It’s hard to diagnose children with asthma

asthmaAsthma is the No. 1 reason that children miss school in the United States and the most common chronic illness that sends kids to the emergency room.

Some children have only mild, occasional asthma flare-ups, or only show signs after exercising, while others have such severe asthma that it affects their activity level and causes changes in the way their lungs function.

Asthma is a chronic inflammatory lung disease that causes airways to tighten. Asthma flare-ups often appear to happen without warning, even after weeks or months without symptoms. All children who suffer from asthma have airways that are overly sensitive to triggers, such as exercise, allergies, viral infections and smoke. When children with asthma are exposed to triggers such as these, their airway linings become inflamed, swollen and filled with mucus, and the muscles that line the airways tighten and shrink, which makes it difficult for air to move through them. A child experiencing an asthma flare-up may cough, wheeze and sweat, and may feel tightness in the chest, increased heart rate and shortness of breath.

There are four main categories of asthma:

• Mild intermittent asthma — brief flare-ups that occur no more than twice a week. The child rarely shows symptoms between flare-ups.

• Mild persistent asthma — flare-ups more than twice a week and symptoms occur at least twice a month and may affect normal physical activity.

• Moderate persistent asthma — daily symptoms. The child needs daily medication.

• Severe persistent asthma — continuous symptoms with frequent wheezing, coughing or shortness of breath that may require emergency treatment or hospitalization.

It’s not easy to diagnose asthma, because children with asthma have different patterns of symptoms. Some children may cough all night but seem fine during the day, while others seem to get chest colds that don’t go away easily. Doctors normally rule out all other possible causes of a child’s symptoms before diagnosing asthma. The doctor may ask the family for asthma and allergy history, perform a physical exam and order tests, such as chest X-rays, blood tests and allergy skin tests.

The doctor will also want to know about the severity of symptoms; when and how often symptoms occur and how long they last; the child’s allergies; how often the child gets colds; and things that seem to trigger the flare-ups.

Each category of asthma is treated differently, because no single remedy works for every child. There are two categories of asthma medications: quick-relief, or “rescue,” medication, and long-term preventative, or “controller,” medications. Prescription asthma medications treat symptoms and causes, so they control asthma effectively. Over-the-counter medicines, home remedies and herbal medicines should not be substituted for prescription asthma medicines, because they cannot quickly and effectively treat the causes or reverse the flare-ups.

Your doctor will provide a written, step-by-step plan, detailing what to do between flare-ups and how to recognize and manage them when they do occur. Families that take the time to learn more about asthma are often the most successful in controlling it. Check out local support groups or contact organizations, such as the American College of Allergy, Asthma and Immunology at 800-842-7777 or the American Lung Association at 800-LUNGUSA.

Sally Robinson is a professor of pediatrics at UTMB Children’s Hospital, and Keith Bly is a hospitalist and assistant professor of pediatrics. This column is not intended to replace the advice of a physician. For information, contact your pediatrician. Or, contact Robinson and Bly at To view past articles, visit the UTMB Web site at

via Galvestone Today