The Impact of Childhood Asthma
by Christopher Smith. M.D.
traditionally been described as a reversible obstructive airway disease. The
assumption was that after each asthma attack, the lungs returned to normal.
Asthma experts now know, however, that if asthma sufferers fail to treat
effectively the chronic airway inflammation that characterizes asthma, they
will begin to develop scar tissue in their lungs. In the course of a year, a
person with severe asthma can lose up to one percent of his or her lung
function. It doesn’t sound like much until you consider that over several
decades, you could permanently lose a significant amount of your lung function.
This is called airway remodeling.
Asthma has three
components: airway constriction due to muscle contraction around the airways;
swelling of the lining of the airways due to chronic inflammation; and the
accumulation of mucous in the airways. The first component—muscle constriction—
occurs during an asthma attack and is treated with bronchodilators. These
drugs, also known as rescue medicine, cause the muscles to relax and
quickly restore a person’s ability to breathe more easily. The most common of
these is albuterol, which is delivered by an aerosol inhaler.
components—inflammation of the airways and the production of mucous—are treated
with preventive medicine. These medications (cromolyn, antileukotrienes,
and inhaled steroids) typically take about a week to work. If you are relying
on rescue medicine several times a week, your asthma is not under control and
you need a preventive medicine. The only way to know if you are on the
appropriate amount of preventive medication is a lung function test,
interpreted by an asthma specialist.
Managing childhood asthma
when asthma symptoms are “tolerable,” children run the risk of losing lung
function in the long run if they are left untreated. With the help of your
allergist, the specific asthma triggers should be identified, preventive
medications should be used when necessary, lung function should be tested
periodically, and severe allergic triggers should be treated with allergy
Asthma is the
most common cause of chronic childhood illness, and is the number one reason
children are admitted to the hospital. In the United States (and many other
Western countries) there is twice as much asthma today as there was in 1980.
While there are a number of theories about the rising incidence of asthma in
Western countries, a leading theory relates to the impact of vaccines on the
systems have two types of lymphocytes (blood cells responsible for fighting
disease): one type helps the body fight viral infections; the other responds to
allergic reactions. Each of these two aspects of the immune system counter balances
the other. Researchers hypothesize that in children who are well vaccinated
against viral illnesses, they may not develop an adequate counterbalance to the
allergic lymphocytes. In essence, the aspect of the immune system that fights
viral infection is not getting stimulated, and the allergy-fighting arm is
overactive. Studies have shown that allergy shots can restore this balance.
Furthermore, medical experts agree that children must continue to be
vaccinated, as this is just a theory that researchers are looking at as a
have demonstrated the importance of proper treatment early in life to increase
the likelihood of a full, healthy, active adult life. While there is currently
no cure, we do have the tools to manage asthma properly by working closely with
patients, parents, and school nurses.
medical management, children with asthma should be able to do everything their
friends do, including racing around the playground, playing sports, and
participating fully in gym class. If your child with asthma has difficulty
being fully active or suffers frequent asthma attacks, this means the asthma is
not well controlled. Your allergist can formulate a plan of treatment that can
make all the difference in your child’s quality of life.
Smith is board certified in both pediatric medicine, and asthma, allergy, and
immunology. He serves on the medical staff of Cayuga Medical Center and is in
practice with Asthma and Allergy Associates, P.C.