With  change in the weather and the winters knocking at our doors , I thought this topic needs to be covered now. In addition, in India, winters are associated  not only with  cold weather but festivities , fire crackers and increased levels of pollution , all the above factors exacerbating bronchitis in children and adults . As it is a vast topic, I have divided it into two parts , first part dealing with factors and changes in a child’s airways in asthma/ wheezy conditions and part two helping parents to understand the various treatment modalities.

Childhood Asthma is a chronic condition which presents itself in the form of dry cough,wheeze , chest tightness , chest pain or difficulty in breathing. These symptoms can occur periodically with various trigger factors.

The small airways in lungs become narrow and inflamed which limits the flow of the air out of the lungs . This causes breathlessness, wheeze and chest tightness . These symptoms are almost completely reversible by correct asthma treatment. The figure below demonstrates narrowing of small airways :

Factors which increase the risk of Asthma:  Listed below are the common risk factors which have been identified. However, asthma can occur  even in children who do not have family history, live in non-polluted areas and have not been exposed to smoke

  1. Viral infections : Certain viruses can trigger changes in a child’s airway giving rise to symptoms of asthma
  2. Pollution :Both Indoor and outdoor
  3. Exposure to tobacco  smoke:  Smoking both during pregnancy and exposure during childhood increases risk
  4. Family history: Of asthma, allergies, eczema, allergic rhinitis ( frequent multiple sneezes)
  5. Stress

Symptoms of Childhood Asthma :

  1. Cough and wheeze : The cough is usually dry in nature and most commonly noticed during sleep and early morning.  These can come and go throughout the day.Wheeze is a musical sound that’s heard with a stethoscope because of narrowed airways . The video below demonstrates what a wheeze sounds like :
  2. Breathlessness : Child may find it difficult to breathe and you might notice fast breathing in your child.
  3. Chest tightness and pain
  4. As these symptoms are common in children before the age of three, a diagnosis of asthma is given usually after the age of 3 years if these symptoms continue to happen when the kids are expected to grow out of it.Asthma triggers — Wheezing and coughing may occur at any time, but certain triggers are known to worsen asthma in many children.
    1. Environmental conditions — Cold air, change in weather, rain, or wind may trigger asthma symptoms. Pollution and exhaust fumes can do the same.
    2. Upper respiratory infections — Viral upper respiratory infections (head and chest colds) Children with asthma should use their asthma treatments for cough and chest congestion rather than over-the-counter cold remedies, which are not effective therapies for asthma.
    3. Exercise — Narrowing of the airways can be triggered by exercise. This is called exercise-induced asthma. Breathlessness, wheeze, and/or cough usually occur within 5 to 10 minutes of the cool-down period after vigorous exercise but may occur during exercise. These symptoms tend to disappear after 20 to 45 minutes.
    4. Allergens and irritants — Indoor and outdoor allergens are an important trigger of childhood asthma, particularly for children older than three years of age. Dampness and rainy season, house dust , animal hair , paints, perfumes, fumes can all trigger asthma.

    Symptom patterns — Children with chronic asthma may have one of several distinct patterns of symptoms, and the asthma pattern may change over time:

    • Intermittent asthma attacks with no symptoms between attacks
    • Chronic symptoms with intermittent worsening
    • Attacks that become more severe or frequent over time
    • Morning “dipping,” when symptoms worsen in the morning and improve as the day progresses.
    • Symptoms that begin during upper respiratory tract infections (eg, colds) and linger for several weeks after, with resolution during warmer weather.

    Hopefully the above information will help you to understand your child’s asthma better . I will cover different modalities of treatment in Part 2 of this topic . Definitely before the temperature dips and festivities begin 😉 !


    Uptodate.com : Asthma symptoms and disgnosis in Children : Beyond the Basics

    Childhood Asthma : Symptoms and Causes : http://www.mayoclinic.org


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