Asthma in Children
Girish Sharma, MD
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Approximately 17 million Americans have asthma. The cost of illness related to asthma is around $6.2 billion per year in the United States. Each year, an estimated 1.81 million people with asthma require treatment in the emergency department with approximately 500,000 hospitalizations. Children younger than 18 years of age account for 47.8% of the emergency department visits and 34.6% of the hospitalizations due to asthma exacerbations. The magnitude of the impacts of asthma in children is illustrated by the fact that asthma accounts for more hospitalizations in children than any other chronic illness. Moreover, asthma causes children and adolescents to miss school and causes parents to miss days at work. As might be expected, asthma also accounts for more school absences than any other chronic illness.
Asthma is a disorder caused by inflammation in the airways (called bronchi) that lead to the lungs. This inflammation causes airways to tighten and narrow, which blocks air from flowing freely into the lungs, making it hard to breathe. Symptoms include wheezing, breathlessness, chest tightness, and cough, particularly at night or after exercise/activity. The inflammation may be completely or partially reversed with or without medicines.
The inflammation of the airways makes them very sensitive ("twitchy"), resulting in spasm of the airways that tend to narrow, particularly when the lungs are exposed to an insult such as viral infection, allergens, cold air, exposure to smoke, and exercise. Reduced caliber of the airways results in a reduction in the amount of air going into lungs, making it hard to breathe. Things that trigger asthma differ from person to person. Some common triggers are exercise, allergies, viral infections, and smoke. When a person with asthma is exposed to a trigger, their sensitive airways become inflamed, swell up, and fill with mucus. In addition, the muscles lining the swollen airways tighten and constrict, making them even more narrowed and blocked (obstructed).
So an asthma flare is caused by three important changes in the airways that make breathing more difficult:
Anyone can have asthma, including infants and adolescents. The tendency to develop asthma is often inherited; in other words, asthma can be more common in certain families. Moreover, certain environmental factors, such as viral infections specially infection with respiratory syncytial virus or rhinovirus, may bring the onset of asthma. Recent medical reports suggest that patients with asthma are likely to develop more severe problems due to H1N1 infection. It has also been suggested that there is an association between day-care environment and wheezing. Those who started day care early were twice as likely to develop wheezing in their first year of life as those who did not attend day care. Other environmental factors, such as exposure to smoke, allergens, automobile emissions, and environmental pollutants, have been associated with asthma.
Many children with asthma can breathe normally for weeks or months between flares. When flares do occur, they often seem to happen without warning. Actually, a flare usually develops over time, involving a complicated process of increasing airway obstruction.
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