What is Asthma?
Asthma is a chronic lung disease that causes airways to become inflamed, leading to symptoms such as coughing, wheezing, and shortness of breath. Anyone can have asthma, including infants and adolescents. Asthma flare-ups (also called an asthma attack, flare, episode, or exacerbation). The tendency to develop asthma is often inherited.
What happens during an asthma flare-up?
Many kids with asthma can breathe normally for weeks or months between flare-ups. When flare-ups do occur, they often seem to happen without warning. Actually, an asthma flare-up usually develops over time, involving a complicated process of increasing airway obstruction.
All children with asthma have airways that are inflamed, which means that they swell and produce lots of thick mucus. In addition, their airways are also overly sensitive, or hyper-reactive, to certain asthma triggers.
“Anyone can have asthma, including infants and adolescents.”
When exposed to these triggers, the muscles surrounding the airways tend to tighten, which makes the already clogged airways even narrower. Things that trigger flare-ups differ from one person to another. Some common triggers are exercise, allergies, viral infections, and smoke.
So an asthma flare-up is caused by three important changes in the airways:
- swelling of the lining of the airways
- excess mucus that results in congestion and mucus “plugs” that get caught in the narrowed airways
- bronchoconstriction, which refers to the tightening of the muscles surrounding the airways
Together, the swelling, excess mucus, and bronchoconstriction narrow the airways and make it difficult to move air through (like breathing through a straw). During an asthma flare-up, children may experience coughing, wheezing (a breezy whistling sound in the chest when breathing), chest tightness, increased heart rate, sweating, and shortness of breath. ”I often feel some kind of heaviness on my chest, as I can’t fill my lungs with air. My heart beats very quickly and I get a terrible headache due to low oxygen intake”, describes Dahlia Zaki who has a long family history of asthma.
What can cause an Asthma Flare-up?
People with asthma have airways that are overly sensitive to certain things that normally might not bother people without asthma. These things are called triggers because they bring on asthma symptoms. Common triggers include:
- cold air
- infections, such as colds
- animal dander
- dust mites
A lot of people who have asthma also have allergies. For these people, the allergens – the things that cause the allergic symptoms – can also cause asthma flare-ups. “My sons get attacks if they eat eggs or mandarins. Strong scents and smoke also trigger their asthma. As for me, it’s usually dust, humidity and emotional disturbances in addition to smoke”, says Dahlia Zaki. Nahla Mohamed who has two asthmatic daughters also mentions that they get severe attacks during seasonal changes especially in autumn and spring as well as with colds. “The black cloud resulting from burning rice straw also plays a major role”, she says. Her daughter, Magda reacts to dust, pets, birds and perfume.
If left untreated, a flare-up can last for several hours or even several days. In some cases, it can even be life-threatening. Nahla illustrates this telling “Once Magda had a terrible attack to the extent that she couldn’t swallow her saliva. My other daughter Nadia once had to cough for three hours continuously to the extent that the doctor was afraid that her lungs would be permanently damaged. He had to give her cortisone injection right on the spot”. Rescue medications often take care of the symptoms pretty quickly. Your child should feel better once the flare-up is over, although it can take several days to completely resolve.
“Asthma severity can both worsen and improve over time, placing the child in a new asthma category that requires different treatment.”
How is Asthma diagnosed?
Diagnosing asthma can be tricky and time-consuming because kids with asthma can have very different patterns of symptoms. For example, some kids cough constantly at night but seem fine during the day, while others seem to get frequent chest colds that don’t go away. It’s not uncommon for children to have symptoms like these for months before being seen by a doctor.
When considering a diagnosis of asthma, a doctor rules out other possible causes of a child’s symptoms. He or she asks questions about the family’s asthma and allergy history, performs a physical exam, and possibly orders laboratory tests such as chest X-rays, blood tests, or lung function tests.
During this process, parents must provide the doctor with detailed information, such as:
- symptoms: how severe they are, when and where they occur, how frequently they occur, how long they last, and how they go away
- allergies: the child’s and the family’s allergy history
- illnesses: how often the child gets colds, how severe they are, and how long they last
- triggers: exposure to allergens and things in the air that can irritate the airways, recent life changes or stressful events, or other things that seem to lead to a flare-up
This information helps the doctor understand the pattern of symptoms, which can help determine what type of asthma the child has and how best to treat it.
Nahla Mohamed herself was asthmatic as a child. That is why it was easy to determine that her daughters had asthma. Same goes for Dahlia Zaki. At the age of two months, as she started putting her son Mohamed on his stomach, she noticed that his color became darker and he started coughing incessantly. His doctor used to call him wheezy chest. As for her other son Gamal, she discovered the disease when he was one month old. He used to get severe cough attacks, especially when he used to cry at night while becoming short of breath.
To confirm the diagnosis of asthma, a breathing test may be performed using a spirometer, a machine that analyzes airflow through the airways. A spirometer can also be used to see if the child’s breathing problems can be helped with medication, a primary characteristic of asthma.
How can a Flare-up be predicted?
The severity and duration of asthma flare-ups vary from one person to another and even from attack to attack. Flare-ups may happen without warning, with sudden coughing, shortness of breath, and wheezing. But because people with asthma have inflamed airways that worsen with gradual exposure to triggers, flare-ups can also build up over time, especially in people whose asthma isn’t well controlled.
“Diagnosing asthma can be tricky and time-consuming because kids with asthma can have very different patterns of symptoms.”
Flare-ups can and should be treated at their earliest stages, so it’s a good idea to recognize early warning signs that a child might experience just before a flare-up occurs. These clues are unique to each child and may be the same or different with each asthma flare-up. Some early warning signs include:
- coughing, even if your child has no cold
- throat clearing
- rapid or irregular breathing
- unusual fatigue
- trouble sitting or standing still
- restless sleep
“With my old daughter, it is easy to know that an attack is coming soon, as she cannot run well due to shortness of breath. Her tone of voice changes and there is a little cough accompanying it. Accordingly, I give her the prescribed medicine or I put her on the nebulizer. However, my younger one does not show any symptoms at all. She just wakes up at 2 or 3 a.m. suffocating”, explains Nahla.
A peak flow meter can also be a useful tool in predicting when a flare-up may be on its way. However, not all flare-ups can be prevented. Because they can be life threatening, asthma flare-ups demand attention. Your child might need to take rescue medication, visit the doctor, or even go to the hospital. Having a set of instructions called an asthma action plan can help you know which course of action is needed.
A child’s asthma symptoms will fall into one of four main categories of asthma, each with different characteristics and requiring different treatment approaches:
- Mild intermittent asthma
A child who has brief episodes of wheezing, coughing, or shortness of breath occurring no more than twice a week is said to have mild intermittent asthma. Symptoms between flare-ups are rare, with the exception of one or two instances per month of mild symptoms at night.
- Mild persistent asthma
Kids with episodes of wheezing, coughing, or shortness of breath that occur more than twice a week but less than once a day are said to have mild persistent asthma. Symptoms usually occur at least twice a month at night and flare-ups may affect normal physical activity.
- Moderate persistent asthma
Kids with moderate persistent asthma have daily symptoms and require daily medication. Nighttime symptoms occur more than once a week. Flare-ups occur more than twice a week, last for several days, and usually affect normal physical activity.
- Severe persistent asthma
Kids with severe persistent asthma have symptoms continuously. They tend to have frequent flare-ups that may require emergency treatment and even hospitalization. Many children with severe persistent asthma have frequent symptoms at night and can handle only limited physical activity.
Even mild asthma should never be ignored, since in between flare-ups, airway inflammation exists. Asthma severity can both worsen and improve over time, placing the child in a new asthma category that requires different treatment.
Preventing Asthma Flare-ups
By taking the following steps, you and your child can also help prevent flare-ups:
- Always make sure you or your child has his rescue medication on hand such an inhaler and spacer. Rescue medications are a type of medication used to relieve asthma symptoms or to treat an asthma flare-up. They’re also known as quick-relief or fast-acting medications because they act quickly to stop symptoms, but the effects aren’t long lasting. Most are inhaled and work by relaxing the muscle around the airways (the tubes that carry air into and out of the lungs), making the airways wider and allowing breathing to become easier within minutes. They don’t treat the underlying inflammation of the airways.
- Encourage and help your child avoid substances that you know trigger flare-ups. “I stopped wearing pullovers as I had to carry my newborns a lot. It is not worth their sickness”, says Dahlia Zaki. Nahla Mohamed gives some extra tips such as removing the carpet from the child’s room, regularly washing curtains or even removing them, regularly washing soft toys and cooling them in the freezer. Blankets should not cover up the baby to be near the nose. One can even make a cover for the blanket if necessary. Room ventilation is of great importance. All this might reduce the attacks.
- Make sure your child takes his or her controller medicine (also called preventive or maintenance medications) as the doctor has directed – even if your child is feeling better, it’s important not to skip it. Usually these should be taken on a daily basis to control asthma and prevent symptoms from developing. Most work by reducing inflammation of the airways; others work by relaxing the airways and making them wider. Controller medications are slow acting, meaning that they can take days or even weeks to begin working. They don’t provide immediate relief of symptoms and shouldn’t be used when an effect is needed quickly.
- Work with your child’s doctor to follow an asthma action plan.
- In case of an attack, it is of utmost importance that parents do not panic so that mistakes would not happen. “My son once had a severe flare-up as he was a baby. I panicked and I gave him a lot of medications, one medicine after the other. On my way to the hospital, I held him up sitting and the attack calmed down. I completely forgot that when you hold your baby in an upright sitting position, breathing becomes easier. We arrived at the hospital while my son had an overdose of everything”, tells Dahlia Zaki.
Any airway infection should not be ignored, as it can lead to more severe attacks. It should never remain untreated.
 An asthma action plan is a set of individualized written instructions, designed with a doctor, that detail how a person with asthma should manage his or her asthma at home. The plan includes: a list of what triggers the person’s symptoms and how to avoid these triggers, a list of symptoms to watch for and what to do should they occur, and the names and doses of medications the person needs and when to use them. It can also include emergency telephone numbers, locations of emergency care, and instructions on when to contact the doctor or when to go right to the emergency department. If the plan is kept up to date and followed closely, asthma symptoms can be prevented or treated and a person’s asthma can be well controlled.