The challenges of diagnosing, treating asthma in children

Asthma is a chronic respiratory condition that is quite prevalent today. There is no perfect test to diagnose asthma in babies and children, since they cannot reliably perform pulmonary function tests, which are used in adults to assess lung function. So we are left with an imperfect system to decide if a child has asthma.

Many babies develop wheezing as infants when they have common respiratory viruses. We call wheezing with a cold in babies bronchiolitis—meaning an inflammation of the small airways. Sometimes this wheezing is caused by a specific virus that is known to cause wheezing, called the Respiratory Syncytial Virus or RSV. There is a simple test that involves placing a cotton tip in the baby's nose to test for RSV. There is not much we can do to help babies with wheezing from RSV, other than to be sure they are getting adequate oxygen and fluids. Sometimes babies will wheeze with other viruses, too.

If there is a family history of asthma or allergic conditions such as eczema, and your baby tends to wheeze with each cold, your pediatrician may start to consider asthma as a diagnosis.

Asthma has two main components: bronchospasm or narrowing of the smaller airways, and inflammation that causes extra mucus production, which also narrows the airways. Your doctor may give the baby or child a nebulizer treatment, which involves a machine that aerosolizes medication so that your baby can breathe it in. A parent or other adult adds medicine to the machine and then holds a mask over the baby's mouth and nose. Initially, your baby or child may fight this mask, but often once children realize that it makes them feel better, they welcome the treatment. Reading a book to your child during the treatment may provide a distraction. The medicine is usually albuterol mixed with saline or Atrovent. The albuterol works by opening up the narrowed passageways. In older children, Albuterol can also be given by an inhaler with a spacer. A spacer is a chamber that collects the medicine after you compress the inhaler. All your child needs to do is breathe in and out.

The other medication used to treat asthma is a steroid. Steroids are used to reduce inflammation, which will cut down on mucus production. Your doctor may give your child a steroid in the nebulizer or he may give it as another inhaler.

Asthma is a complicated disease, and you should carefully monitor your child's condition. Your doctor may give you an asthma action plan that outlines what symptoms to watch for and when to give what medication. If you are confused, call your pediatrician—it is important that you understand the management of your child's asthma.

Many parents understandably do not like to have their child on long-term medication. Asthma is one condition, however, that, if chronic and recurring, needs to be carefully and faithfully controlled. That may mean keeping your child on an inhaled steroid on a daily basis for long periods of time. But the benefits are worth it—if you manage asthma successfully, you can keep your child out of the emergency room and hopefully, out of the doctor's office for every cold.

Many children do outgrow their asthma. Be sure you discuss with your pediatrician whether or not to discontinue a medication. Remember asthma is a potentially life threatening condition and should be taken seriously.

Tell me about your experience treating your child's asthma. Do you have any hints for getting him or her to tolerate the nebulizer mask or using an inhaler?

Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS. She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons.

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