Hope for children with asthma

For the 15 percent of Canadian kids with asthma, that's not so easy. But there's new hope for controlling this chronic disease

It’s a terrifying feeling when your child can’t breathe. That’s something Colleen Charland-Wright knows all about. The North Gower, Ont., mom has worried about her six-year-old’s lungs ever since he was born with breathing difficulties.

Ryan was diagnosed with asthma while still a baby, and his mom got used to rushing him to emergency every time he struggled for air. “When we went on holidays, I would plan all our trips based on how close we were to the hospital,” says Charland-Wright. “There’s stress living with that, not knowing if he’s going to have an asthma attack or not.”

Asthma, a chronic lung disease, affects about 15 percent of kids and 10 percent of adults. Their bronchial tubes overreact to allergens and other triggers that lead to inflamed airways when they’re breathed in. This inflammation can cause wheezing, coughing and breathing problems, and it’s made worse by triggers like cigarette smoke, cold air and viral infections of the respiratory tract. Asthma can be deadly serious; about 20 kids in Canada lose their lives each year from asthma attacks, when their airflow is restricted by mucus and spasms in the bronchial tubes.

The rate of asthma has spiked aggressively in the last few decades, perhaps four times what it was in the ’70s, before levelling off at the current rate. No one knows exactly why. Could it be explained by an increase in air pollution? “Maybe those kinds of stresses are what train the immune system to behave differently. But we don’t yet have definitive proof,” says Mark Greenwald, a Toronto allergy and asthma specialist, and chair of the Asthma Society of Canada’s medical and scientific advisory committee.

Despite that baffling question, there’s a lot we do know about control and prevention of asthma, and we’re learning more all the time. But it’s not all information you’ll hear from your family doctor. Read on for four key things that parents of kids with asthma should know.

Asthma should be controlled

At least three-quarters of Canadians with asthma do not have their disease under control, says Greenwald. In some cases, front-line doctors may not be providing the most up-to-date advice or treatment. Parents may be reluctant to give ongoing meds to their kids, or may underestimate the danger of uncontrolled asthma. “Optimal control means no cough, no wheeze, no visits to the doctor [for asthma complications] and being able to participate in activities,” Greenwald says. If your child hacks at night or wheezes when he isn’t sick, his asthma is not controlled.

How much of a problem is minor inflammation? Even mild uncontrolled asthma results in more visits to the emergency room and school absenteeism. It can also lead to long-term health complications, such as fatigue, short stature and lung infections. And it can be fatal: Of the roughly 20 children who die of asthma each year in Canada, typically one-third are considered to have a mild case.

If asthma is uncontrolled, it will also compel your child to avoid activities, including exercise, that tend to bring on symptoms. But, ironically, “exercise has been shown to be helpful in treating asthma,” says Zave Chad, a paediatric allergist in Ottawa who explains that exercise conditions the lungs. And, he adds, “if you get out of the habit of exercise when you’re a kid, you don’t do it as an adult.”

The bottom line: Do what you can to make sure your child is symptom-free as much of the time as possible. “If you treat asthma early and you get it mild and you get it aggressively, your ultimate outcome is better,” Greenwald says.

The benefits of medication usually outweigh the risks

To keep inflammation at bay, your child’s doctor may recommend he take an inhaled corticosteroid like fluticasone (Flovent) twice a day. Unlike bronchial dilators, which are taken in a time of crisis, anti-inflammatories stave off breathing problems before they start. “It’s like treating sunburn,” says Chad. “You use your sun lotion before you get a burn and you prevent the symptoms.”

But many parents worry about giving their children drugs on a daily basis. When an emergency-room doctor told Colleen DeSantis her son Romano (now two) had asthma, regular medication was a big concern for her. “I feared having to raise my child on puffers and steroids,” says DeSantis, who lives near Calgary. “In our household, everything we do, we try to do as natural as possible.”

Studies have shown that the long-term benefits of inhaled steroids are significant, while side effects, such as weight gain or lowered resistance to infection, are not common. Most parents are concerned about slowed growth, another of the possible effects. “But you have to realize that poorly controlled asthma is an impediment to growth also,” says Chad. “I’ve actually seen kids with poorly controlled asthma whose growth improved when they went on the steroids.”

Another anti-inflammatory medication used as an alternative to steroids, Singulair, made headlines when both Health Canada and the US Food and Drug Administration investigated a link to suicidal behaviour and other psychological effects like aggression. Although both agencies ended up issuing advisories, these effects are considered extremely rare.

Some people have explored alternative therapies, such as biofeedback or chiropractic treatments, to control asthma. But Greenwald says there’s no strong objective evidence that these help. Acupuncture is thought to relax the airways and reduce bronchospasms in some people, but this is not widely accepted by the scientific community.

“The thing is asthma is a treatable problem,” says Chad. “It’s not the kind of thing where we can do nothing much for it.”

Do make sure, though, you’re using your child’s asthma meds properly. Although Anne Marchinetz’s son was identified as asthmatic at six months of age, it wasn’t until he was three that she went to a parent workshop at a Toronto-area hospital and found out she had been making mistakes when administering his medication. The clinic helped her get back on track, teaching her the right order for using the meds, and to wait a few minutes between each one.

Help your child at home

Marchinetz knows that environmental triggers can aggravate asthma symptoms in her son Daniel (now 10), so she does what she can to minimize them. “I really, really try to keep his room clean,” she says. She doesn’t let him overdo activity on smoggy days, and she tries to avoid long visits in dusty or cigarette-smoky houses. Plus, when the aging family dog is gone, she says, “we will not be renewing the pet issue.”

Reducing triggers in the home is hugely important, ays Greenwald. “Environment management is not emphasized as much as it should be. That’s something your health care practitioner may not have time to go through.”

Cutting your child’s contact with dust mites will go a long way toward controlling his asthma. Don’t allow any smoking around your child, and avoid using a wood stove. Check for household moulds, and use a humidistat in your home to track humidity: It should be under 50 percent to inhibit growth of dust mites and mould. Your aim is to minimize any tiny particles that can irritate your child’s airway. “We’re ripping out the last of the carpet in the house,” says DeSantis, who has also installed air purifiers in their home.

Got a cat? The experts will tell you to get rid of it. Cats, like dust mites, generate such tiny particles of allergen, they are more easily breathed in. If sending kitty away is not a solution your family can live with, do keep her out of your child’s room and definitely off the pillow, and use special cat wipes or plain water to reduce her dander. “It’s not a question of doing all or nothing,” Chad notes. “Every little bit helps. Do what you can.”

If your child catches fewer colds, he’s also less likely to have asthma problems. That’s because viral infections can inflame the lungs. Plus, an uncongested nose can filter and humidify air as it’s inhaled. Colleen Charland-Wright has worked at improving her son’s diet and putting him to bed earlier. Now he no longer wheezes, and just coughs when he’s sick. “If you’re healthier,” she says, “you’re less susceptible to anything around you.”

A healthy lifestyle also helps your child maintain a healthy weight. Many researchers have found a link between obesity and asthma, possibly because obesity and inflammation are connected (think cardiovascular disease). Recently, a Dutch study that followed more than 3,700 children found that those who were overweight at age six or seven were more likely than normal-weight kids to have asthma symptoms by age eight. (The good news: Heavy preschoolers who achieved a healthy weight by age seven did not face the same risk.)

But be careful how you spin some research studies. A Manitoba asthma study that’s following children from birth through their early years has found they’re more likely to have asthma if their mothers are chronically stressed. But stressed-out moms are less likely to breastfeed and more likely to be smokers, two factors we already know increase the rate of asthma.

An asthmatic child may not be an asthmatic adult

Will your child outgrow asthma? That depends. Not all wheezing in young childhood is true asthma. It’s more difficult to diagnose asthma in the under-five age group, and some young kids who wheeze with airway infections won’t have asthma as adults. They may have what’s called reactive airway, or transient viral-induced wheezing. These kids often outgrow those symptoms as their airways get bigger.

Children whose asthma goes hand in hand with allergies and eczema will likely have a tendency toward lung inflammation. But their symptoms may come and go over time as their lung size changes relative to their body, as they undergo hormonal shifts at puberty, or as pets depart (or new ones arrive). “We can’t predict who’s going to get better and who’s not, except, as a general rule, the more allergic you are, the more persistent the asthma,” says Chad.

Anti-asthma products

Confused by the array of anti-asthma products on the market? The price tags on some of these products will take your breath away. Before you open your wallet, find out which ones will be money well spent.

Hypoallergenic bedding These mattress and pillow encasings are made to seal in dust mite allergens and keep your child from inhaling them. They’re a great idea, but they don’t all work. So instead of buying off the shelf at your local department store, ask your allergist to make a recommendation.

Dust mite sprays and laundry detergents These products are designed to kill dust mites in mattresses and carpets. They’re non-toxic and meant for people with allergies (although, of course, anyone can have a reaction to household products). But there’s debate about their effectiveness, and they’re not widely available in Canada. Again, ask your allergist for advice.

Electronic air purifiers These work, but not enough to eliminate all the allergens in your home. Look for a label of “true HEPA” or “absolute HEPA” on the product, which will be more effective at picking up the tiniest particles.

HEPA-filter vacuums They’re better than regular vacuums, which often circulate the smallest particles back into the air.

UV handheld air sanitizers or UV vacuum cleaners They won’t kill dust mites so, like other air purifiers, they won’t do the whole job.

Allergy shots

Immunotherapy (allergy shots) is an approach that may keep asthma symptoms at bay. Kids with allergies and eczema are more likely than other children to develop asthma as they get older. But if they receive regular allergy injections, not only will they increase their tolerance of allergens, they’ll also cut their risk of asthma in half. If they already have the disease, their need for medications and hospitalizations will be reduced with immunotherapy.

Allergy shots are not so new. But, says Greenwald, “they’re improving all the time. They’re much better today than they have been in the past.”

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