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Asthma in children; predisposing factor, treatment and prevention

October 31, 2017 - Olusanya Omokorede

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Asthma is a chronic disease of the airways that makes breathing difficult. With asthma, there is inflammation of the air passage that results in a temporary narrowing of the airways that carry oxygen to the lungs

Asthma is one of the most common chronic disease affecting children. About 300 million people have asthma worldwide. The World Health Organization (WHO) estimates about 250 000 deaths from asthma every year, mainly in low- and middle-income countries. Children younger than 18 years of age account for a large portion of emergency department visits and hospitalizations due to asthma exacerbations.

The prevalence of asthma has been on the rise in Africa due to increased urbanization. The prevalence between 1995 and 2002 among children aged 13-14 years old in South Africa increased from 16.1% to 20.3% while Nigeria (West Africa) recorded an increase from 10.9% to 13.0%. Ethiopia (Horn of Africa) reported an increase from 6.2% to 9.1%, and Kenya (East Africa) an increase from 13.9% to 18.0%.

According to W.H.O. asthma accounts for about 500,000 annual hospitalizations and 34.6% of these cases are aged 18 years or younger.

The prevalence is 8-10 times higher in developed countries (such as United States, Great Britain, Australia and New Zealand) than in the developing countries

In the United States of America, the prevalence of asthma is higher in minority groups (eg, blacks, Hispanics) than in other groups; however, findings from one study suggest that much of the recent increase in the prevalence is attributed to asthma in white children. Approximately 5-8% of all black children have asthma at some time. The prevalence in Hispanic children is reported to be as high as 15%. In blacks, the death rate is consistently higher than in whites.

In most children, asthma develops before age 5 years, and, in more than half, asthma develops before age 3 years. Before puberty, the prevalence of asthma is 3 times higher in boys than in girls. During adolescence, the prevalence is equal among males and females. Adult-onset asthma is more common in women than in men.

 

SIGNS AND SYMPTOMS OF ASTHMA IN CHILDREN

  • Wheezing: A musical, high-pitched whistling sound produced by airflow turbulence is one of the most common symptoms of asthma. The wheezing is usually during exhalation.
  • Cough: Usually, the cough is nonproductive and nonparoxysmal; coughing may be present with wheezing.
  • Cough at night or with exercise: Coughing may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma; children with nocturnal asthma tend to cough after midnight, during the early hours of morning
  • Shortness of breath
  • Chest tightness: A history of tightness or pain in the chest may be present with or without other symptoms of asthma, especially in exercise-induced or nocturnal asthma

 

 

PREDISPOSING FACTORS TO ASTHMA IN CHILDREN

  • Heredity: Asthma can be transmitted  from one generation to another via genetic traits which means that if you have asthma as a parent or any one in the family, there is a every possibility of your children developing asthma as well.
  • Infections; rhinovirus infection in infancy has been found to increase the chances of having asthma before three years
  • Race: Asthma incidence is high in Australia and New Zealand and in black children than in white children in the United States.  Although, these differences may be attributable more to socio-economic factors than a racial disposition. Others include allergen exposure and dietary factors .
  • Parental smoking:  these increases the chances of a child having asthma and it is worse if it’s the mother that smokes. The more cigarettes the mother smoked, the greater the risk of asthma.
  • Sex: It is more common amongst males before puberty but it becomes equal after puberty.
  • Allergens: This can be foods, household inhalants such as; animal allergens, moulds, fungi, roach allergens, dust mite and seasonal outdoor allergens such as mold spores, pollens, grass, trees.
  • Maternal stress during the pre- and postnatal period increases the chances of having asthma. This was only true in non-atopic mothers.
  • Maternal obesity (BMI ≥35) and gestational weight gain (≥25 kg) during pregnancy increases the risk of asthma and wheezing in the offspring.

However, it’s has been shown that the prevalence of asthma is reduced in children who experience the following events:

  1. Certain infections (Mycobacterium tuberculosis, measles, or hepatitis A)
  2. Rural living
  3. Exposure to other children such as presence of older siblings and early enrollment in childcare
  4. Less frequent use of antibiotics, including in the first week of life
  5. Early introduction of fish in the diet

TREATMENT OF ASTHMA IN CHILDREN 

  • Once you notice your child has any of the above symptoms, it’s important you present to your doctor. The goal of treatment is to educate about prevention, control environmental factors and pharmacological treatment.
  • Prevention is very important in the management of asthma. It is important the child avoids the triggers that can cause an asthmatic attack.
  • Pharmacological treatment involves the use of nebulizers, inhalers and at times drugs such as steroids. Nebulizers and inhalers contain drugs which help to open up the airway and reduce secretions which obstruct the airway. Inhaled treatment is recommendable so as to reduce the systematic side effect of the drugs that characterises oral treatment.
  • Inflammatory conditions of the upper airways such as; allergic rhinitis, sinusitis, or chronic and persistent infections. Patient must treat such infections before they can completely control their asthmatic symptoms.

 

PREVENTION OF ASTHMA IN CHILDREN

It is important to identify asthma triggers and take steps to avoid them. Some asthma triggers may include:

  1. Air pollution
  2. Allergies
  3. Cold air
  4. A cold or flu virus
  5. Sinusitis
  6. Smoke
  7. Fragrances

 

PROGNOSIS

  • Children with mild asthma who are asymptomatic between attacks are likely to improve and be symptom-free later in life.
  • Children with asthma appear to have less severe symptoms as they enter adolescence, but half of these children continue to have asthma. Asthma has a tendency to remit during puberty, with a somewhat earlier remission in girls.
  • Globally, morbidity and mortality associated with asthma have increased over the last 2 decades. This increase is attributed to increasing urbanization.
  • According to the most recent report from the US Centre for Disease Control and the National Center for Health Statistics, 187 children aged 0-17 years died from asthma, or 0.3 deaths per 100,000 children compared with 1.9 deaths per 100,000 adults aged 18 or older in the year 2002. Non-Hispanic blacks were the most likely to die from asthma and had an asthma death rate more than 200% higher than non-Hispanic whites and 160% higher than Hispanics.

Olusanya Omokorede

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