Asthma (part 1)
Dear Dr. Lanny:
Last winter my 6-year-old daughter had a cough that seemed to last forever, and from time to time she's made some wheezy noises; they sound like "hee-eeh, hee-eeh." As the soccer season starts, I've started to hear the wheezing sound again. We're wondering if she has asthma. How do we find out, and what do we do if she does have asthma? Is this a lifetime thing?
Wheezing is a high-pitched, drawn-out expiration; that is, the breathing-out part of breathing. Although it can come from other causes, wheezing most likely indicates asthma. Asthma can be defined as a reversible, recurring narrowing of the air passages that causes the patient to have wheezing or a feeling of breathlessness or chest tightness or coughing--or any combination of these symptoms.
An asthmatic attack can be triggered by many different factors, particularly allergies, colds, irritants such as cigarette smoke, extreme cold air or vigorous exercise. In the past, treatment was directed at relaxing tightened muscles in the walls of the airways. More recently it has been recognized that the walls of the airways also become inflamed and swollen. This swelling also interferes with air movement. Understanding the important role of inflammation has allowed for more effective types of treatment, which I will address in the next column.
Some 15 to 20 million Americans are estimated to be affected by asthma. Accurate numbers are difficult to come by since many patients can be falsely diagnosed with the illness, and many are not diagnosed at all. But clearly asthma is a major personal and public health problem in the United States and the rest of the world.
Returning now to your child. There are many causes of cough. Infection can trigger asthmatic symptoms, and that could be involved in last winter's long-standing cough. It would be harder to explain the soccer-related problems based on illness as she is not presently sick. Now, unfortunately, we come to the fact that children can have multiple triggering factors. In your daughter's case, illness, exposure to cold air and vigorous exercise could all be a part of the picture.How do we know your daughter even has asthma? At this point we don't, although the story is quite suspicious. If exercise-related asthma is a part of the story, then the likelihood is that each time she goes out and gives 100 percent (despite sports announcers' babble, 100 percent is as much as you can give) she is likely to develop the same problems. It may be shortness of breath with the game, or, interestingly, it may be a cough when she stops playing.
Ideally, her doctor gets to listen to her when these symptoms are occurring. It is possible for the doctor to run her around the building a few times to provoke the symptoms. There are also special lung function tests that your doctor may choose to do in her office or with the help of a pulmonary specialist.
If symptoms occur with a cold-type illness, then a visit to the doctor's office when your child is sick is likely to be diagnostic. There are children, particularly in the first few years of life, who only wheeze with a cold, and your doctor may call this WARI (Wheezing with A Respiratory Illness) rather than asthma. Treatment will be the same, but the prognosis is particularly positive.
You ask if this is a life-long illness. Very tough to answer, as outcomes are variable. Do you or her father have asthma? Allergies? What has been your history? Certainly not all, but many children with asthma seem to "outgrow" the symptoms by 10 to 12 years of age. I don't believe you can say to someone, "You're cured!," but you can be very encouraging that the future is clear breathing.
There is much to say about treatment, but that will have to wait for our next installment, "Harry Potter and The Prisoner of Asthmakaban."Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family's health care. Send e-mail to him at email@example.com.