June Thompson explains how
Asthma, already the most common chronic disease in childhood, is on the increase. A survey by the National Asthma Campaign has found that as many as one in seven children have asthma.
What is asthma?
Asthma is an inflammatory condition of the airways or bronchioles (the small tubes that carry air in and out of the lungs). In children with asthma the airways are almost always inflamed. Inflammation causes the tissues that line the airways to swell and produce extra or thick mucus (phlegm). The inflamed airways become more sensitive to trigger factors and react by narrowing. This makes it difficult for air to pass through and sets the scene for an asthma attack.
The most common symptoms are: A cough that lasts for more than a week or a recurrent cough Repeated episodes of wheezing (a high-pitched whistling or hissing sound when breathing out) Shortness of breath Feeling of tightness in the chest Production of phlegm The symptoms are often worse at night or after exercise.
However, not everyone with asthma gets all these symptoms, and not all children who have a cough have asthma. Nor do all children with asthma wheeze. Many children only have symptoms after having a cold. For other children the only symptom may be a dry, irritating cough.
What causes asthma?
It is still not known exactly what causes asthma, why it is on the increase, or why one person gets asthma and another doesn't. It is known that asthma often runs in families and may be inherited, although an asthma gene has not yet been found.
A number of other, environmental, factors may also contribute. Modern lifestyles, such as types of housing, diet and passive smoking, have been implicated. Central heating and fitted carpets, for example, may have caused the house-dust mite, which is the most common allergen in children, to multiply. On the other hand, research has found that living in homes where there is a bit of dust and dirt can protect young children from asthma later in life - so being too houseproud doesn't help. Once a child has asthma, though, measures should be taken to keep the dust down.
Less exposure to early childhood infections may also make children more vulnerable to asthma. It is known that first-born children are more likely to have asthma, while children with older siblings are less likely. This may be because early infections help the development of the immune system. Finally, although there is no evidence that traffic pollution causes asthma, poor air quality can be a trigger if someone already has asthma.
What triggers asthma?
A trigger is anything that irritates the airways and causes symptoms of asthma to appear. Because children with asthma have sensitive airways, everyday things that cause little or no trouble for most people can be a trigger for an asthma attack in these children. Everyone's asthma is different and a child may be allergic to one or more of these common allergens or triggers: Animal dander (that is, flakes from the skin, hair, or feathers of pets) House-dust mite faeces Moulds
Pollens
Some food additives or preservatives Certain medicines (such as aspirin).
Other important asthma triggers have nothing to do with allergies, but cause the same airway changes from breathing in. Examples are cigarette smoke, room deodorisers, paint or petrol fumes, household cleaning products, chemicals, perfumes, and outdoor air pollution. Respiratory infections, such as the common cold, exercise, cold air or sudden changes in air temperature may also trigger an attack. Recent research has found events that cause high levels of stress in children increase the risk of an asthma attack over the following few weeks.
Treatment of asthma
Asthma is a lung disease that can be treated, although there is no cure. It can be very different from one person to another and from one episode (attack) to another. For many children, asthma causes only mild symptoms once in a while, and most children with asthma lead full, active lives. For a few children, however, an untreated asthma attack may be fatal.
Preventing the symptoms is the best way to avoid attacks. Children diagnosed as having asthma will be given medicine through an inhaler. Inhalers send drugs directly to the lungs, and they can be used for both preventer and reliever treatments.
There is a huge array of inhalers, with or without 'spacer' attachments which make use easier for very young children. They are identified by colour for easy recognition. The doctor will prescribe the most appropriate one for the child. There are two main types of medication - preventers, which prevent allergens triggering attacks, and relievers, which treat attacks when they occur. A dose of reliever before going out in the cold air or an extra amount of a reliever when the pollen count is high may help.
Reducing asthma attacks As well as using medication, try to reduce exposure to allergens that you know can trigger a child's asthma. Cigarette smoke is one of the worst triggers for asthma, so help children avoid contact with smoke. And try to build up a child's resistance to colds and chest infections with plenty of fresh food, fresh air and sleep.
House dust mites live in carpets and bedding. Eighty-five per cent of children with asthma are affected by their droppings, which are inhaled through the lungs. Dust mites cannot be eliminated, but the following measures can reduce their numbers: Wash bed linen at 60xC weekly Use barrier covers on bedding Soft toys can collect millions of mites. Remove these from the child's cot or bedroom if possible. If a child has a favourite soft toy, place this in the freezer for 24 hours weekly to kill the mites Vacuum carpets daily and soft furnishings weekly with a high-efficiency vacuum cleaner or one that does not blow out lots of dust D Damp-dust surfaces.
Animals are second to dust mites as a source of allergens. Pets should be kept out of the child's bedroom and the living room.
Reduce humidity or condensation that cause mould by opening windows as much as possible, and keep kitchen and bathroom doors closed when cooking or bathing.
Children in pushchairs are sitting at the same level as car exhausts, so try to avoid taking a child out in rush hours, or pushing them too close to vehicles.
Children's diets have been implicated in asthma, but it takes a specialist to really diagnose it. However, as a nanny you can help if you think foods or additives make the child's asthma worse, by keeping a diary of what they eat for a week or two. Peanuts may trigger an allergic reaction and should be avoided until the age of three. Soya milk can also cause an allergic reaction, but major dietary changes should not be made without consulting a doctor.
National Asthma Campaign helpline: 0845 7010203 (9am to 7pm)
