Asthma: Children And The Elderly
How common is asthma in children?
Believe it or not, but asthma is the most common chronic disease in children. Over 10% of children have asthma. And as a result, it's the leading cause of school absenteeism in our country. Asthma is having a tremendous impact on the public health and not only does it effect the child, but every child who is sick with asthma and has to stay home, also has a parent, either mother or father, who has to miss work to stay home with the child. So it's not only having a huge medical impact but also has a great economic impact on our society.
How do I know when to take my child with asthma to the hospital?
When people or children end up in the hospital with asthma it's usually because they haven't been diagnosed; this may be their first asthma attack, so they aren't on any medication and haven't been given any action plan. Or, it's a child who is constantly using their beta agonists; their short-acting bronchodilator, instead of adding the medications they really do need to help treat their asthma. So, if your child is having coughing, wheezing, or shortness of breath, that is not responding to the medications; if they are losing their ability to stay awake, which means that they're not getting enough oxygen; or if they're breathing very rapidly and the muscles between their ribs are going in and out; those are all signs that there's an impending severe attack. It is always better to seek emergency care, even if you don't need it, than to not seek it and have a disaster occur in the house.
How can I make nebulization easier for me and my child?
Nebulizer treatments have to be used on a regular basis, at least once and sometimes twice a day for the use of controller medications. One of the things that we have found that helps, is get a mask that is properly fitted. An adult nebulizer mask doesn't fit on a child. Second, very often we find that when parents hold their child in their arms to comfort them while the child is using the nebulizer mask, the child finds it easier to use the nebulizer mask. With toddlers, it's very often, and I am not above bribery to make a child happy while they are using the nebulizer. So we will put on, or bribe them with their favourite cartoon while they are receiving the nebulizer so that they associate the use of the nebulizer with something they like to do. The most important thing for parents to know is when the child is crying the nebulizer doesn't work very well because they are actually putting up airway resistance to the medication from the nebulizer. So one thing that many parents have found is that using the nebulizer while the child is sleeping makes it a much easier experience. Bottom line is, parents know their kids. Find out what your kids like so that they associate the nebulizer with things that they like, and then they are more apt to use it.
Will my child grow out of his or her asthma?
Most children don't outgrow their asthma, in fact if they're not properly treated, very often their asthma will get worse, especially when they get older. Many of my adult asthmatics actually have severe asthma because they weren't treated properly as children; they were in and out of the hospital all the time, and developed irreversible changes in their lungs that make them very susceptible to asthma attacks when they're older. So, if a child is going to get better when they have asthma, it's only going to be because they've been treated appropriately. The most common type of asthma that we see is allergic asthma, where people have other allergic problems such as eczema, dry itchy skin, or nasal problems (allergic rhinitis) and allergic asthma follows the progression that we call the allergic march; they just continue to have allergic symptoms. Those patients usually tend not to develop their asthma and have it into adulthood.
How is my asthma treated differently if I'm elderly?
As opposed to children and young adults, the elderly population with asthma very often have other medical problems. As a result, we have to be aware of those medical problems, not treat the asthma and complicate their other medical conditions. For example, many patients over the age of 60 have a history of cardiovascular problems, heart problems and blood pressure problems. We certainly would like to keep them away from any medications, such as beta-agenes, that might cause a complication of their heart or their blood pressure problems. In addition, a lot of patients with asthma have nasal problems and we may want to treat them with antihistamines or decongestants, but older men might have prostate problems that will then get complicated with the use of these medications. As a result, when you take a history from an elderly patient with asthma, it's very important that you're aware of their other medications. In addition, medications such as beta blockers, which are very often used in patients with cardiac conditions, can actually make their asthma worse. Very often we need to work with their own doctor to see if there are alternate medications that they can use for their other medical conditions that won't complicate their asthma.
Can the elderly get asthma?
Asthma can show up at any age. In fact, asthma over the age of 40 tends to predominate more in women as opposed to in children, whereas you see more asthma in boys. It may have to do with the protective hormonal effect that women have until they are in their forties and reach menopause. The elderly population with asthma very often will have more severe asthma and require higher dosages of inhaled coriticosteroids. The bottom line is, if you are coughing, wheezing and short of breath, and you're in your fifties and sixties, you might have asthma. As a result, you need to see your doctor to get properly diagnosed and treated.
