INTRODUCTION: 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.
Inflammation of the airways is linked to bronchial hyper responsiveness, which means that the airways leading to the lungs can narrow when they are exposed to anything to which they are sensitive, making it hard to breathe. All children with asthma have airways that are overly sensitive, or hyper reactive to certain asthma triggers. 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).
An asthma flare is caused by 3 important changes in the airways that make breathing more difficult:
- Inflammation of the airways
- Excess mucus that results in congestion and mucus “plugs” that get caught in the narrowed airways
- Bronchoconstriction (bands of muscle lining the airways tighten up)
Anyone can have asthma, including infants and adolescents. The tendency to develop asthma is often inherited; in other words, asthma can run in families.
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.
Symptoms of Asthma
- Wheezing: Wheezing is when the air flowing into the lungs makes a high-pitched whistling sound. Mild wheezing occurs only at the end of a breath when the child is breathing out (expiration or exhalation). More severe wheezing is heard during the whole exhaled breath. Children with even more severe asthma can also have wheezing while they breathe in (inspiration or inhalation). However, during a most extreme asthma attack, wheezing may be absent because almost no air is passing through the airways.
Asthma can occur without wheezing, so wheezing is not necessary for the diagnosis of asthma. Also, wheezing can be associated with other lung disorders, such as cystic fibrosis.
In asthma related to exercise (exercise-induced asthma) or asthma that occurs at night (nocturnal asthma), wheezing may be present only after exercise or during the night.
- Coughing: Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma. Cough due to nocturnal asthma (night time asthma) usually occurs during early hours of the morning, such as 1 am to 4 am. Usually, the child doesn’t cough anything up, so there is no phlegm or mucus. Also, coughing may occur with wheezing.
- Chest tightness: The child may feel like the chest is tight or won’t expand when breathing in, or there may be pain in the chest with or without other symptoms of asthma, especially in exercise-induced or nocturnal asthma.
- Other symptoms: Infants or young children may have a history of coughs or lung infections (bronchitis) or pneumonia. Children with asthma may get coughs every time they get a cold. Most children with chronic or recurrent bronchitis have asthma.
Symptoms can be different depending on whether the asthma episode is mild, moderate, or severe.
- Symptoms during a mild episode: Children may be out of breath after a physical activity, such as walking. They can talk in sentences and lie down, and they may be restless. The feeding may be with interruption; therefore, the infant takes longer to finish feeding.
- Symptoms during a moderately severe episode: Children are out of breath while talking. Infants have a softer shorter cry, and feeding is difficult. There is feeding with interruption and the child may not be able to finish the usual quantity of food/milk.
- Symptoms during a severe episode: Children are out of breath while resting, they sit upright, they talk in words (not sentences), and they are usually restless. Infants are not interested in feeding and are restless and out of breath. Infants may try to start feeding but cannot sustain it due to breathlessness.
- Symptoms indicating that breathing will stop: In addition to the symptoms already described, the child is sleepy and confused. However, adolescents may not have these symptoms until they actually stop breathing. The infant may not be interested in feeding.
- In most children, asthma develops before the age of 5 years, and in more than half, asthma develops before the age of 3 years.
Diagnosing asthma can be difficult and time-consuming because different children with asthma can have very different patterns of symptoms. For example, some kids cough at night but seem fine during the day, while others seem to get frequent chest colds that don’t go away.
To establish a diagnosis of asthma, a doctor rules out every other possible cause of a child’s symptoms. The doctor asks questions about the family’s asthma and allergy history, performs a physical exam, and possibly orders laboratory tests (see Tests Used to Diagnose Asthma). Be sure to provide the doctor with as many details as possible, no matter how unrelated they might seem. In particular, keep track of and report the following:
- Symptoms: How severe are the attacks? When and where do they occur? How often do they occur? How long do they last, and how do they go away?
- Allergies: Does the child or anyone else in the family have any history of allergies?
- Illnesses: How often does the child get a cold, how severe are the colds, and how long do they last?
- Triggers: Has the child been exposed to irritants and allergens? Has the child experienced any recent life changes or stressful events, and do any other things seem to lead to a flare?
This information helps the doctor understand a child’s pattern of symptoms, which can then be compared to the characteristics of different categories of asthma (see below).
The criteria for a diagnosis of asthma are:
- Airflow into the lungs is reduced periodically (due to narrowed airways).
- The symptoms of reduced airflow are at least partially reversible.
- Other diseases and conditions are ruled out.
Categories of asthma
The severity of asthma is classified based on how often the symptoms occur and how bad they are, including symptoms that happen at night, the characteristics of episodes, and lung function. These classifications do not always work well in children because lung function is difficult to measure in younger children. Also, children often have asthma that is triggered by infections, and this kind of asthma does not fit into any category. A child’s symptoms can be categorized into one of four main categories of asthma, each with different characteristics and requiring different treatment approaches.
- Mild intermittent asthma: Brief episodes of wheezing, coughing, or shortness of breath that occur no more than twice a week are called mild intermittent asthma. Children rarely have symptoms between episodes (maybe just one or two flare-ups per month involving mild symptoms at night). Mild asthma should never be ignored because, even between flares, airways are inflamed.
- Mild persistent asthma: Episodes of wheezing, coughing, or shortness of breath that occur more than twice a week but less than once a day are called mild persistent asthma. Symptoms usually occur at least twice a month at night and may affect normal physical activity.
- Moderate persistent asthma: Symptoms occurring every day and requiring medication every day are called moderate persistent asthma. Nighttime symptoms occur more than once a week. Episodes of wheezing, coughing, or shortness of breath occur more than twice a week and may last for several days. These symptoms affect normal physical activity.
- Severe persistent asthma: Children with severe persistent asthma have symptoms continuously. Episodes of wheezing, coughing, or shortness of breath are frequent and 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.
Causes of Asthma
Asthma in children usually has many causes, or triggers. These triggers may change as a child ages. A child’s reaction to a trigger may also change with treatment. Viral infections can increase the likelihood of an asthma attack. Common triggers of asthma include the following:
- Respiratory infections: These are usually viral infections. In some patients, other infections with fungi, bacteria, or parasites might be responsible.
- Allergens (see below for more information): An allergen is anything in a child’s environment that causes an allergic reaction. Allergens can be foods, pet dander, molds, fungi, roach allergens, or dust mites. Allergens can also be seasonal outdoor allergens (eg, mold spores, pollens, grass, trees).
- Irritants: When an irritating substance is inhaled, it can cause an asthmatic response. Tobacco smoke, cold air, chemicals, perfumes, paint odors, hair sprays, and air pollutants are irritants that can cause inflammation in the lungs and result in asthma symptoms.
- Weather changes: Asthma attacks can be related to changes in the weather or the quality of the air. Weather factors such as humidity and temperature can affect how many allergens and irritants are being carried in the air and inhaled by your child.
- Exercise (see below for more information): Exercise can trigger asthma. Exactly how exercise triggers asthma is unclear, but it may have to do with heat and water loss and temperature changes as a child heats up during exercise and cools down after exercise.
- Emotional factors: Some children can have asthma attacks that are caused or made worse by emotional upsets.
- Gastro esophageal reflux (GER): GER is more commonly known as heartburn. GER is related to asthma because the presence of small amounts of stomach acid outside of the stomach (in the esophagus) can irritate the airways.
- Inflammation of the upper airways (including the nasal passages and the sinuses): Inflammation in the upper airways, which can be caused by allergies, sinus infections, or lung (respiratory) infections, must be treated before asthmatic symptoms can be completely controlled.
- Nocturnal asthma: Nighttime asthma is probably caused by multiple factors. Some factors may be related to how breathing changes during sleep, exposure to allergens during and before sleep, or body position during sleep.
Although an estimated 75-85% of people with asthma have some type of allergy, the allergy isn’t always the primary cause of asthma. Even if allergies are not your child’s primary triggers for asthma (asthma may be triggered by colds, the flu, or exercise for example), allergies can still make symptoms worse.
Children inherit the tendency to have allergies from their parents. People with allergies make too much “allergic antibody,” which is called immunoglobulin E (IgE). The IgE antibody recognizes small quantities of allergens and causes allergic reactions to these usually harmless particles. Allergic reactions occur when IgE antibody triggers certain cells (called mast cells) to release a substance called histamine. Histamine occurs in the body naturally, but it is released inappropriately and at too high an amount in people with allergies. The released histamine is what causes the sneezing, runny nose, and watery eyes associated with some allergies. In a child with asthma, histamine can also trigger asthma symptoms and flares.
An allergist can usually identify any allergies a child may have. Once identified, the best treatment is to avoid exposure to allergens whenever possible. When avoidance isn’t possible, antihistamine medications may be prescribed to block the release of histamine in the body and stop allergy symptoms. Nasal steroids can be prescribed to block allergic inflammation in the nose. In some cases, an allergist can prescribe immunotherapy, which is a series of allergy shots that gradually make the body unresponsive to specific allergens.
Children who have exercise-induced asthma develop asthma symptoms after vigorous activity, such as running, swimming, or biking. For some children, exercise is the only thing that triggers asthma; for other children, exercise as well as other factors triggers symptoms. Young children with exercise-induced asthma may have subtle symptoms such as coughing or undue breathlessness after physical activity during play. Not every type or intensity of exercise causes symptoms in children with exercise-induced asthma. With the right medicine, most children with exercise-induced asthma can play sports like any other child. In fact, over 10% of Olympic athletes have exercise-induced asthma they’ve learned to control.
- If exercise is a child’s only asthma trigger, the doctor may prescribe a medication that the child takes before exercising to prevent airways from tightening up. Of course, asthma flares can still occur. Parents (or older children) must carry the proper “rescue” medication (such as inhalers) to all games and activities, and the child’s school nurse, coaches, scout leaders, and teachers must be informed of the child’s asthma. Make sure the child will be able to take the medication at school as needed.
- Arsenicum album: A person needing this remedy can feel exhausted, yet be very restless and anxious. Breathing problems tend to be worse while lying down, better when sitting up, and may begin, or be the most intense, between midnight and two a.m. Dry wheezing may progress to a cough that brings up frothy whitish fluid. The person can be thirsty, taking frequent tiny sips. General chilliness is usually seen, with burning pains in the chest and heat in the head. Warmth often brings improvement.
- Carbo vegetabilis: This remedy may be indicated when a person feels weak or faint with a hollow sensation in the chest. Coughing jags can lead to gagging. The person may be very cold (especially hands and feet), yet feels a need for moving air, wanting to sit beside a fan or open window. Gas and digestive upset are also likely, and sitting up and burping offers some relief. Feeling worse in the evening, and worse from talking, eating, or lying down are other indications for this remedy.
- Chamomilla: Asthma with a dry, hard, irritating cough that starts after being exposed to moving air, or after becoming overexcited and angry, may be helped with this remedy. The cough is often worse around nine p.m., and may continue into the night. The person seems hypersensitive and may be extremely irritable and agitated. (Children may even shriek and hit, though they often calm down if someone carries them.)
- Ipecacuanha: Coughing spasms that lead to retching or vomiting strongly indicate this remedy. Wheezing can come on suddenly with a feeling of suffocation and heaviness in the chest. Mucus collects in breathing tubes, but the person has difficulty coughing much out. The person may sweat a lot and feel clammy or nauseous, be worse from motion, and sometimes worse from warmth.
- Natrum sulphuricum: This remedy is sometimes indicated when asthma attacks are brought on by exposure to mold and dampness. The person may hold the chest while coughing, because it feels so weak. Wheezing and breathing difficulties are aggravated by exertion, and episodes tend to be worse in the very early morning.
- Nux vomica: Indications for this remedy include a tense, constricted feeling in the chest during asthma attacks, with pressure in the stomach. Problems are often worse in the morning. Overindulgence in stimulants, alcohol, sweets, or strong spicy food can bring on or aggravate an episode. Both physical effort and mental exertion can make things worse, and warmth and sleep often bring relief. A person needing this remedy is typically very irritable and impatient, with a general feeling of chilliness.
- Pulsatilla: Wheezing that starts when a person gets too warm (especially in a stuffy room), or after eating rich food, can indicate this remedy. Coughing brings up yellow-colored mucus, with gagging and choking. Tightness in the chest tends to be worse in the evening and at night, and is relieved by cool fresh air. A person who needs this remedy is likely to be changeable and emotional, wanting a lot of attention and comforting. (Pulsatilla is often useful in children’s illnesses.)
- Spongia tosta: A hard or “barking” cough during an asthma attack is a strong indication for this remedy. Breathing can be labored, with a sawing sound, and not much mucus is produced. The person may feel best when sitting up and tilting the head back, or when leaning forward. Warm drinks may be helpful. The problems often start while the person is asleep (typically before midnight). Spongia is often used in croup, as well.
- Kali bic might help patients who experience attacks at about 3 or 4 a.m., with a feeling as if there were no air in the chest. The patient feels compelled to sit up to breathe, and bending forward while sitting brings some relief. The patient coughs up stringy yellow mucus.
- ·Natrum Mur treats general symptoms including a worsening of asthma when exposed to mold and dampness; attacks occur at about 4 to 5 a.m.; and the patient sits up and holds the chest with the hands while coughing. Wheezing and breathing difficulties are aggravated by exertion. The patient usually also has loose bowels after each attack.
- Antimonium tartaricum (Ant.t), a remedy used by conventional medicine for asthma, can also be used as a homoeopathic treatment for certain symptoms. The keynote for using this option is the presence of fine rattling or crackling sounds in the chest. The chest also seems full of phlegm that the patient cannot cough up. The patient must sit up at about 3 a.m., has great difficulty breathing, and feels suffocated. Antimonium tartaricum is especially suited to young children and the elderly.
- Blatta orientalis: A remedy for asthma. Especially when associated with bronchitis. Indicated after arsenic when this is insufficient. Cough with DYSPNOEA in bronchitis and phthisis. Acts best in stout and corpulent patients. Much pus-like mucus.
- Aralia Racemosa: (American Spikenard) This is a remedy for asthmatic conditions, with cough aggravated on lying down. Drenching sweat during sleep. Extreme sensitiveness to draughts. Diarrhea, prolapse of rectum. Aching in rectum extending upwards; worse lying on side lain upon.
- Lobelia inflata: Asthma attacks with weakness, felt in the pit of stomach and preceded with prickling all over. Feels as if heart would stop. Sensation of weight or pressure in chest, better by rapid walking.
- Sambucus nigra: Paroxysmal suffocative cough coming on about midnight with crying and dyspnoea. Sniffles of infants, nose dry and obstructed. Child awakes nearly suffocating, sits up and turns blue. Cannot expire.Millars asthma.
- Cuprum met: Cough has a gurgling sound and he is better by drinking cold water. Suffocative attacks worse 3 a.m. Spasm and constriction of chest. Spasmodic asthma alternating with spasmodic vomiting. Angina with asthmatic symptoms and cramps.
- Causticum: Cough with rawness of chest. Expectoration scanty and must be swallowed. Cough with pain in hip, better by drinking cold water. Cannot lie down at night. Voice re-echoes. Own voice roars in ears and distresses. Intensely sympathetic child.
- Sulphur: Oppression and burning sensation in chest. Difficult respiration, wants windows open. Dyspnoea in the middle of night, better by sitting up. Pulse more rapid in morning than in the evening. Complaints relapse
- Croton tig: Coughs as soon as he touches the pillow and must get up. Sensitive to deep breathing. Asthma with cough; cannot expand the chest. Drawing pain from left of back into chest.
- Stercula: Asthma. It gives power to endure prolonged physical exertion with taking food and without feeling fatigued. It promotes appetite and digestion.