The diagnosis of asthma is confirmed in children above the age of 6 years. In general boys under 12 years of age are more affected than girls of that same age group. However as children grow older, after puberty girls are more affected.
About one third of children under the age of 3 years have episodic expiratory wheeze (that is when a child wheezes during expiration). This occurs typically when a child has a viral infection. Parents can become very worried and assume that their child has asthma, but this is not always the case. More than 50% of children with episodic expiratory wheeze will grow out of this by the time they are 6 years old and the remaining will have symptoms when they are adults.
Asthma is defined as episodes of bronchus obstruction and increased sensitivity of the respiratory tract due to allergic and non-allergic agents. This can lead to a chronic infection with eosinophils in the airways.
Examples of allergic agents include
- Dogs/cats or other furry animals
- Housemites (this is one of the most important causes of allergic agents and most often causes symptoms during the fall and winter period)
- Pollen from trees, flowers and/or grass
- Seasonal changes
Examples of non-allergic agents include:
- Exercise or increased emotional state
- Viral infections
- Various odours (around the home or at work)
Protective versus non-protective factors in asthma
- Genetic factors including eczema is associated with asthma
- Social factors such as second or third hand smoke can cause asthma
- Breastfeeding can provide protection against asthma
- Chronic viral infections at young age can be protective against asthma
- Obesity has been associated with asthma
Things your GP will ask you about your child
- is there an audible wheeze
- How severe are breathing difficulties if any
- Do symptoms occur mainly at night
- Are there any episodes when the child does not have any symptoms
- What are the potential allergic or non-allergic factors
- If anyone smokes in the near vicinity of the child
- What if any are diseases that occur in the family
4 things the GP examines looks at in a child with wheeze
- Signs of respiratory distress
- Increased respiratory rate, children have higher frequency compared to adults.
- Ear-nose-throat inspections for signs of congestion or infection
- Skin inspection for signs of eczema or infection
- Growth curve, does the child grow according to his age and height
If needed, a GP can request a blood test call the Radioallergosorbent (RAST) test to detect specific antibodies (IgE) for substances that a child is allergic to. When the GP requests the test, it will dependson the child’s age.
- Less than 6 years of age in the event of a clear allergic component in the history
- Above 6 years must always be done
- RAST for allergies against food is senseless.
Another exam that can be performed is a spirometer which can be done above the age of 6 years. It is best to do this during symptoms in order to get a reliable diagnosis. This way the doctor can determine the effect of medication that is applied during the examination.
A GP will diagnose asthma in children older than 6 years when they have the following symptoms
- Shortness of breath
- Recurrence particularly in the evening
- Positive RAST, history of eczema or family history of asthma
If a GP has doubts about the diagnosis they could consider
- Pseudocroup or known as acute laryngotracheitis
- Foreign item/toy stuck in a child’s throat
- Above 12 years : dysfunctional breaths such as when hyperventilating
- Below 1 year tracheomalacia
“Asthma can either be well controlled or poorly controlled”
GP’s play a vital role in management of childhood asthma:
- Educate parents and children about asthma
- Explain causes,, what the future looks like and how to reduce recurrence of episodes
- Discuss fears and limitations associated with asthma
- Inform on the effect of daily activities such as sport, social life on asthma
- Take time to explain which (various) medication can be used
- Show how the child can inhale the medication properly with use of instructions or videos. Up to 75% of children do not use inhalation medication properly.
- Ensure that both parents and child adhere to follow-up appointments
The GP will advice on other treatment options for asthma such as
- Stop smoking management in case a family member smokes in the vicinity of the child. Even when residues are on the clothes, this can cause a child to develop asthma.
- Influenza vaccination particularly in those that are on corticosteroids
- Clean the house and air it in order to reduce the presence of dust and house mites
- Breathing exercises w
- Physical activity
- Manage obesity
The GP wi start a child on a trial basis with 2 medication
- Short-acting-beta sympathicomimetica (SABA)
- Inhalation corticosteroids (ICS)
Inhalation medication should be provided with a chamber in order to be more effective. Only when the child has shown effective inhalation technique can puffs be used. If a child needs to inhale SABA more than twice a day then the child must be started on ICS. This is important because ICS work on the inflammation component of asthma.
The reason why a GP will want to follow-up with parents and children on inhalation therapy for asthma, is because of the risk of under-treatment. There are reports of children who unfortunately pass away because they are poorly treated and many of them did not attend follow-up with their GP.
The GP will check regularly whether symptoms have improved. If symptoms have improved then your child can continue with the dosage.
Referral to a paediatrician by the GP when
- Indication for ICS in children less than 1 years
- A child is older than 1 year but needs a higher dosis of ICS than standardly allowed
- There are more than 1 episode of severe illness that required prednisolone
- There are co-morbidities that can cause severe complications
- The diagnosis is not fully determined
- If the child is acutely ill and does not respond to treatment provided by the GP
In short: Asthma in children is a diagnosis that is made after the age of 6 years. It is important to determine factors in and outside the home that could trigger an asthma attack. Children can be managed well with medication however it is important that a GP spends time with parents and children with asthma on education and proper use of inhalation medication.
Four things that a GP will do immediately if your child has an asthma attack
- Give salbutamol 100 mcg/dosis dosis-aerosol with chamber, 4 to 8 inhalation (1 inhalation per go in chamber, 5 times inhale and exhale)
- repeat the above after 15 minutes.
- If the child responds the GP can give prednison tablets or drink.
- If the child does not respond then the GP will refer the child to the paediatrician.
Support is widely available for children who suffer from asthma, ask your GP for such services. asthma is either well controlled or poorly controlled. In the latter case, it is often due to non-compliance with medication or follow-up appointments.