15 September 2011 | Dr George Du Toit | Children’s Allergy Specialist | The Portland Hospital
Many parents are concerned their child has asthma – after all, most young children experience some degree of chesty symptoms during early childhood.
When symptoms are at the extremes, this is an easy question for your doctor to answer. For example, young children with three or four ‘innocent’ chest infections a year that are not associated with a wheeze but rather a ‘fruity-bronchitic cough’, do not have asthma; indeed, such symptoms are normal for pre-school children in the UK.
However, those with a ‘persistent wheeze’ that comes on with lower respiratory tract infections (LRTI's), exercise or during the pollen season that responds to the drug Salbutamol are extremely likely to have asthma.
Where the symptoms fall somewhere in between, a diagnosis can be more difficult.
Whilst nearly one in every two children will wheeze at some point during early childhood, only a minority will go on to have persistent troubling asthma.
The most common sign of asthma – an inflammatory disease of the lower airways – is wheezing (a high pitched whistle on expiration); this tends to be worse in the evening or early morning and usually settles with medication. These symptoms typically recur over a period of weeks. Breathing noises on inspiration tend not to be asthma.
Asthma can be brought on by exercise and, when an attack happens, the child is likely to be quiet, develop faster breathing with nasal flaring, a tracheal tug and a hyper-inflated barallel shaped chest with associated hunched up shoulders.
Infections and allergens such as pollen, house dust mites, pet danders and mould can cause asthmatic inflammation of the lungs. Many children with asthma will also have rhino-conjunctivitis and it is important, therefore, to assess and treat both conditions in order to optimise symptom control.
At The Portland Hospital we offer skin prick tests and specific blood tests to measure the allergy antibody (IgE).
The most accurate test for diagnosing asthma is the bronchodilator reversibility test. This involves a child inhaling a drug such as Salbutamol and then measuring whether that gives them any relief from wheezing. Those who get some relief are more likely to have asthma.
As children get older it is easier to measure outcomes using fancy lung function meters, but most children under the age of five years are not able to produce reliable results.
If an asthma diagnosis is made, specialist doctors and nurses at The Portland Hospital will teach you how the reliever and preventor medications should be taken, and which devices should be used.
Young children are not always crazy about face masks attached to spacer chambers but there are tricks which our experienced specialist paediatric nurses will be happy to share with you.
Once symptoms are controlled, there is no reason why a child cannot participate in normal sporting activities. Indeed, swimming is an excellent activity for asthmatics as it encourages breath-holding and greater respiratory control.
The long-term outcome of childhood wheezing is generally good; children with mild to moderate symptoms fare the best, while those with recurrent severe symptoms are, frustratingly, likely to continue with symptoms for some years.
Asthma can be outgrown at any age but the ‘transient early-onset wheezers’ tend to do the best and typically outgrow their asthma between the ages of three and five.
To arrange a consultation appointment with Dr George Du Toit at The Portland Hospital please call 0845 5561261.