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Asthma Overview

By Gregory Lawton, MD

“She can’t have asthma,” the parent implores. “She dances.” Or “He plays lacrosse.” Or “She’s never seen a specialist or been to the emergency room (ER).”

Such statements are common in my practice and they are spoken out of fear, ignorance or denial. Such statements offer all primary care physicians and myself an opportunity to have a significant impact in the lives of our patients and their families.

When I sit down with families, I don’t start with numbers, because parents are concerned with their child and their child’s diagnosis. However, the numbers are striking. Asthma affects one in every 13 school children in the United States. It results in over 650,000 yearly visits to the ER can be blamed for over 10 million missed school days each year.

The old name for asthma is Reactive Airway Disease. I like this term, I explain, because it conveys a visual image. Asthma happens when a person’s airways react to something. Common triggers include colds, allergies, exercise, cold air or cigarette smoke. When asthma-prone airways encounter a potential trigger, they react in a couple of ways.

First, the airways narrow. Breathing through a narrow airway is like drinking a thick milkshake through a cocktail straw. Good luck. Second, swelling or inflammation can make the lungs less efficient at doing their job.

When airways react like this, a person may wheeze (this sound is produced when air passes through narrowed airways and sounds a bit like a rough, medium-pitched whistle), cough, or both. A persistent cough at night, frequent or long-lasting colds, or cough with physical activity may also indicate asthma.

According to the National Institutes of Health, the frequency and severity of a person’s symptoms dictate the appropriate management. Asthma management is divided into the Prevention phase and the Treatment phase, and makes use of several medications. The trade or company names of several of these medications are listed here:

Prevention medications - for daily, regular use

Inhaled steroids (decrease airway inflammation) Flovent, Aerobid, and Advair (via inhaler) Pulmicort (via air pump or nebulizer) Leukotriene modifiers (interfere with the asthma-reaction) Singulair or Accolate Treatment medications - for onset or worsening of asthma symptoms

Airway-widening medications Albuterol, Maxair, and Xopenex (via inhaler or nebulizer) Oral steroids (decrease moderate to severe inflammation) Prednisone, Orapred, or Pediapred (tablets or liquid) Many parents are concerned about the side effects of these medications. I tell parents that I share their concerns but also worry about the side effects of under-treated or ignored asthma, such as frequent infections, missed days of school (and, for the parents, work), sub-optimal athletic performance, visits to the doctor’s office or ER, or worse.

Many parents want to know if their child will “grow out of it.” I pull out a coin. (The answer really is around 50 percent).

Many parents want to prevent asthma attacks. I encourage three things:

Maintain informed and open communication between parents, physicians, coaches, and school officials; Adhere to an asthma action plan, which is an individualized guide that indicates what medications should be used and when, based on the child’s symptoms; Get a flu vaccine every October.

I like to tell parents that “she can still be a dancer” or “he can still be a lacrosse player” AND have asthma. If we all manage asthma appropriately, the world will have healthier dancers and lacrosse players.

Gregory Lawton, M.D. is board certified by the American Board of Pediatrics and a Fellow of the American Academy of Pediatrics. He is a member of the medical staff at The Children's Hospital of Philadelphia and practices at Kids First West Chester. Children's Hospital operates the largest pediatric healthcare system in the U.S. with more than 40 locations in PA, NJ, and DE, which includes 27 Kids First pediatric and adolescent primary care practices. For more information please visit www.chop.edu.