Childhood Asthma: Part I

Asthma is the most common chronic disease in children and is responsible for more school absences than any other childhood disease in this country. It is a disease with a long history and is surrounded by much misconception and fear. Asthma is constantly being studied in the medical community which leads to new methods of diagnosis and treatment.

What is Asthma?

Asthma is a disease characterized by repeated, mostly reversible episodes of wheezing. The symptoms of asthma are the end result of a series of reactions occurring in the body set off by a variety of causes. These causes vary from true allergy to specific substances in the air, to emotions, to exercise, to plain old colds. The tendency to develop asthma may very well be an inborn trait present from birth but the final common pathway of observable events remains the same: the development of small airway narrowing (bronchioles) with a decreased ability to move air in and out of the lungs, slowing down the normal process of exchanging oxygen from the air for carbon dioxide from the body through the lungs. The reasons for this narrowing are related to inflammation in those airways with the production of mucus, and muscle spasm surrounding the airways: all have the effect of narrowing these airways. Oxygen is needed by every cell in the body in order to carry on the process of metabolizing various products that we use every minute of every day.

When the inability to properly exchange these gases is recognized by the body, a series of changes immediately takes place to make the system work better. Because each breath brings in less oxygen, the rate of breathing increases so as to equalize the gas exchange rate. We see that as breathing faster in the child with an asthmatic attack. Since the air that does get in and out must go though narrower airways, a person having an asthma attack must use accessory muscles (such as abdominal and even neck muscles) to help breath, and we see that as working harder to breath, and may even hear it as a whistling sound as the air is forced through narrow spaces (wheezing). Cough is produced as a reflex to the various changes in the airways. As the lack of gas exchange progresses there are further changes that can lead to failure of the lungs to do any of the work.

Needless to say, it is important to recognize the symptoms of asthma and treat vigorously.

How to recognize asthma

Many children will have wheezing during the first two years of life and this is usually part of a viral respiratory infection. This child will usually not have wheezing at any other times. A small percent of these children will develop true asthma over time but at this time it is difficult to tell who they will be. Many children outgrow this type of wheezing and therefore many physicians will withhold labeling a child with “asthma” until at least 2-3 years of age. There is also several other types of “asthma”. Some children with allergies develop wheezing secondary to exercise – or exercise induced asthma (especially in cold weather). Others might just have a persistent cough without wheezing for no apparent reason and might eventually be diagnosed with “cough variant asthma”.

What to do

If your child has already been diagnosed with asthma you will already know most of the information in this article. If your child has had a few previous episodes of “wheezing” or seems to be “wheezing” for the first time and your child’s breathing is not normal (remember the symptoms mentioned above), you will need to call your Doctor for further information and treatment.

What else can be done?

There are many ways to treat the symptoms of asthma and get these under control. There are also many ways to control and prevent the episodes of asthma and therefore the aim of treatment is to relieve and prevent the symptoms, allowing your child to be normally active and to enjoy all the activities of childhood without breathing problems. These treatments are very effective, and the well educated family unit blends with the medical home to produce excellent outcomes and many fewer episodes leading to sickness and missing school.

Note: Childhood Asthma: Part II will deal more specifically with the diagnosis and treatment of asthma

Is My Child’s “Barky Cough” CROUP and How Can I Help?

Croup, or laryngotracheobronchitis, is caused by many viral infections and falls into the category of upper respiratory infection along with the common cold. Croup tends to occur in the autumn and early winter months. In croup, the major areas affected are the ones referred to in the long name of this illness (above); the larynx, trachea and bronchi, which are all structures that convey air from the mouth and nose down toward the lungs. As with all colds or upper respiratory infections there is inflammation of the mucosa (most superficial covering) of the inside of the nose, mouth, throat and upper respiratory tract, leading to mucous production and irritation of those sites.

In croup, the area of the upper respiratory tract most prominently affected is the larynx, or the voice box area located very close to the firm lump in the front of your neck, the “adam’s apple”. When vocal cords are irritated and swollen, adults merely get hoarse or raspy talking and a “normal” sounding cough. Children have a much narrower windpipe and therefore with even the slightest swelling of their vocal cords, there is less room for air to get by and they also get hoarseness along with a cough and raspy breathing. There is also a characteristic barky (yes sounds like a animal barking) kind of cough and occasional difficulty breathing. All symptoms tend to be worse at night, a time when all illnesses seem to worsen.

For the most part this illness remains mild and the only treatment needed is a cool mist humidifier, fluid intake, elevated head at night and reassurance for the child and parents.

Rarely a child may progress to real difficulty breathing, with a characteristic whooping noise when taking a breath in versus a wheezing sound when breathing out found more commonly in those with asthma. So if your child exhibits difficulty breathing along with the above symptoms, call your doctor for further instructions.

Once a child has had croup, parents seldom forget what the barky cough sounds like and can make the diagnosis themselves. Usually, as with other upper respiratory viral infections there is a mild amount of fever and the child is not real sick.

If there is sudden high fever with the onset of “croup” and your child is drooling, cannot swallow or speak, and is very anxious, you must call your doctor immediately or call 911.

This symptom complex describes a rare but life threatening illness called epiglotitis which can be very dangerous. I stress that this is a rare illness which used to be far more common before we were able to vaccinate against the bacteria which causes this illness.

Your Kids Can’t Catch Cystic Fibrosis- What You Need to Know

Cystic fibrosis is an inherited condition that causes sticky mucus to build up in the lungs and digestive system. This causes lung infections and problems with digesting food.

In the UK, most cases of cystic fibrosis are picked up at birth using the newborn screening heel prick test.

Symptoms usually start in early childhood and vary from child to child, but the condition gets slowly worse over time, with the lungs and digestive system becoming increasingly damaged.

Treatments are available to help reduce the problems caused by the condition and make it easier to live with, but sadly life expectancy is shortened.

Symptoms of cystic fibrosis

The build-up of sticky mucus in the lungs can cause breathing problems and increases the risk of lung infections. Over time, the lungs may stop working properly.

Mucus also clogs the pancreas (the organ that helps with digestion), which stops enzymes reaching food in the gut and helping with digestion.

This means most people with cystic fibrosis don’t absorb nutrients from food properly and need to eat more calories to avoid malnutrition.

Symptoms of cystic fibrosis include:

• recurring chest infections
• wheezing, coughing, shortness of breath and damage to the airways (bronchiectasis)
• difficulty putting on weight and growing
• jaundice
• diarrhoea, constipation, or large, smelly poo
• a bowel obstruction in newborn babies (meconium ileus) – surgery may be needed

People with the condition can also develop a number of related conditions, including diabetes, thin, weakened bones (osteoporosis), infertility in males, and liver problems.

Diagnosing cystic fibrosis

In the UK, all newborn babies are screened for cystic fibrosis as part of the newborn blood spot test (heel prick test) carried out shortly after they’re born.

If the screening test suggests a child may have cystic fibrosis, they’ll need these additional tests to confirm they have the condition:

• a sweat test – to measure the amount of salt in sweat, which will be abnormally high in someone with cystic fibrosis
• a genetic test – where a sample of blood or saliva is checked for the faulty gene that causes cystic fibrosis

These tests can also be used to diagnose cystic fibrosis in older children and adults who didn’t have the newborn test.

The genetic test can also be used to see whether someone is a “carrier” of cystic fibrosis in cases where the condition runs in the family.

This test can be important for someone who thinks they may have the faulty gene and wishes to have children.

The Cystic Fibrosis Trust has more information on genetic testing for cystic fibrosis (PDF, 130kb).

Treatments for cystic fibrosis

There’s no cure for cystic fibrosis, but a range of treatments can help control the symptoms, prevent or reduce complications, and make the condition easier to live with.

People with cystic fibrosis may need to take different medicines to treat and prevent lung problems.

Physical activity and the use of airway clearance techniques may also be recommended to help clear mucus from the lungs.

Find out more about treatments for cystic fibrosis.

Complications of cystic fibrosis

People with cystic fibrosis also have a higher risk of developing other conditions.

These include:

• weak and brittle bones (osteoporosis) – medicines called bisphosphonates can sometimes help
• diabetes – insulin and a special diet may be needed to control blood sugar levels
• nasal polyps and sinus infections – steroids, antihistamines, antibiotics or sinus flushes can help
• liver problems
• fertility problems – it’s possible for women with cystic fibrosis to have children, but men won’t be able to father a child without help from fertility specialists (see a doctor or fertility specialist for more advice)

They’re more likely to pick up infections, and more vulnerable to complications if they do develop an infection, which is why people with cystic fibrosis shouldn’t meet face to face.

The Cystic Fibrosis Trust has more information about complications of cystic fibrosis and preventing cross-infection.

Cause of cystic fibrosis

Cystic fibrosis is a genetic condition. It’s caused by a faulty gene that affects the movement of salt and water in and out of cells.

This, along with recurrent infections, can result in a build-up of thick, sticky mucus in the body’s tubes and passageways – particularly the lungs and digestive system.

A person with cystic fibrosis is born with the condition. It’s not possible to “catch” cystic fibrosis from someone else who has it.

How cystic fibrosis is inherited

To be born with cystic fibrosis, a child has to inherit a copy of the faulty gene from both of their parents.

This can happen if the parents are “carriers” of the faulty gene, which means they don’t have cystic fibrosis themselves.

It’s estimated around 1 in every 25 people in the UK are carriers of cystic fibrosis.

If both parents are carriers, there’s a:

• 1 in 4 chance their child won’t inherit any faulty genes and won’t have cystic fibrosis or be able to pass it on
• 1 in 2 chance their child will inherit a faulty gene from one parent and be a carrier
• 1 in 4 chance their child will inherit the faulty gene from both parents and have cystic fibrosis

If one parent has cystic fibrosis and the other is a carrier, there’s a:

• 1 in 2 chance their child will be a carrier
• 1 in 2 chance their child will have cystic fibrosis

Outlook

Cystic fibrosis tends to get worse over time and can be fatal if it leads to a serious infection or the lungs stop working properly.

But people with cystic fibrosis are now living for longer because of advancements in treatment.

Currently, about half of people with cystic fibrosis will live past the age of 40. Children born with the condition nowadays are likely to live longer than this.

Support

Support is available to help people with cystic fibrosis live as independently as they can and have the best possible quality of life.

It can be helpful to speak to others who have the same condition, and to connect with a charity.

The following links may be useful:

• British Lung Foundation – which includes experiences from people with the condition
• Cystic Fibrosis Trust – which has an online forum and news about ongoing research into cystic fibrosis
• CF Kids – a support group for parents of children with cystic fibrosis
• Cystic Fibrosis Care – a charity that provides practical help and support

Information about you

If you or your child has cystic fibrosis, your clinical team will ask you if you consent to being on the UK Cystic Fibrosis Registry.

This is a secure anonymous registry sponsored by the Cystic Fibrosis Trust that records health information on people with cystic fibrosis.

The registry helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time.

Find out more about the registry

**Resources outside the U.K.

• Cystic Fibrosis Foundation – provides assistance to people with the condition and is a top researcher of it
• Claire’s Place Foundation – offers support to families living with CF
• Cystic Fibrosis Research Inc. – provides educational materials, news, and support
• CysticFibrosis.com – online forum and support community

How to Help Your Family Cope With Springtime Allergies

We, as humans, are so prone to allergic problems that it seems to be the “human condition” helping to define who we are. Don’t get me wrong, other species can also have allergic problems and you have probably seen that at some point in your domestic cats and dogs.

But we humans are not very tolerant of these annoying symptoms and aside from cold medicines and possibly antibiotics, medications for allergies are one of the leading popular medications for allergy sufferers and pharmaceutical companies.

Not to belittle symptoms of allergies in humans but in the overall scheme of illnesses that cause substantial morbidity and mortality, allergic problems are way down on the list; this is not to include the very serious types of allergic problems leading to anaphylaxis and sometimes death- bee stings, certain drug allergies, etc.

During the springtime, the allergens (substances causing allergic reactions) tend to come out into the air sometime between April and July. We all know what these are; tree pollen usually appears first followed by residue of growing grass, and then certain weeds such as goldenrod, etc. which tend to show up in the later summer and early fall. The very things that create a beautiful, colorful springtime are bothering us. The only way to avoid some contact with these elements is to remain indoors for 4-5 months with your heat or A/C on: a totally impractical solution. So we must learn to live with these allergens.

The first thing to do is to prioritize the symptoms that you are having (runny nose, sneezing, coughing, itching, etc.) in order to decide which of these are really affecting your life style and help determine which methods of treatment are the best. The allergic symptoms one sees is the end result of a pattern of reaction.

1. The allergen enters the field of attention, usually the respiratory or skin systems and attach to certain cells lining these areas.
2. This causes a chemical reaction that ends in the release of many substances called mediators, of which histamine is one.
3. These mediators then attach to cells disrupting them and causing the symptoms that we recognize as “allergies”.
4. These cells become soft, leaky and sometimes swollen, producing mucus at the site and causing runny nose and sneezing.

This problem can be treated by attacking the process at any stage along the way.

• Initially, avoiding the allergen would be ideal but this can only happen under unusual circumstances.
• The next step would be to interfere in some way with the attachment of the allergen to the cell. There are some medications available to hinder this process but it is not very effective.
• The next process would be to interfere with the release of mediators from the cell that is damaged by the previous processes mentioned and there are medications that try to do this, but again not very efficiently.
• There are medications available that can counteract the effects of the mediators on the active cells lining the respiratory tract; the most well-known and common of these are the antihistamines that are used widely, such as Benadryl and others. The antihistamines counteract the effects of the histamines and other mediators on the cells of the respiratory tract so that the symptoms tend to occur less frequently or severely.
• Finally there are common medications available that can try to alter the function of the affected cells in the respiratory tract and diminish the effects of the mediators on these cells. These are the decongestants (such as Sudafed) that are present in just about every cold medicine. Decongestants act to, among other effects, to cause the small leaky blood vessels in the respiratory tract to constrict and “leak less”.
• Finally there are allergy shots which expose the individual to increasing amounts of the offending allergen in an attempt to “desensitize” the person to the effects of exposure to that allergen.

Now back to the symptoms and their importance. These symptoms can and do regularly interfere with normal comfortable functioning in our everyday life. These can vary from very mild to constant and very severe. It is best not to medicate the very mild end of the spectrum as each of the medications mentioned above have their own individual side effects (e.g. sleepiness, irritability, and elevated blood pressure), and these can sometimes be worse and more annoying than the symptoms of the allergy. So, choose your red line in the sand as far as reducing symptoms in your child- are they significant enough to treat at all? The unfortunate corollary to this is that your child’s teacher may interpret any sneezing coughing or runny nose as a “cold” worthy of separating from the other children in the class.

The bottom line is to work closely with your child’s doctor to establish a plan of action as the severe symptoms can interfere with school, sleeping and eating.

How to Recognize If Your Child Has An Airway Problem

Have you noticed any unnatural or worrisome behavior in your child’s sleeping patterns? For example, does your child snore, even as an infant? Does your child gasp for air, appear to choke, or thrash around in his or her sleep? If so, you may want to have your child’s airway development evaluated.

We all know proper breathing habits are essential to our children’s health, development, and intellectual success. Early detection and correction of airway problems is critical to their overall quality of life. Children who cannot adequately breathe through their noses tend to breathe through their mouths. Constant mouth breathing is not only unhealthy, but also tends to affect the growth of facial features.

Even if your child has never had any respiratory issues, his or her ability to easily and efficiently breathe depends on more than lung functionality. Even if your child’s lungs are functioning properly, any obstructions or constrictions of the airway over a significant amount of time can lead to unhealthy breathing habits and anatomical pathologies. As your child grows, a restricted airway increases his or her chances of asthma, allergies, and chronic sinus and throat infections.

Don’t forget – the tongue is the strongest muscle in our body! The more your child’s tongue sits in the lower jaw, the more pressure exerted. This leads to severely compromised nasal breathing, causing the upper jaw and midface to develop at a slower rate, because the natural growth stimulant of air flow through the nasal passages is absent. The deficiency of growth in our upper jaws and midface affects our facial balance, beauty and function. A poorly-developed upper jaw means less support for the eye sockets and nasal airways, leading to a deviated septum, asymmetrical nose, snoring, and sleep apnea.

By examining, diagnosing and treating your child’s airway development at an early age, you can:

• Remove dangerous factors influencing your child’s growth
• Ensure proper growth in your child’s development
• Assist in the psychological well-being of your child
• Save your child from a potential jaw surgery in adulthood
• Prevent crowding and crooked teeth in your child’s smile

To determine which course of treatment would be the most beneficial to your child, reach out to your pediatrician, dentist, orthodontist, or sleep specialist.

Loli-O’s and Kids: Puts the Treat in Breathing Treatments

Have you ever received a breathing treatment, either in an ambulance or in the hospital? It can be uncomfortable and you might be a little hesitant if you haven’t done one before. Now imagine you’re a child…

A lot of children in the pre-hospital setting as well as clinics, offices, homes and urgent care facilities tend to become very anxious and uneasy when you try and place a mask over their face or get them to hold a tasteless plastic mouthpiece in their mouth to receive breathing medications. Anxiety causes symptoms to increase and that is certainly where you do not want to go. Loli-O’s helps children from the ages of 3+ receive breathing treatments while enjoying a sugar free and dental friendly lollipop. Using Loli-O’s allows the child to focus on something that is comforting and enjoyable other than “I’m getting medicine”. And if used as directed, it delivers the medication at nearly the same equivalence as a mouthpiece nebulizer with ZERO anxiety and a happy kiddo in the process because let’s face it…… kids love lollipops!

I came up with the concept that is now Loli-O’s while transporting a 4 year old girl from a rural hospital to a metropolitan hospital in Nashville, TN. I am a 23 year veteran paramedic and have run across this scenario many times in my career. The child was ordered by the physician to receive continuous breathing medication during the over 1 hour transport. The child was already very anxious because I was a stranger and she was scared not knowing what was going to happen. During the transport, she would become more excited and upset during the treatment attempts, which in turn caused the shortness of breath to increase, her heart rate to increase and the oxygen level to decrease – the exact opposite of where we wanted to be. Despite many attempts to administer the treatments as ordered, I was unable to effectively give the treatment.

After arriving at the receiving hospital, care was released to the staff and the report was given. The staff was attempting to give the breathing treatment as we were leaving but were having the same problems I had faced in the back of the ambulance. After leaving the hospital we stopped at a convenience store to get a soft drink for the ride back home. While standing in line to pay, I noticed an older gentleman with what I assumed was his grandson standing at the counter. The little boy was about the same age as the little girl I had just transported. While at the counter, the little boy grabbed a whole handful of lollipops and put them on the counter. The grandfather asked him “so you want a lollipop huh?” The boy jumped up and down and said “yes yes yes!” That was it! Kids love candy, especially lollipops! There is something comforting to a child about having a sweet treat that I knew could work with helping receive breathing treatments.

I jotted down some rough drawings and came up with a plan. I bought a candy kit at Hobby Lobby and some cpvc fittings from Lowe’s and went to work. In just a couple of hours I had a working prototype right there in my kitchen. I shared this idea and prototype of mine with a long time physician friend and he was just as convinced as I that we had something worth pursuing here. 3 years later, our team consists of 4 top physicians as well as an accomplished ACNP (acute care nurse practitioner). Loli-O’s is ready to help children get that treatment they need with a little less anxiety and a whole lot more fun. We like to say that with Loli-O’s we put the “treat” in treatment. Loli-O’s uses lollipops that are sugar free, gluten free, dairy free, have no added dyes and are manufactured in a peanut free facility. In fact, the lollipops are considered “dental friendly” and the best part is they taste amazing and come in 5 different flavors.

Until Loli-O’s, there have basically only been 2 delivery methods for breathing medications. One being a mask that is strapped to the child’s face and the other is a plastic mouthpiece that the child has to hold in their mouth while they are breathing the medication. Loli-O’s is not trying to replace these devices because they are very effective for children who are already used to receiving treatments or are old enough to understand the reasoning behind that particular treatment device. But for the child who has to have a breathing treatment for the first time, or who might be scared and anxious, or who is younger, or for any reason at all, Loli-O’s is here to help the child, the parent and the provider. We have spoken with countless EMS professionals, ER physicians, pediatricians, nurses and respiratory therapists and have all concluded what we have thought from the beginning……. Loli-O’s can help!

Loli-O’s is set to hit the consumer market in July 2017. It already has commitments from EMS agencies and emergency departments in our area and will eventually make its way to ambulances, emergency departments, acute care clinics and pediatrician offices all over the US. In time, our goal is to see Lolio’s become a go-to among the already established nebulizer options. Another tool in the toolbox is always a good thing.

HEALTHFUL HINTS:

• Anxiety with children during doctor visits is all too common. Children, especially at a younger age have certain “comforts”. A parent/guardian is of course a big one but there are other comforts that can help make that trip to the doctor a little easier on the child as well as mom and dad.
  • First start off simple and if possible bring that stuffed animal or action figure that your child loves to play with. You would be surprised what a little “toy time” can do to alleviate some of that anxiety.
  • Next, let the child hold the stethoscope and let them hear their own breathing and heartbeat! I’ve seen more smiles from kids who hear their own ticker working than you could imagine.
  • Unfortunately, sometimes at the doctor the child has to get a treatment or injection that is either frightening or painful. In these circumstances, I’ve found that a little soft talking and explanation of why they are receiving it is very helpful.
• There are many respiratory conditions that effect children. From simple occasional allergies, to bronchitis, to asthma, to cystic fibrosis and etc., not every child will have the same symptoms or the same diagnosis which only proves that just 1 treatment device/medication is not the answer. Pay attention to your doctor and more importantly your child. Children have the ability to compensate very well when it comes to illness and injury but when their compensating mechanisms have run their course, children can and will become severely ill very quickly. When it comes to respiratory problems, there are a few tell-tale signs that let you know that your child is getting worse.
  • The first would be to watch your child’s posture. If you find your child setting uncharacteristically straight or in a position known as “tripod” where the hands are propped on the knees and leaning forward, then this would indicate a more severe respiratory distress.
  • Also watch for flaring of the nostrils. This indicates a forceful respiratory pattern that the child involuntarily does in order to move air in and out of the lungs.
  • You can also see what is referred to as “retractions”. This is where the child is having so much difficulty that the muscles between the ribs and other areas of the chest are sucking inward with inspiration. This is usually a sign of severe respiratory distress.
• As proactive parents and guardians, it’s a good idea to be prepared for health situations that could arise.
  • Have your child’s general and medical information written down on an index card and kept in a safe location.
  • Include your child’s name, date of birth, any allergies to medications, any current prescription medications they are taking and a thorough medical history. Having this card on hand will help so much if you should have to call an ambulance or if your child is being taken by someone other than yourself to receive medical treatment. When your child is severely ill is not the time you want to have to remember these important details.

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