Asthma Health Article

Risk factors

There are many risk factors for childhood asthma, including:

• presence of allergies
• family history of asthma and/or allergies
• frequent respiratory infections
• low birth weight
• mother's exposure to tobacco smoke during pregnancy and/or child's exposure after birth
• wheezing with upper respiratory infections

Symptoms

Wheezing is often very obvious, but mild asthmatic attacks may be confirmed when the physician listens to the patient's chest with a stethoscope. Wheezing is often loudest when the child breathes out, in an attempt to expel used air through the narrowed airways. Besides wheezing and shortness of breath, the child may cough and experience pain or pressure in the chest. The child may have itching on the back or neck at the start of an attack. Infants may have feeding problems and may grunt while sucking or feeding. Tiring easily or becoming irritated are other common symptoms.

Some children with asthma are free of symptoms most of the time, but may occasionally experience brief periods during which they are short of breath. Others spend much of their days (and nights) coughing and wheezing, until the asthma is properly treated. Crying or even laughing may bring on an attack. Severe episodes, which are less common, may be seen when the patient has a viral respiratory tract infection or is exposed to a heavy load of an allergen or irritant. Asthmatic attacks may last only a few minutes or can go on for hours or even days (a condition called status asthmaticus).

Asthma symptoms can be classified as:

• Mild intermittent: Symptoms occur twice a week or less; nighttime symptoms occur twice a month or less; symptoms are brief and last a few hours to a few days; no symptoms occur between more severe episodes.
• Mild persistent: Symptoms occur more than twice a week but not every day; nighttime symptoms occur more than twice a month; episodes are severe and sometimes affect activity.
• Moderate persistent: Symptoms occur daily; nighttime symptoms occur more than once a week; quick-relief medication is used daily; symptoms affect daily activities; severe episodes occur twice a week or more and last for days.
• Severe persistent: Symptoms occur continually throughout the day and frequently at night; symptoms affect daily activities and cause the patient to limit activities.

Shortness of breath may cause a patient to become very anxious, sit upright, lean forward, and use the neck or chest wall muscles to help with breathing. These symptoms require emergency attention. In a severe attack that lasts for some time, some of the air sacs in the lung may rupture so that air collects within the chest. This makes it even harder to breathe in adequate amounts of air.

Almost always, even patients with the most severe attacks will recover completely.

When to call the doctor

If a child has the following symptoms, the parent should contact the child's pediatrician:

• inability to participate in normal activities
• missed school due to asthma symptoms
• symptoms that do not improve about 15 minutes after initial treatment with medication
• signs of infection such as increased fatigue or weakness, fever or chills, sore throat, coughing up mucus, yellow or green mucus, sinus drainage, nasal congestion, headaches, or tenderness along the cheekbones

If the parent is unsure about what action to take to treat the child's symptoms, he or she should call the child's doctor.

The parent or caregiver should seek emergency care by calling 911 in most areas when the child has these symptoms or conditions:

• bluish skin tone
• bluish coloration around the lips, fingernail beds, and tongue
• severe wheezing
• uncontrolled coughing
• very rapid breathing
• inability to catch his or her breath
• tightened neck and chest muscles due to breathing difficulty
• inability to perform a peak expiratory flow
• feelings of anxiety or panic
• pale, sweaty face
• difficulty talking
• difficulty walking
• confusion
• dizziness or fainting
• chest pain or pressure