Bronchial Asthma is a common
problem in childhood that
affects about 20% of children
in Singapore. It is a condition
where there is chronic
inflammation of the airways.
Various triggers can affect the sensitive
airways of children with asthma, and
bring on symptoms. However, it is not
always possible to pinpoint the exact
Common causes are:
Viral Infections. Asthma is often
brought on by viral respiratory
infections in young children. Such
viral infections are unavoidable and
are very common in a young child. As
the child grows older and resistance
to viral infection improves, asthma
attacks also decrease.
Exercise. Symptoms may occur a
few minutes after exercise ends, or
it may occur many hours later e.g. in
the night. This is known as exerciseinduced
Allergies. Asthmatic children are
sensitive to certain substances called
allergens, which when inhaled causes
asthma. Common allergens are house
dust mites and animal dander. Food
allergy as a direct cause of asthma is
uncommon but occasionally peanuts,
citrus fruits, strawberries, egg or milk
products, or bird’s nest may provoke
Irritants. Air pollution can cause
breathing problems. Children with
asthma have more symptoms during
periods of haze. Strong fumes and
odours can also induce asthma.
Cigarette smoke is particularly bad for
children with sensitive airways and
should be avoided at all cost.
Weather Changes. Sudden changes in temperatures and humidity may worsen asthma. Cold, dry air is a trigger to the sensitive bronchial airway. Exercising in cold air may also increase the symptoms of exerciseinduced asthma.
Drug and Chemicals. Aspirin and other anti-arthritic medicines e.g. ibuprofen (Brufen), diclofenac (Voltaren) may cause asthma in some children. Certain cough mixtures, particularly those containing codeine, may sometimes worsen asthma symptoms. Children with asthma also react adversely to artificial coloring (tartrazine dye), food preservatives (metabisulfite) and monosodium glutamate (MSG).
Emotional Factors. Emotional problems on their own do not cause asthma but anxiety, excitement and stress can aggravate the condition.
Wheezing. A high-pitched whistling sound that occurs when a child breathes out. This is an important symptom of asthma but may not be present in all cases of asthma.
Cough. Generally troublesome at night or early in the morning. Cough may be the only complaint in a small group of asthmatic children.
Shortness of breath. This may be severe enough to interfere with normal activity, sleep or exercise. In older children, it may occur after exercise.
Chest tightness. A complaint, particularly of older children, after vigorous exercise. The symptoms of asthma vary for each child. Some children are troubled mainly by wheezing, while others may be bothered by a chronic cough.
Diagnosis is made on a detailed history and careful examination. Special tests are usually not required, unless there are certain doubts in the diagnosis. The following tests may be ordered:
Chest x-ray. May be necessary to exclude other medical conditions and reasons causing the narrowing of the airways.
Lung function test. This test gives an indication of the severity of the condition and the response to treatment.
Peak flow rate. This gives an indication of how quickly air can be forced out of the lungs – the lower the reading, the more obstructed the lungs are.
Spirometry. This test allows the doctor to get a detailed assessment of airflow in the smaller airways.
Challenge tests. In children whose history is not definitive and breathing tests are normal, ‘stress’ tests may be used to induce airflow obstruction.
Allergy tests. Allergy tests may be useful to confirm certain suspected allergens.
There is no cure for asthma. But
with effective treatment, asthma
can be kept under control and
the child can lead a normal life,
participate in sports and have
normal lung function.
There are two main groups of
medicines that can improve the
symptoms due to asthma.
Relievers or Bronchodilators.
These medicines act to relax
the muscles around the airway,
relieving the obstruction to airflow
rapidly. They provide relief from
asthma symptoms within minutes
and are used during an acute
Reliever medications should be
carried at all times and be used
promptly to treat any asthma
symptom. School children should
carry reliever medicines in their
Preventers. They act to reduce the
swelling of the airway lining and
reduce mucus production. They
do not provide immediate relief of
symptoms but treat the underlying
medications are now the first line
of treatment in many guidelines
for managing problematic asthma.
They have to be given over a
long period of time in order to
modify the disease. Preventive
medications should always be
used, whether or not there are
symptoms of asthma. Never stop
preventive medications without
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