Winter sees chest problems more commonly reported by patients around the country. One of the most common chronic chest problems occurring among both adults and children at this time of the year is asthma, which is often triggered by infections such as the common cold.
Dr Steve Ponde, a paediatric pulmonologist who practises at Netcare Waterfall City Hospital in Midrand, says it has been estimated that 6-10% of South Africans have asthma. “That’s a considerable number of people. Fortunately, the great majority of asthma cases are mild and easily managed by a family doctor or paediatrician,” said Dr Ponde.
“Evidence suggests, however, that SA does have a relatively high child mortality rate related to asthma when compared with other countries. This highlights some of the potential dangers of severe and complex forms of the condition, as well as the importance of careful medical management of these cases,” he said.
THE IMPORTANCE OF MANAGING ASTHMA
“It’s critical that children with more severe asthma receive regular treatment to control the disease and reduce the number of flare-ups. Regular treatment with preventive medication results in better asthma control, reduces the burden of disease, and enables the child to live a more normal lifestyle over the longer term.
“Parent and patient education about asthma and allergies is vital in the treatment and management of asthma in the child. Parents and patients who are well informed tend to follow treatment plans, make regular visits to their doctors, and are also better at managing the early signs of asthma flare-ups.
“Children whose asthma is well managed tend to require fewer emergency visits, are able to concentrate better at school, and are better able to lead a normal active lifestyle,” explained Dr Ponde.
“Although asthma is not curable, some children’s symptoms do disappear later in life and it can be well controlled, so the patient is able to live a completely normal lifestyle. Asthma treatment is safe, and doctors will look to use the lowest medicine doses necessary to achieve control,” he explained.
Asthma is a chronic inflammatory condition characterised by a recurrent or chronic cough, and/or shortness of breath with exercise. In severe cases it can prevent the child from participating in activities, prevent them from thriving, and have a severely negative impact on their lifestyle.
“Asthma is almost always due to underlying allergy and is therefore strongly associated with eczema, food allergy, or allergic rhinitis,” said Dr Ponde.
“The child’s doctor will take a detailed history, do a thorough physical examination and may require tests such as x-rays, allergy tests and lung function tests. Using the test results the doctor will in most cases, be able to make a firm and accurate diagnosis of asthma, although in some complex cases this can be trickier.”
THE ALLERGY CONNECTION
“It should be remembered that asthma almost always occurs in the context of allergy and therefore a young child may already be showing signs of allergy. The propensity for allergy is inherited, so parents who suffer allergy problems should be sure to look out for signs of it in their children.
“The younger the child is, the more careful a doctor needs to be in differentiating asthma from other conditions. This is especially true in children younger than four years old where there is failure to thrive, no clinical allergy detected, and the child does not respond to asthma treatment.”
According to Dr Ponde, the conditions that can mimic asthma in young children are recurrent viral infections, chronic infectious tuberculosis (TB), a weakened immune system, and reflux. Sometimes, the problem could even be related to the child having aspirated (breathed in) a foreign body.
“In some cases, the youngster may need a lung function test to determine the presence and severity of lung disease and assess the response to exercise and medication. We are now able to get reliable lung function tests in co-operative children from as early as four years old.
“Blood tests for allergy, immunity, TB, nutrition, and cystic fibrosis may also be undertaken. These tests are important in establishing a firm diagnosis of asthma and assisting in avoiding the triggers of asthma and allergy.”
“Most asthma exacerbations occur after exposure to an allergic ‘trigger’. The patient’s doctor will undertake allergy tests to determine whether there is an allergy to common airborne and food allergens. The most common trigger of asthma is a respiratory virus, especially the common cold. Some triggers are less obvious and therefore harder to pinpoint,” he said.
“Asthmatics may react to strong scents and aromas such as cigarette smoke, perfume, or detergents, as well as colourants and preservatives in treats and cool drinks, and even silent acid reflux could trigger episodes of cough. Environmental pollution is a well-known trigger of asthma. Identifying and then avoiding such triggers is imperative for good control of asthma.”
According to Dr Ponde, children should never be exposed to parental tobacco smoke. This is even more important for asthmatics. Studies confirm children of parents who smoke have three times the burden of disease from asthma, recurrent chest infections, ear infections, and poor sleep.
“Sometimes allergy in children is associated with defects of the protective immune system. Some children suffer recurrent infections of the ear, nose, throat, and respiratory tract. They often need many courses of antibiotics, heal poorly, and may require surgery for sinus and ear infections.
“This is sometimes associated with a family history of a weak immune system. Recognising these features of immune deficiency, the patient’s doctor may refer them to a specialist for further investigation and management.”
Dr Ponde said it is vital all children receive the full set of available vaccines. These have been shown to reduce vaccine-preventable disease and serious complications. It is also recommended asthmatic children receive the yearly influenza shot.
ASTHMA-RELATED SLEEP DISTURBANCES
“People with asthma may suffer breathlessness, night-time waking, and other sleep disturbances. This is much easier to pinpoint in very young children who will wake up and cry but is often overlooked in adolescents and adults.”
In a study recently published in The Journal of Allergy and Clinical Immunology, nearly 300 adolescents with and without asthma were surveyed. More adolescents with severe asthma reported deficient sleep (less than seven hours per night) compared to adolescents without asthma. Notably, almost 40% of adolescents with severe asthma reported clinically significant insomnia. Adolescents with severe asthma reported more daytime sleepiness than adolescents without asthma.
“It is well known that children with persistent nasal allergy, asthma, and obstructive breathing can develop behavioural and concentration problems. This in turn affects school performance and leads to hyperactivity and attention problems. Severe untreated asthma can have a severe impact on the development of a young child,” said Dr Ponde.
“The treatment of disrupted sleep and control of nocturnal symptoms often results in a marked improvement in learning and daytime function. Overnight sleep studies are a useful tool in diagnosing sleep disorders and can help determine whether further medical intervention is needed in this regard.”
Dr Ponde said parents, caregivers, and older children need to be actively involved in the management of the disease and should keep themselves well informed by speaking to their doctors and undertaking their own research. Locally, the Allergy Society of South Africa (ALLSA) is an excellent source of support and information.
“Properly managed asthma will greatly improve the whole family’s quality of life and enable our children to just be children,” he concludes.