February 15, 2009
An Asthma Story
by Christine Grem, Pediatric Nurse Practitioner
When I was 9 months old, I got a congested nose, then a low fever. The next night I was breathing very fast. My mother and father took me to the emergency department in our small town in Connecticut.
The doctor told my parents I had a virus. The nurses gave me nebulizer treatments and I got better. They sent me home with pills my mother had to crush to give to me. I was sick for a week with coughing and wheezing.
A few weeks later the same thing happened, fast breathing with wheezes and coughs.
My doctor gave my mother more pills to crush and treated me for a week. I got better, but every time I got a cold, or was out in the cold winter air, I would wheeze and cough. The doctor told my parents I had asthma and would wheeze off and on my whole life.
As I got older I could not run like other children my age; I did not have the energy. If I did run I would wheeze. The doctor wrote a note for me to stay out of gym class. I missed playing with the other kids. My mother noticed a pattern to my wheezing. Every time oak trees were blooming, or the grass was cut, I would wheeze. Every time grandma got in the car with her strong perfume I would wheeze.
My parents smoked heavily and did not notice how much the smoke caused me to wheeze and cough. In those days, there were no nebulizer machines to take home, so every wheezing episode was a trip to the doctor or emergency room.
Because I did not get the same exercise as other children my age, I was heavier, which made wheezing worse. If my parents had an argument and I got upset I would wheeze. The doctor thought I was allergic to our little dog, Peanuts, that we had for 13 years. My mother was determined that we were not going to get rid of Peanuts. She decided to try allergy testing and shots. My doctor tried to discourage her because at that time testing and treatment was not very accurate. I had two shots a week for seven years. It did not really help, but as I got older I did not wheeze as often. By the time I was 10 years old, both my mother and father had quit smoking.
In those days, 50 years ago, doctors did not know a lot about asthma, the name given when repeat episodes of wheezing occur.
The wheezing is due to tightened muscles around the airpipes, thick secretions blocking the airpipes, and swollen narrowed airpipes. There are many reasons why these symptoms occur. Every person is different, and every person's asthma is different. Some may be bothered by grandma's heavy perfume, others may not. Some may wheeze from blowing dust in the air.
Some may have a pattern of allergies when the cottonwood trees are blowing.
Others may get a wheezing trigger when they breathe in cold air.
Some may wheeze with animal dander, others may not.
Some may wheeze when around dust and the mites in the dust.
Some may wheeze when breathing in the air pollution.
Some may only wheeze when they get a cold or virus.
Some may wheeze when they take aspirin and motrin.
Some may wheeze only if they get a sinus infection or pneumonia.
For some, cockroaches and mold trigger their asthma episode.
Most people with asthma will be affected by smoke.
Scientists have determined that the chemicals in cigarette smoke affect the hairs in our lungs and ears. The job of the hairs is to move fluid along. When the hairs get paralyzed by the chemicals, the fluid sits and more ear infections, more wheezing, more pneumonias occur.
Asthma has been around for years. One of the first asthma medications came from the Thorn apple flower of India. The flower had anti-inflammatory effects, which helped shrink the swelling of the air pipes. Because of unwanted side effects better medications were developed.
In the past, asthma treatment focused only on helping the patient breathe better at the moment they were in the hospital. Today, asthma treatment is greatly improved with the goal to prevent wheezing. Parents, patient and doctor work together as partners. The goal is to have as little or no hospital stays and little or no symptoms of cough, wheeze, shortness of breath, or working to breathe. The goal is for the patient to have no limits in function, no change in quality of life, and be able to run and play like other children. Asthma treatment is driven by the National Heart, Lung and Blood Institute (NHLBI). The NHLBI Health information center studies the best ways to treat asthma and provides guidelines for physicians.
Research has proven that smoke exposure triggers asthma, that breastfed babies have less asthma and that if reflux is controlled there are fewer asthma episodes. Research has shown that if allergies are controlled there is less asthma.
Research is still underway that is showing the impact of smoking on the unborn child and the likely increase of asthma. Research is beginning to support the association of air pollution with increased asthma, as well as obesity. Increased use of probiotics may contribute to a decrease of asthma.
We now know that there is a partly genetic reason for asthma. Some parents have super sensitive lung reaction to triggers and those super sensitive genes are passed on to their children. We now know that asthma is also affected by environmental exposures.
A child exposed to a virus that affects the lungs and causes them to wheeze may wheeze again and again if they have the wheezing genes from their parents.
The NHLBI has helped detail the steps of treatment of asthma dependent upon severity. Steps of treatment also depend upon age.
We now know that asthma, like Bethel weather, is constantly changing, and treatment must be according to how it changes.
Parents can help their child with asthma symptoms by noticing and reporting how many times a day the child coughs, wheezes, is short of breath, or complains of chest tightness.
Tell the doctor how many times the child coughs during the night, if the child is working to breathe and wheezing after exercise. Tell your doctor what you think the triggers are and try to avoid them. Treat early. Don't wait.
Ask your doctor to explain which medications are for prevention and which are for fast action. Follow all instructions carefully and faithfully so you can become a partner with your medical providers for controlling asthma.
For more information check out this website: www.nhlbi.nih.gov.
