On World Asthma Day 2019 take the time to remind yourself of causes and treatment of the condition.
The Global Initiative for Asthma (GINA) has designated the first Tuesday in May to be World Asthma Day since the scheme began in 1998. This year it falls on the 7 May. The day should be an important reminder of two things; the common instance of asthma amongst children as well as the condition’s potential severity.
This article will outline the basic information about asthma – causes and treatment as well as a note on air pollution – and finally provides some ideas from GINA to spread awareness of asthma in your setting for World Asthma Day.
Three people die per day due to asthma and, tragically, two thirds of these deaths are preventable. Asthma.org.uk.
Being a potentially life-threatening condition, it is vital that everyone in contact with the asthmatic child knows the best way to quickly help quickly in an emergency. When someone is having an asthma attack; their airways go into spasm which causes tightness of the chest; the linings of the airways become inflamed and phlegm is produced, further obstructing the airways and leading to severe difficulty in breathing.
Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness. Severity varies and the symptoms can be controlled most of the time, except in some more severe cases.
Diagnosing asthma in children can be a lengthy process. Often, young children are prescribed blue reliever inhalers (salbutamol) to try and control symptoms until a confirmed diagnosis is reached.
What causes asthma?
Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. When you come into contact with something that irritates your lungs – known as a trigger – your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm).
How asthma is treated
While there is no cure for asthma, there are a number of treatments that can help control the condition.
Treatment is based on two important goals, which are:
- relieving symptons
- preventing future symptoms and attacks.
For most children, this will involve the occasional – or, more commonly, daily – use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important. Once children have been diagnosed they should have a personal asthma action plan that includes information about the medicines they need to take, how to recognise when their symptoms are getting worse, and what steps to take when they do so. This plan should be regularly reviewed with the parents to ensure that those caring for the child are updated with any changes.
Children should have their prescribed asthma inhaler easily and quickly accessible at all times.
Learn the triggers:
There are many different triggers for asthma attacks and many asthmatics are well aware of their trigger points, although they may not always be able to avoid them. In young children, they may be still trying to establish the cause.
Often a child may have other known allergies and sensitivities and may have been prescribed an adrenaline autoinjector (Epipen, Jext or Emerade) too.
If there is a family history of asthma, eczema or allergies there is a higher incidence that the child may develop asthma. Research has also shown that smoking during pregnancy significantly increases the risk of a child developing asthma. Similarly, children whose parents smoke are more likely to develop asthma.
Exercise can trigger attacks in some children; children should not avoid exercise because they are asthmatic, however they should always have their reliever inhaler with them.
Symptoms of an asthma attack:
- Persistent cough (when at rest)
- A wheezing sound coming from the chest (when at rest)
- Difficulty breathing (the child could be breathing fast and with effort, using all accessory muscles in the upper body)
- Nasal flaring
- Unable to talk or complete sentences. Some children will go very quiet.
- May try to tell you that their chest ‘feels tight’ (younger children may express this as tummy ache)
CALL AN AMBULANCE IMMEDIATELY AND COMMENCE THE ASTHMA ATTACK PROCEDURE WITHOUT DELAY IF THE CHILD:
- Appears exhausted
- Has a blue/white tinge around lips
- Is going blue
- Has collapsed
Not everyone will get all of these symptoms.
NOTE: Encouraging someone to sit upright is generally helpful when dealing with breathing problems. Sitting the wrong way round on a chair may be a good position for them as it it a good open position for their lungs and the back of the chair will give additional support.
DO NOT take them outside for fresh air if it is very cold as cold air can make symptoms worse.
Using a spacer device delivers medication more evenly and can help children achieve better control of their asthma.
Not all spacers fit all types of inhalers –the spacer prescribed with the child’s inhaler should be used. Spacers for smaller children are usually fitted with a face mask. There is considerable coordination required to use an inhaler without a spacer and this can lead to increased stress and worsening of symptoms.
How to help in an asthma attack
The following guidelines are suitable for both children and adults:
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Calm the situation and reassure the child as this can help them to control their symptoms. Panic can increase the severity of an attack. Assist them to take one to two puffs of the reliever inhaler (usually blue) – using a spacer device if available.
- Sit them down, loosen any tight clothing and encourage them to take slow, steady breaths.
- If they do not start to feel better, they should take more puffs of their reliever inhaler (up to 10 at roughly two-minute intervals)
- If there is no improvement after taking their inhaler as above, or if you are worried at any time, call 999/112.
- They should keep taking the reliever inhaler two puffs every two minutes, whilst waiting for the paramedics to arrive
Do not panic if the child has taken more puffs than this. Salbutamol is a well-tested medication and the main side effects from overdosing are light headedness and a slight tremor of the hands – both of which will resolve without treatment.
After an asthma attack:
Within 48 hours of their attack, they should see their asthma nurse for an asthma review.
People often have a variety of different asthma inhalers and medication to control their asthma – if they are having an asthma attack it is the reliever inhaler that they need. Reliever inhalers are usually blue and the other inhalers are often steroid based to reduce their sensitivity to asthma inducing agents.
Just like cigarette smoke, woodfire smoke and pollen, air pollution can worsen the symptoms of asthma. Children with asthma are more at risk from the effects of pollution because they have faster breathing rates and their lungs are still developing. It is a good idea to avoid busy high roads, at peak hours, if you have a small child with asthma. Exercise in schools should ideally not be located near to a busy road.
To promote World Asthma Day:
GINA have some recommendations for including asthma education in schools. Some of these are not, of course, aimed at young children. However, spreading awareness and knowledge of asthma amongst parents is an equally valuable use of the day.
Here are some of their ideas:
- Make learning about asthma control fun by creating games for children that will educate them about asthma control, or invite physicians to compete in a quiz about GINA's recommendations for asthma control.
- Arrange school visits on or prior to World Asthma Day—educate children about asthma and offer on-the-spot peak flow meter testing. These activities could be combined with plays, concerts, or poetry competitions highlighting the concept of asthma control.
- Set up a display of asthma information, treatments, the definition of control, and the relationship between uncontrolled asthma and hospitalization in your school or nursery.
- Host a panel discussion at a group for parents & teachers in which two or three parents of children) with asthma discuss their experiences with asthma control. Invite a local pediatric asthma specialist to be part of the discussion.
About the author
Written by Emma Hammett, founder and CEO of First Aid for Life.
Please visit www.firstaidforlife.org.uk, firstname.lastname@example.org or tel 0208 675 4036 for more information about our courses and the specialist First Aid support we give to schools, nurseries and child carers.
First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.