Whether you’re a young person trying to exercise, a youth athlete seeking to compete, or a coach or parent who wants know what he or she should be doing to support, you’ve got to know some of the cold, hard facts about asthma. Here are the basics of asthma.
Do you know exactly what asthma is and what causes it? You may have some of the signs and symptoms, whether it turns out you have it or not. Recognize it early if you do. Understand what triggers asthma, what to do and how to respond.
Partner with the right pediatric pulmonologist or asthma specialist for diagnosis, evaluation and treatment.
Once you know what you’re dealing with, you can build a “can win, will win” attitude from Day One.
You can’t beat asthma but, then, asthma can’t beat you either—unless you let it. That’s why everyone needs to know their Asthma ABCs.
Asthma: What Is It?
Asthma is the most common chronic inflammatory disease in youngsters.
Asthma is caused by swelling (inflammation) of the lining of the breathing passages that makes them irritable and very sensitive, leading to a narrowing (or obstruction) of the airways. While asthma symptoms may be intermittent, low-grade inflammation inside the airways is always present.
Certain outside stimuli, commonly called “triggers”, frequently aggravate the inflammation leading to asthma symptoms. These triggers may include: upper respiratory infections, exercise, cold weather, allergens and other conditions.
When the breathing passages (airways) are irritated by a trigger, the lining of the airways becomes swollen and inflamed, muscles around the airways tighten and extra mucus is produced. This produces constriction of the breathing passages and asthma symptoms.
Typical asthma symptoms include: cough, shortness of breath, rapid breathing, wheezing, chest tightness and chest pain.
Other symptoms to look for-especially in younger children who cannot explain themselves or are less self-aware-may include fatigue, irritability, poor exercise tolerance and sleeping difficulty.
There is no known cure for asthma, but it is a manageable condition that can be controlled and will have a minimal impact on a young person’s lifestyle with the right proactive treatment plan and a strategy that identifies and deals effectively with individual triggers.
The incidence of youth asthma has risen by an astounding 150% in the past two to three decades. And, the increase of asthma among minority youth in urban and city areas has been even greater.
Currently, almost 9 million young people (through the age of 18)-or at least 1 in 10-have asthma in the U.S. And, it is estimated that the actual number may be as high as 12 million since many young people with asthma remain undiagnosed or improperly diagnosed.
Annually, youth asthma generates:
12 million missed school days
800,000 emergency room visits
A total healthcare cost of $3 billion
Causes: Genetic + Environmental
While the exact cause of asthma remains unknown, asthma is most likely a combination of environmental factors and genetic tendencies. In other words, environmental factors often trigger genetically inclined youngsters.
Several DNA regions on chromosomes have been identified with asthma.
We know that asthma runs in families. When one parent has asthma, the chance of their child developing asthma is 25%, and this chance increases to 50% when both parents have asthma.
A difference in genetic makeup of individual young people with asthma most likely contributes to their varying responses to asthma medications.
- Air Quality
Increasing ozone concentrations and particles from fuel exhaust can increase airway sensitivity to triggers. Children of smokers are twice as likely to develop asthma than children of non-smokers. And, children born to mothers who smoked during pregnancy have a significantly increased risk of asthma.
- Respiratory Infections
Infection with certain viruses during infancy and early childhood significantly increases chances of wheezing during the first ten years of life.
A combination of an early respiratory viral infection and a genetic tendency can lead to asthma.
- Hygiene Hypothesis
Asthma has a lower rate of increase in developing countries than in developed countries with high standards of hygiene and excellent health care. Theory: Exposure to infections early in life primes the immune system to respond to infections-instead of to allergens and other triggers that aggravate asthma
More young people are spending time indoors playing video games, watching TV and using the computer. They are therefore exposed for greater periods of time to indoor irritants, such as dust mites, mold, and cockroaches- all potential asthma triggers.
The increasing incidence of asthma over the past 2-3 decades parallels the increase in obesity in youth. There is a direct correlation between higher body mass index (weight), irritability of the airways and the development of asthma symptoms in children.
- Other Factors
A family history of asthma or allergies, exposure to cigarette smoke in the womb or early childhood, viral respiratory infections in infancy, male gender (until age 10) and eczema all increase a young person’s chance of developing asthma.
Asthma triggers are the factors that heighten, intensify and generally worsen an already chronic condition. Each person with asthma has his/her own individual triggers.
Common asthma triggers include:
- Environmental irritants and allergens (e.g., pollen, dust, mold, cat dander, cigarette smoke, wood smoke)
- Upper respiratory infection (e.g., common cold)
- Sudden or extreme change in temperature or barometric pressure (e.g., extreme cold or humidity, impending snow or thunderstorm)
- Emotional extremes (e.g., laughing, crying, anxiety)
- Non steroidal anti-inflammatory medication (e.g., ibuprofen, aspirin)
- Untreated underlying medical conditions (e.g., sinusitis, gastroesophageal reflux)
- Certain foods (rarely) and medications (aspirin and ibuprofen)
- If increased airway inflammation and/or muscle constriction is triggered by any of the above aggravating factors, the airways become narrowed and irritated leading to asthma signs and symptoms.
Click here for more detailed info on asthma triggers.
Proper Usage of Inhaler
Click here for a video on the proper usage of an inhaler.
Signs & Symptoms
If a young person exhibits any of the following signs or symptoms, consider asthma, and schedule an evaluation with a pediatric pulmonologist or allergist who specializes in asthma as soon as possible. This evaluation will help the youngster determine the cause of their symptoms and the most effective treatment. The earlier asthma is treated, the sooner the youngster returns to a very active lifestyle and reduces the chance of long-term airway scarring and reduction of lung function.
- Lingering cough
- Recurring coughing episodes
- Coughing related to physical exertion
- Cough triggered by laughing or crying
- Wheezing (high pitched whistling sound)
- Shortness of breath or difficulty breathing
- Episodic chest tightness or pain
- Nighttime cough or shortness of breath
- Itch or tickle under the chin or in the throat
- Repeated diagnoses of reactive airway disease, wheezy bronchitis, allergic bronchitis, bronchiolitis, or pneumonia
- Poor exercise tolerance
- Sleeping difficulty
Evalution & Diagnosis
A thorough asthma evaluation has three components, including:
1. Patient and family medical history
During the initial evaluation, the physician asks the young person about symptoms they are experiencing, their duration and the frequency and circumstances under which they occur.
Information about emergency room visits, hospitalizations, or missed school days, speaks to the severity and level of control of asthma.
Other typical questions asked in an evaluation include but are not limited to:
- What known factors (triggers) tend to cause or aggravate symptoms?
- Do symptoms interfere with your daily routine (sleep, physical activity, school, etc.)?
- Do your symptoms have an impact on your family’s life?
- Does any immediate family member have asthma or allergies?
- Which medications have been used so far to lessen your symptoms? Have they helped?
- And, questions about newborn and infancy history, as well as non-respiratory systems may identify contributing factors.
2. A complete and thorough physical examination
After a review of the young person’s medical history and symptoms, the next step in the evaluation is a respiratory system examination with attention paid to other systems as well. The chest findings may be subtle or non-existent, unless the child is experiencing an asthma episode at the time of examination. Not every young person with asthma wheezes. Some may just cough or experience shortness of breath or chest tightness, and have subtle findings on physical exam.
Approximately 70% of youth with asthma may show signs of associated allergies, such as eczema, runny nose with swollen nasal membranes (rhinitis), or dark circles under the eyes.
3. Pulmonary function and supplemental testing
Spirometry is a two-part pulmonary function test that measures how quickly air can be forced out of the lungs. The first phase of the test, the baseline study, allows your physician to determine the presence and degree of airway obstruction or narrowing. If the airways are narrowed, air empties at a slower rate than normal during exhalation (breathing out)-and this is reflected in the result. The airflow obstruction is partially caused by reversible constriction (tightening) of the muscles around the airways.
In the second phase, the patient inhales a fast-acting bronchodilator (a drug often used in the treatment of asthma, that eases breathing by relaxing the muscles around the airways). Measurements are then repeated, checking for the reversibility of airway narrowing-one of the hallmarks of asthma. A significant improvement in airflow suggests asthma.
Basic spirometry may not demonstrate airflow obstruction due to the typically intermittent nature of the obstruction in asthma or because asthma is not the cause of the symptoms. So, sometimes more advanced pulmonary function studies may be necessary.
Various pulmonary challenge tests can reveal airflow obstruction much like a cardiac exercise stress test can uncover coronary artery obstruction and disease. These may be especially useful in diagnosing EIA or EIB.
The pulmonary challenge tests include:
- The EVH test (eucapnic voluntary hyperventilation)
- The methacoline test
- The mannitol test
- The exercise challenge test
These are tests in which airway obstruction may be provoked in sensitive young people by the inhalation of various air mixtures or chemical substances, or, intense exercise. Your pulmonologist will determine which, if any, challenge or provocation study is necessary.
Non-invasive testing that analyzes exhaled air for the level of nitric oxide checks for evidence of airway inflammation or asthma. This test may be performed as well.
It may be necessary to do additional testing to determine if there is either an alternate diagnosis to asthma or underlying conditions that may be aggravating asthma. Supplemental tests may include blood work, a sweat test, a chest x-ray, nasal swab, laryngoscopy, or a sinus CT scan.
Once diagnosed with asthma, it is important to begin a proper treatment regimen so that you can begin to take control over your asthma.
With the proper treatment regimen, you can decrease your symptoms, allowing you to live a normal life-including, for example, being able to participate in sports and other physical activities, eliminating school absences and sleeping through the night without interruption or distress.
Proper treatment reduces inflammation as well as the possibility of long-term airway changes. It addresses attacks when they occur and reduces and prevents future attacks.
Ultimately, it improves self-esteem and paves the way to a healthier, happier adulthood.
Ideal asthma management includes:
- Partnering with a pediatric pulmonologist or asthma specialist
- Identifying your own personal triggers
- Developing an individualized treatment plan with your physician
- Adhering to your individual treatment plan every day
- Understanding your long-term and quick-relief medications
- Learning how to properly use your inhalers
- Educating yourself as much as possible about asthma
- Monitoring your asthma at home and learning how to become proactive
Dr. J’s Bonus “Attack Asthma” Program
You usually don’t see these in an asthma treatment plan but incorporating certain life improvement strategies such as good dietary habits, relaxation techniques and a definite “no smoking” policy will help you gain control over your asthma.
Diet and Weight
A healthy, well-balanced diet can strengthen your body’s immune system, leading to fewer colds and bouts of upper respiratory infections that can intensify asthma symptoms.
But let’s get into some specifics. Incorporate foods into your diet that are rich in anti-oxidants (vitamins C & E, selenium, glutathione, oleurpein, flavanoids, beta carotene), and anti-inflammatory substances (omega-3 fatty acids, resveratrol) by eating lots of fruits (including red grapes), vegetables, nuts (make sure you are not allergic!), whole grains, legumes, olive oil and fish. This diet approach may protect the lungs from stress and reduce swelling and inflammation of the airways. And, for athletes, a diet that is lower in salt may lessen the swelling that occurs within the airways during intense exercise.
What do obesity and asthma have to do with each other? More than you might think on first glance. Recent studies suggest that obesity may actually lead people to develop more severe forms of asthma. Although the link between the two isn’t exactly clear, researchers think that the hormone leptin, which is produced by fat cells and contributes to weight regulation and airway inflammation, may be involved. Also, the lungs of obese young people are under-expanded which causes their breathing to be shallower. Reports actually show that the majority of emergency room visits for asthma happen among obese patients!
We’ll be updating this section with more breaking developments that link asthma and obesity as they become available.
Relaxation and Stress Relief
If you are a sports or exercise fanatic not used to trying something new, you may not want to hear this but both yoga and meditation relieve tension and stress, and decrease asthma symptoms.
Between school, family life, friends, work, and planning our futures, it’s impossible to avoid stress and anxiety but we can learn some ways to relax and return our breathing to a slow and steady pace. So, consider incorporating yoga or meditation into your life in some way, even if it is only in the privacy of your own room. We think your coach, gym teacher or parent will appreciate the results they will produce for you.
The body poses, pranayama (deep breathing and breath control techniques) and relaxation practices utilized in yoga help calm the body. They promote smoother breathing, increase lung airflow and capacity, boost endurance, and may actually decrease your need for a rescue inhaler! Similarly, 15 to 20 minutes of meditation in a quiet, relaxing environment calms you in the throes of a stressful situation. During meditation, breathing returns to a slow, steady and deep rhythm, airways relax and asthma symptoms decrease.
Smoking is terrible for your health, period. It can take up to 14 years off your life. It increases your chance of developing lung cancer and at least 17 other types of cancer, as well as heart disease, a stroke, a ruptured aorta, and lots more horrible health problems. You probably already know this, so we’re not going to preach to the choir.
And if you have asthma, you are taking on even greater risks if you smoke. Smoking (of any kind!) will enhance wheezing and causes the airways to become swollen and full of mucus-making it harder to breathe. Smoking can undo the positive effects of the asthma control medication that you use as well as force you to use your rescue medication more often.
So, if you don’t already smoke, don’t even think about starting! And if you do smoke, quit! Your asthma control and stamina will greatly improve and you will become such a better athlete. And, try at all possible costs to avoid secondhand smoke, as it’s a known asthma trigger.
OK, enough said. End of story.
Living & Loving Life with Asthma
Once you know more about asthma, there is nothing asthma can stop you from doing in your life, absolutely nothing.
There’s only one important thing to remember: Pay attention to the following details.
- Seek the appropriate diagnosis
- Identify individual triggers
- Develop an individualized strategy and treatment plan with your physician
- Follow the treatment plan
- Learn everything you can about asthma
- Always maintain a positive and proactive attitude