Getting Ahead of Asthma This Spring

For many parents of children with asthma, spring is a season to be on guard because of risk for deteriorating asthma. Often, this manifests with children who experience cough, wheezing, chest tightness or difficulty breathing with a variety of triggers. Unfortunately, it may not be easy for parents to connect these symptoms with a chronic condition such as asthma since numerous school season viral infections overlap with these problems and are often easy to identify as "just another infection". However, asthma is widely considered to be the most common childhood chronic disease and is a major cause of chronic or recurrent respiratory symptoms. Moreover, uncontrolled asthma can lead to numerous school absences, sports limitations, and recurrent pediatrician visits for upper and lower respiratory infections, bronchitis, and pneumonia.

Knowing the Red Flags

It is often difficult to distinguish asthma from common acute childhood illnesses, but certain unique features are often present. Asthma is often a "multi-trigger" condition, with cough, wheezing and chest tightness triggered by infection, high allergen days, cold weather, exercise and poor quality. It is common for excessive coughing and breathlessness to be triggered by a variety of common activities even as minor laughing or raising your voice. For children in athletics, the condition may trigger inappropriate athletics limitations that did not previously exist and/or trigger breathlessness that is prolonged after intense exercise. Primary care physicians may signal signs of asthma without naming it because they may prescribe inhaled medications or oral corticosteroids, medications typically used in the treatment of acute asthma exacerbations. At other times, an asthma exacerbation may diagnosed as bronchitis or even pneumonia.

Making a Diagnosis, Having a Plan

Since identifying the condition can often be a challenge, both the NIH NHLBI (National Heart Lung and Blood Institute) Guidelines for Asthma and GINA (Global Initiative for Asthma) recommend utilizing pulmonary function testing to help establish the diagnosis. A variety of such tests have been validated for this purpose including pre/post bronchodilator spirometry, lung volumes measurement, impulse oscillometry, and biomarker testing (FENO). All of these tests are available in an outpatient clinic setting and have been supported with strong evidence to diagnose and monitor persistent asthma. A significant percentage of children with asthma will benefit from prevention medication and a written Asthma Action Plan that can help parents and schools with guidance on identifying and treating asthma symptoms out of the office. A large body of well established research such prevention strategies is highly effective in reducing the risk for severe exacerbation such as emergency room visits, hospitalizations, and oral steroid use, as well as reducing quality of life burdens on children such as missed days of school and exercise symptoms.

Severe Asthma: What are the next steps?

Approximately 5% of children with asthma have a severe, difficult to treat variant called severe persistent asthma. Children with this form of asthma have the highest number of missed days of school, athletics restrictions, asthma exacerbations requiring steroids and greatest risk for emergency room visits and hospitalizations. Parents of children with this form of asthma may see certain seasons like spring as major triggers for deterioration, despite prevention medications and an asthma plan. Parents should know that the latest advances in asthma care have revolutionized the care for these children. By utilizing sophisticated lung function testing and biomarker assessment, asthma "phenotyping" and "endotyping" become possible and make it easier to understand patterns of disease and therapies may help. Advance instruction on inhaled therapies and asthma education can provide needed boosts to already utilized prevention strategies. Other chronic conditions or "comorbidities" may also be diagnosed (sinus disease, reflux esophagitis, etc) that worsen asthma and can be simultaneously treated. Finally, asthma "biologics" or monoclonal antibodies selected to target therapy for hard to treat asthma can be life changing and help restore a normal quality of life.

This spring, be sure to seek a Pediatric Pulmonologist's consultation to explore new pathways to better asthma control and easier breathing.