May 8, 2000 -- When Deborah Marcom's son Trevor was 3, she spent an anxious week waiting for the results of a medical test. With a persistent cough, frequent bouts of flu, and a general lack of energy, doctors suspected the boy had cystic fibrosis. Instead, the diagnosis was asthma.
"I was so relieved to find out it was asthma," says the Sausalito, Calif., mother. Now 16, Trevor uses an inhaler twice a day, sings in a band, and plays on his school's baseball and basketball teams. Fortunately, with careful management, asthma can usually be controlled to the point where it has little impact on daily life. But the disease is difficult to diagnose in young children, and if left untreated it can lead to permanent respiratory damage.
Almost 5 million kids in the United States have asthma, and the figures are growing at an epidemic pace, according to the Centers for Disease Control and Prevention (CDC). Between 1980 and 1994, asthma cases in children under 4 increased by a staggering 160%. Gary Rachelefsky, MD, a clinical professor of pediatrics at the University of California at Los Angeles and past president of the American Academy of Allergy, Asthma, and Immunology (AAAAI), says asthma in kids is one of the most critical public health issues today. It is considered the leading chronic illness in children -- but nobody is certain why the frequency of the disease is spiking.
Some theories suggest that crowded urban environments, with increased exposure to allergens such as cigarette smoke, smog, and dust, are a key factor in the increase, says Rachelefsky. Decreasing breastfeeding rates may also contribute, because breast milk transmits important antibodies to babies. Asthma clearly runs in families, and a susceptibility to the disease is often inherited. Yet much remains unknown. "Everything is speculative," says Rachelefsky.
Why Early Diagnosis Is Tricky
What is known is how asthma affects the body. "Asthma is a chronic respiratory condition that causes inflammation in the airways," says Robert Nathan, MD, a clinical professor of medicine at the University of Colorado Health Sciences Center and a member of the AAAAI board of directors. "As these tissues swell, they limit the volume of air that can pass into the lungs." The muscles that surround the airways often constrict, he explains, also narrowing the diameter of the bronchial passages. Furthermore, the airway walls tend to secrete excess mucus, which blocks the passages further. The result can make trying to breathe feel like sucking a thick milkshake through a narrow straw.
The catch-22 of the disease is that it is critical to find it early, but difficult to diagnose accurately in the very young. Not only do children lack the verbal skills to explain their symptoms, but the best test for asthma -- measuring respiratory volume -- can't be used until they can blow strongly through a tube, usually at around 5 to 6 years old.
Most parents don't realize that a stubborn cough and a constantly running nose are actually warning signs of asthma. As a result, the disease can go untreated in young children for a long time. And that can lead to long-term damage to a child's airway.
"If you start therapy early, there is a greater chance of returning airway functioning to normal," says Nathan. "But if you don't intervene, it can lead to scarring in the airways. Such damage can permanently impair breathing ability. According to several studies, untreated asthma -- which puts the body under constant stress in the struggle to obtain enough oxygen -- can even inhibit overall growth.
Treating and Controlling Asthma
The good news is that asthma can be managed. Nathan says that any course of medication needs to control both airway inflammation and bronchial constriction. "These can only be prevented with inhaled steroids," he says. "Nothing else has been shown to be as effective." While some steroids themselves have been shown to limit childhood growth in the past, Nathan says that recent studies have documented that the lower dosages prescribed today do not cause this problem.
Medication can stabilize the situation, but it is also vital to minimize exposure to the environmental conditions that can spur asthma attacks. Keeping the house clean in order to limit dust and cockroaches can go a long way towards preventing asthma episodes. Some families choose not to keep pets in the home, or at least don't allow them to sleep with an asthmatic child. Rachelefsky also recommends that parents remove rugs and carpets from children's rooms, encase their mattresses in plastic, and avoid feathers in comforters and pillows. "The idea is to dust-proof the bedroom," he said. Even stuffed animals can carry dust mites and should be laundered regularly.
With a good management plan, asthma attacks can be limited in both frequency and intensity. Nicholas, a Berkeley, Calif., 7-year-old, diagnosed with asthma after an attack at the age of 3 left him briefly hospitalized, is a case in point. "He's definitely got it," says his father, Jim Hart. "We could put him in an empty box and he would still probably have some trouble with his breathing. But it doesn't keep us from living our life. It's just something we have to deal with."
Will Wade is a San Francisco-based writer. He has a 4-year-old daughter and was the co-founder of a monthly parenting magazine. His work has appeared in POV Magazine and The San Francisco Examiner.
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