Between Allergies and Asthma

Allergies and asthma frequently often go together. Pediatric asthma is actually very common in the US especially in children. Your child's body's reaction to an allergen can often lead to an asthma attack, or it might cause an existing condition to become worse. This is a serious issue for those who suffer from both allergies and asthma, because it involves twice the discomfort and a greater risk of health problems.

Allergens cause your body to produce antibodies to get rid of the irritant, causing you to experience a reaction that usually involves sneezing and watering of the eyes. The airways and nasal linings become inflamed as a result of your body's response, which frequently leads to an asthma attack in those who suffer from the condition. Those who have respiratory allergies along with asthma typically experience more severe attacks.

Can treating your child's allergies prevent pediatric asthma? It can certainly lower your chances of experiencing an asthma attack. Receiving injections to treat your allergies is beneficial because it restricts your antibodies from reacting to the allergens. And so the chances of an asthma attack are reduced.

For those children who suffer from pediatric asthma attacks, it's essential that parents should do their best to avoid the irritants that lead to inflamed airways. The most typical culprits are dust mites, pet dander, pollen and certain foods. Those who have family members with allergic asthma are more likely to acquire the disease. These people are advised to be very careful with possible allergens. Most allergy induced asthma is triggered by more than one factor.

You don't always have to use medication if you are successful at avoiding the situations that lead to an attack. However, if you do use medication, it's important that you treat the symptoms of both conditions. Nasal sprays can reduce inflammation caused by allergies. Inhalers can reduce inflammation caused by asthma. Be aware, though, that self-medication can have serious consequences. First of all, you should visit your doctor to discuss the most appropriate course of treatment. You can use medication to cure either of these conditions, but caution is advised because they can aggravate certain health problems.

People are advised to take control of their problem by making sure they know which factors trigger their attacks. Discuss all this information with your physician so he or she can formulate the best possible asthma treatment for your situation. The doctor will try to gauge the factors that you have encountered before and the reactions of your body towards past treatments.

P.S. Boost your immunity against pediatric asthma by taking Vitamin D rich foods.

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How Exercise Can Trigger Asthma

Although it comes as a surprise to many people, exercise is one of the most common triggers of pediatric asthma attacks. As many as 9 out of 10 people with asthma experience exercise-induced asthma, an exacerbation of their symptoms during or after a workout.

Exercise is still one of the best things you can do for your body, but if you have exercise-induced asthma, it can be tricky to work out without triggering asthma symptoms such as shortness of breath and coughing. But it’s not impossible. Indeed, many star athletes suffer from exercise-induced asthma, and the symptoms can be minimized by taking medication and precautions, such as avoiding exercise in cold weather.

With the right treatment, children with exercise-induced asthma can still be active and participate in sports.

To learn more about exercise-induced asthma and how to prevent it, check out the following information from our A–Z Health Library.

An asthma attack is a short period when breathing becomes difficult, sometimes along with chest tightness, wheezing, and coughing. When this happens during or after exercise, it is known as exercise-induced asthma or exercise-induced bronchospasm. About 70% to 90% of people with persistent asthma and about 10% of the population without asthma have exercise-induced asthma.
Exercise-induced asthma develops most often in athletes, especially those who train or perform in cold air. Swimming appears to cause the fewest problems for children with asthma; it may even help reduce the severity of exercise-induced asthma.

For most people:

* Shortness of breath may occur early in an exercise period. Some people get worse 5 to 10 minutes after exercise stops.
* Difficulty breathing usually goes away within 20 to 30 minutes after stopping exercise.

Exercise-induced asthma is often not diagnosed, especially in children. Most experts agree that a medical history and a physical exam are not accurate tools for diagnosing exercise-induced asthma. If you notice the symptoms of asthma (such as wheezing or shortness of breath) after your child exercises, it is important that you bring this to the attention of your health professional. However, children with asthma should still be encouraged to exercise and should not be excused from exercise unless really necessary.

For people with pediatric asthma symptoms during exercise, using asthma-controlling medicine before exercise may help reduce symptoms, especially in cold, dry weather. For these people, some asthma experts recommend the following:

* Take your medicine daily, if needed, to decrease airway inflammation Click here to see an illustration. and decrease the overreaction (hyperresponsiveness) of the airways that carry air to the lungs (bronchial tubes).
* Use an inhaled bronchodilator (beta2-agonists), cromolyn, nedocromil, or leukotriene pathway modifier before exercising.
* Warm up before exercising.

Other steps you can take to decrease asthma symptoms when you are exercising include the following:

* Avoid exposure to air pollutants and allergens whenever possible. Exercise indoors when air pollution levels are high.
* Wear a mask or scarf wrapped around your nose and mouth if you are exercising in cold weather. This may help warm and moisten the air you breathe in.
* Exercise slowly for the first 10 to 15 minutes.

If your child has exercise-induced asthma, be sure his or her teachers and coaches know when your child’s daily medicines should be given and what to do if your child has an asthma attack, especially before and during physical exercise. Your child’s daily treatment and asthma action plans provide this information. School officials need to know the early warning signs of an asthma episode, how your child’s medicines are used, and how to give the medicines. School personnel also should know how to contact your child’s health professional.



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Pediatric Asthma Treatment: How to Avoid Indoor Asthma Triggers

Asthma is a long-lasting disease wherein the airways tend to become reversibly narrowed and results to shortness of breath. Coughing and wheezing often accompany the main symptom. An asthma attack is an immediate progression of asthma from a steady state to acute. This occurs when the asthmatic is exposed to triggers. Triggers are usually airborne irritants that an asthmatic may inadvertently inhale.

Outdoor triggers include molds, pollen, and smoke. While most families keep their asthmatic child inside the house, the childs condition may not get better because indoor triggers are not eliminated. Indoor triggers pose as much of a risk as outside triggers. Pets, for instance, should be left outdoors or at least outside the childs bedroom.

Cigarette smoke is pretty popular in their role as an asthma trigger. Not only are they triggers, but they can also contribute to the development of asthma in a child. The earlier the child is exposed to cigarette smoke, the earlier their lungs start deteriorating. An already asthmatic child should not be exposed to cigarette smoke. If theres a smoker around, it should be done outside the home. Even if the child has left, indoor smoking should be avoided. There is a study going on to prove that smoke residue inside the home can trigger asthma.

Low humidity levels decreases growth rate of indoor molds. Damp or wet bathroom tiles are ideal grounds for mold growth. With this in mind, it would be a good idea to fix water leaks. The house should also be kept clean. Food should be kept in closed containers or refrigerators. Trash cans must be kept closed. This attracts less cockroaches ” which is a well-known asthma trigger.

Peak flow meters are handy devices that can help measure the amount of air that a person breathes out. Its readings are color coded with green, yellow, and red. Peak values falling under the green indicates good breathing, while red signifies an asthma attack. A peak flow may also help you monitor lung function. Regular use of it may warn you of upcoming asthma attacks as it can detect airway obstruction even in the absence of symptoms.


P.S., Boost your resistance to asthma by heavy intake of Vitamin C rich foods or fuits.



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How to Use a Nebulizer?

Nebulizers are commonly used to deliver asthma medications to children, including albuterol when your child is wheezing and Intal, an anti-inflammatory medication used to prevent asthma attacks.

For many children without a nebulizer, using a metered dose inhaler with a spacer and mask, can be just as effective as a nebulized treatment. Still, younger children under age 5, those that have trouble using an inhaler and children with severe asthma may benefit from having a nebulizer to use at home.

Here are tips for using your nebulizer correctly:

* Always use clean equipment.
* Assemble the air source, nebulizer and tubing per the manufacturers instructions.
* Measure the medications and place them in the nebulizer (remember that ml and cc are the same). Measure your child's dose of Albuterol with 2cc of Bronchosaline or with an ampule of Intal if it has also been prescribed.
* Turn on the nebulizer and hold it close to your child's nose and mouth (or you can use a mask and strap it in place). Older children can use a mouthpiece that is held in their mouth with their lips closed, as long as they only breathe through their mouth (or consider using a nose clip).
* Teach your child to take long, slow, deep breaths during the treatment (and hold his breath for a few seconds if possible).
* Continue the treatment until all of the medicine is gone from he measuring cup. Most treatments last about 10 minutes.
* Turn off the nebulizer and clean your equipment when the treatment is finished per the manufacturers instructions, including rinsing the mask, mouthpiece and T-shaped part (but not the tubing) in warm water, allow it to air dry and then store everything properly.

Important Reminders

* Use your medications as directed by your Pediatrician. Do not change the medication's dosage or stop using a medication unless instructed to do so by your Pediatrician.
* If your nebulizer breaks, get a replacement as soon as possible, and before your child needs another treatment.
* Always have medication for your nebulizer on hand. Call in advance for refills.



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Natural Cure for Asthma

For people who have asthma, taking medication for a prolonged period of time could really aggravate the situation instead of make things better. It is a common experience for people with asthma that after taking certain medications for sometime, such medication will no longer be able to relieve them during an attack. If you are one of those people who have this kind of problem with your medication, it might be a good idea to start seeking for a natural cure for asthma.

Is there really a natural cure for asthma?

You may not believe it, but nature has the way of healing itself. There is a natural cure for asthma and many people who have tried it would really say that their condition did improve after sometime. The good news about natural cure for asthma is that it has a lasting effect without the ugly side effects that are closely associated with pharmaceutical drugs.

Speleotherapy as a Natural Cure for Asthma

In European countries, speleotherpy is very popular when it comes to a natural cure for asthma. Speleotherapy, which is otherwise known as climatotherapy, is the process of treating asthma by spending some time underground in subterranean caves about 2-3 hours a day for a period of 2-3 months. This practice is based on the belief that salt air is very potent when it comes to treating asthma.

Speleotherapy have been practiced in Eastern Europe for ages. In fact, this type of treatment is so old that this has been handed over from generation to generation and has been proven to be very effective. However, there is no concrete scientific explanation why such treatment could really help in treating asthma.

Aromatherapy as a Natural Cure for Asthma

Another popular natural cure for asthma is aromatherapy. There are a number of scents and oil, which you can use to produce the desired relaxing effect in aromatherapy. For people with asthma, the use of a rock salt crystal lamp has been proven to be quite beneficial. Not only will this rock salt crystal lamp calm the nerves of a person, it is said to relieve bronchial constrictions brought about by an asthma episode.

Purifying the Air You Breathe

You can help prevent asthma symptoms by identifying and avoiding your known asthma triggers. In fact, identifying and avoiding asthma triggers should be part of a detailed treatment plan to help successfully manage your asthma.

A natural way for preventing asthma attacks is to purify the air you breathe. Most asthma attacks are brought about allergic reactions to dusts and pollens that are suspended in the air. If you can minimize the existence of these asthma triggers by purifying the air you breath, you can effectively prevent asthma episodes.


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Recognizing and Managing Asthma in Children

Childhood asthma is a disease that can lead to death if left untreated. The problem is that it can be hard to see the signs of asthma in children. It can be more difficult to control as well. The reason is that kids just aren’t paying attention to the warning signs or just doesn't know about it.

Effective treatment of pediatric asthma requires that parents should be alert for the signs and symptoms of the condition. The most noticable signs of an asthma attack are coughing, wheezing, shortness of breath and difficulty breathing. These symptoms are pretty much the same in both children and adults.

But it can be harder to notice them among children. For instance, children frequently run around while they’re playing, and subsequently become hot and breathless. However, these are also signs of an asthma attack taking place. It’s possible that your child is experiencing more difficulty in breathing than you think.

Until this time, there is still no cure for asthma. Fortunately, there are lots of ways that the problem can be managed. Most often, an inhaler is prescribed for children with asthma symptoms. This is the fastest way of getting medicine to the lungs when it’s required immediately. Frequently, pediatric asthma is treated with something known as combination therapy. This means using an inhaler that contains two or more medications rather than just one.

Some parents like to supplement pharmaceuticals with a more natural approach to managing this disabling condition. But before starting any new treatments, it’s important that you consult with your doctor. Natural asthma treatments can interact with the prescribed medications your child is taking. They might seem harmless because they’re natural. The truth is, though, that they sometimes have ingredients that don’t react well with other medications.

Some natural treatments involve lifestyle factors rather than supplements. These are considered to be a safe and effective supplement to medication. For example, developing an asthma treatment plan is a common approach to managing the condition. You and your child need to be aware of the triggers that can set off an attack. It’s important that you know what the signs are that trigger it. And of course, you both need to know exactly how to treat an attack once you recognize the signs.

Your child could still enjoy a wonderful life even with pediatric asthma. He or she can experience the normal joys of being a child when the condition is well managed. The key to this is learning as much as you can about the condition and how to treat it.


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Symptoms of Asthma in Infants

The symptoms of asthma in infants can be so subtle that you don't even realize infant asthma might be involved. Baby asthma is challenging to diagnose too, because your infant can't tell you in words how he or she is feeling. So doctors rely more on the parent's description of a pattern of symptoms and behavior, as well as family medical history, in deciding what type of breathing problem your baby may have.

Asthma is the most common chronic disease in babies and children. In fact, 1 out of every 10 kids has asthma today. So, if you find out your baby has asthma too, you'll have lots of company. If you do suspect infant asthma is causing your child's breathing problems, it's important to find out for sure as soon as you can. The inflammation of the airways that asthma causes can cause severe respiratory distress and may even lead to death, if left untreated or uncontrolled. Babies are especially susceptible to complications, because their lungs are not as mature to begin with, so early diagnosis and treatment are essential.


What Are the Symptoms of Asthma in Infants?

Common asthma symptoms in adults include:

* Wheezing
* Coughing
* Shortness of breath
* Chest tightness

But it's important to note that the pattern and intensity of asthma symptoms can vary greatly from person to person. With infant asthma, symptoms can be even more variable. They are also different, to some extent, than in adults.

In baby asthma, coughing is often the only symptom the infant will have. Some kids cough all night, but have no noticeable symptoms during the daytime hours. Other infants may cough intermittently throughout the day. Also, when babies wheeze, it's not always because of asthma. It could just be a viral respiratory infection.

So, doctors look closely at patterns when trying to decide whether your infant has asthma. First off, they'll ask you if you've noticed repeated instances of:

* Coughing, especially at night
* Wheezing
* Trouble breathing or fast breathing

The doctor will also look for symptoms that are worsened by:

* Frequent viral infections, such as colds or bronchitis, that seem to "go right to the chest" and last
* Exposure to tobacco smoke or other strong odors / fumes
* Active play
* Contact with common allergic triggers, such as pets, pollen, and dust
* Changes in the weather
* Crying or laughing

Diagnosing asthma in infants can be hard because symptoms must be observed, rather than described. And common testing used to diagnose asthma, such as spirometry, can't be used with infants. And just having any one of the above findings is probably not going to lead your baby's doctor to an asthma diagnosis. But having several of them may. In the end, doctors often diagnose asthma by ruling out other possibilities.


What Other Diagnoses Have Similar Symptoms?

As noted above, wheezing in infants can be caused by more than just asthma. And the good news is that these other conditions are often milder than asthma and may go away completely within a few years, as opposed to asthma, which usually lasts throughout childhood and maybe even into adulthood.

Some of the names for conditions that cause recurrent wheezing and coughing episodes in infancy are:

* Wheezing bronchitis, which is a viral infection
* Bronchiolitis
* Asthmatic bronchitis
* Wheezing associated with respiratory illness or breathing problems
* Para-infectious bronchial hyperreactivity
* RAD

The common factor with all of these labels is that the wheezing is not associated with allergic disease as asthma usually is in children. One of the most common catch-all terms for non-asthma wheezing is reactive airway disease, which is also called RAD for short. RAD may be used to avoid labeling an infant too soon with a more serious diagnosis of asthma.

However, both RAD and infant asthma are often treated the same, because doctors really can't tell for sure if an infant has asthma, and won't know until at least age 5. So, they treat "as if" the infant has asthma.

But parents' worries about their babies taking possibly unnecessary medicine can be soothed by the knowledge that asthma treatment is safe, even for infants. What risks there may be are considered to be offset by the very real benefits of keeping asthma – if it does exist – under control. Preventing more serious respiratory problems down the line is well worth it.
In Summary

If you notice a chronic cough in your infant, especially if it is waking your baby and you up at night, it would be wise to talk with your pediatrician about it. The same is true if you notice your baby having frequent and / or severe chest colds. And remember, wheezing does not have to be present in infants with asthma, as it almost always is with adults. And if your baby does wheeze, it doesn't necessarily mean he or she has asthma.

Don't ignore such symptoms or fear an asthma diagnosis. Asthma is fairly easy to manage with medicine and environmental changes, and taking such steps can help ensure that your infant is able to have a normal, active life.


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Inhalers for Asthma

From my childhod days until I turned 23 years of age, my asthma medication consists only of tablets and capsules or just leave it be. But right after that, I tried the asthma inhaler and immediately I got hooked. The healing time of tablets ranges from 2 hours to 3 hours but for the inhaler it took only 1 or 2 seconds.

Inhalers are the main source of treatment for asthmatic patients and enables them to lead active lives without the fear of an attack. There are different types of inhalers available in the market which can make things confusing.

This article will give some more information about the inhalers for asthma.

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Pediatric Asthma

Ever since I was a child I far as I can remember, I already have asthma. Most of it would occur at night. I cannot breathe properly when lying down. So I have to sit down while relaxing my breathing. There came a point wherein my parents use a nebulizer to calm my asthma.

Asthma is commonly seen in children. It is a leading cause of hospital stays and school absences. Children with asthma may be able to breathe normally most of the time. When they encounter a substance that can cause problems (a "trigger"), an asthma attack (exacerbation) can occur.

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