Sunday, April 29, 2007

Asthma Medications for Kids

The annual direct health care cost of asthma is approximately $11.5 billion; indirect costs (e.g. lost productivity) add another $4.6 billion, for a total of $16.1 billion dollars. Prescription drugs represented the largest single indirect cost, at $5 billion. The value of lost productivity due to death represented the largest single indirect cost at $1.7 billion.1

INHALED BRONCHODILATOR MEDICATIONS

Inhaled bronchodilator medications are highly effective in opening airways narrowed by asthma. In addition, they have few severe side effects when used in the recommended dose and frequency. They are available by both metered dose inhaler and nebulizer.

Inhaled bronchodilator medication produces much fewer side effects than theophylline and is preferred over theophylline for routine use, for severe episodes and for prevention of exercise-induced asthma. In certain cases both may be used.

For children with mild asthma this is often the only medication they will need. Inhaled bronchodilators are highly effective, and they have also proven to be the bronchodilator medicine of choice for moderate and severe asthma when used with other medications.

Because inhaled bronchodilator medications are very effective with few or no side effects, some patients tend to overuse them, which can be very dangerous. Overuse of these medications can delay proper evaluation and treatment of severe asthma episodes.

Some studies suggest that overuse of these medications may worsen the asthmatic condition and increase the possibility of death from asthma. It should be remembered that under-medication is far more likely to cause severe asthma and death than over medication.

There are now long acting inhaled bronchodilators which are prescribed for use in the morning and evening. It is now recommended that this be used as add on medication from a person who is taking inhaled corticosteroids. REMEMBER:

1. If you need to use inhaled bronchodilator medication more often than prescribed, this is a sign that your asthma is not in control and you should consult your doctor.

2. When medications fail to control asthma and it becomes more severe, immediately call your doctor or emergency room -- day or night.

ANTI-INFLAMMATORY MEDICATIONS

Anti-inflammatory medications are recommended by the National Heart, Lung, and Blood Institute (NHLBI) expert panel for children with mild persistent, moderate and severe asthma as the cornerstone for daily routine medical management. This panel recommend that one of these medications be given daily to control airway inflammation. They are considered safe and effective for long-term use.

Cromolyn (Intal) has been used for 30 years and has very few side effects. An inhaled anti-inflammatory; nedocromil, may also be prescribed. Inhaled corticosteroids are the most used medication. They are very effective and safe but should always be given with a spacer device in the recommended dose to prevent side effects, primarily throat irritation due to yeast infection.

Both of these anti-inflammatory medications must be taken regularly to be effective. These medications frequently fail because they are not taken consistently. These medications do not have an immediate effect and therefore are mistakenly discontinued. Their beneficial effects occur gradually over weeks and months of consistent use.

Therefore, it is important for children to take these medications regularly.

Note: NEVER take more medication than your physician prescribes and always notify him/her of possible side effects.

SYSTEMIC BRONCHODILATOR MEDICATIONS

Systemic bronchodilator medications, prinicipally theophylline, are effective but have more associated side effects that can be unpleasant although rarely life threatening. These medications are available in slow release tablets or capsules that are effective for 12 to 24 hours. These are especially helpful for nocturnal or night-time asthma. They are also used for daily control of asthma symptoms.

Side effects can be a problem and should be brought to the attention of your doctor.When taking theophylline, blood levels are monitored periodically to help reduce side effects and ensure proper dose.

SYSTEMIC CORTICOSTEROID MEDICATIONS

Systemic corticosteroid medications are highly effective in controlling asthma and reversing severe episodes. Unfortunately they can cause serious side effects when used for prolonged periods, and their use is therefore limited to severe episodes or chronic severe asthma which cannot be controlled with the first three groups of medication listed above.

Corticosteroid is a class of normal hormone of the human body and is produced by the adrenal gland. It is very effective in the control of allergies, asthma and many other diseases. It is not like performance enhancing "steroids."

When your child is having a severe allergy or asthma episode, his or her adrenal gland responds by producing more corticosteroids (up to ten times more). In this way, the body can help control asthma.

When asthma is not controlled, despite maximal therapeutic doses of bronchodilator medication, additional corticosteroids must be given. A short course of systemic corticosteroids for less than two weeks is rarely associated with significant side effects. For most children, 5 days of use is adequate.

It must be remembered that severe uncontrolled asthma is potentially fatal; and therefore, a much greater risk than 1 to 2 weeks of systemic corticosteroid. If the asthma is severe, your child may also require hospitalization so that more intensive therapy can be given.
Whenever possible, long-term use of corticosteroids should be avoided. However, severe uncontrolled asthma might require corticosteroids on a regular basis for months or even years. In this case, the risks of chronic uncontrolled asthma are greater than the possible side effects of systemic corticosteroids.

Corticosteroids may be given every other day in the morning, greatly reducing some of the long-term side effects.

INHALED MEDICATION DELIVERY SYSTEMS

Inhalers must be used properly to be effective. Studies demonstrate that inhaled bronchodilator medication is very efficiently delivered by the hand-held metered dose inhaler; however, this requires that the instructions be followed carefully.

Approximately half of asthma patients do not properly use their inhaler and this problem is overcome by the use of a spacer device.

Spacer devices or "spacers" allow the metered dose inhaler to first be sprayed into this container (usually 6 to 16 ounces in size) and then the patient breathes in the inhaled medication from the spacer. This is almost foolproof, thus improving proper use of inhalers from 50 percent to almost 100 percent.

Some authorities recommend spacers for all children. Spacers should be used with inhaled corticosteroids if sore throat or yeast overgrowth (thrush) is a problem.

Pulmonary nebulizer machines or "nebulizers" are also very helpful. They are used to give routine medication treatments of inhaled bronchodilators and/or cromolyn to very young children or any adult who have difficulty using metered dose inhalers and spacers.

Nebulizer machines may also be recommended for anyone with asthma with a severe asthma episode to ensure maximal delivery of bronchodilator medication.

Proper selection and use of inhaled medication, metered dose inhaler, spacer and nebulizer will be provided by your physician and his or her nursing staff. Be sure to carefully follow their instruction for use and cleaning.

NEW MEDICATIONS

Leukotriene modifiers are a new class of oral anti-inflammatory asthma drugs recently approved by the U.S. FDA. Sold under the names Accolate, Singulair and Zyflo, these are also available by prescription.

In July of 2003, The Food and Drug Administration approved a new drug patients with serious asthma. Xolair, is the first in a new class of therapies that are bioengineered to target IgE (the antibody behind allergic asthma) in the treatment of allergic disease.

If your child is not on one of these medications, you should ask your physician if this should be added.

Q & A: KIDS' ASTHMA MEDICINES

HOW ARE ASTHMA MEDICINES PRESCRIBED?


Check with your doctor about your child's medicine needs. Each child has special needs. For instance, if your child has mild asthma and very few episodes, he/she may take a bronchodilator medicine at the first sign of symptoms (such as wheezing or coughing) to keep the symptoms from getting worse.

Your child may take the medicine for about a week after the symptoms end. If your child has more severe asthma and many episodes, he/she may need to take medicines every day, including one or more anti-inflammatory medicines.

HOW LONG DOES IT TAKE FOR BRONCHODILATOR MEDICINES TO WORK DURING AN EPISODE OF ASTHMA?

For bronchodilator sprays prescribed by your doctor, you can tell they are working within 5 to 10 minutes. At that point, your child should begin to feel better. (There are some sprays that are preventive and are prescribed by the doctor even when a child has no symptoms that you can "see." These are anti-inflammatory sprays and they help to prevent asthma episodes from starting.)

For liquids, it usually takes one hour for the medicines to work. For pills and capsules, the time varies, so check with your doctor or pharmacist.

ARE ASTHMA MEDICINES SAFE?

The medicines, including corticosteroids, are safe and highly effective if taken in the recommended doses. No drugs are without some risk or side effect. This is important. All medicines can be harmful if they are not taken properly. Children do not become addicted to asthma medicine.

IF SIDE EFFECTS OCCUR FROM MEDICINES, HOW CAN THEY BE CONTROLLED?

Call your doctor. If your doctor cannot be reached, reduce the dose by half, or skip the next dose. Do not stop the medicine completely. This may cause the asthma to get worse.

For asthma medicine taken by mouth, never have your child take this medicine on an empty stomach. If your child gets nauseous or vomits, try to give the medicine with some milk or food. Be sure to tell your doctor you are doing this because giving the medicine with food or milk can change its effectiveness.

If the side effects, such as vomiting, do not go away, talk to your doctor about changing the dose or the type of medicine. Vomiting is an urgent danger sign.

TO CONTROL ASTHMA SYMPTOMS

Asthma medicine needs to be adjusted if your child has symptoms (such as wheezing or coughing) with exercise, at rest, at night, or early in the morning. According to the NAEPP Expert Panel Report, peak flow meters may be most helpful for people with moderate or severe asthma. A meter reading will tell you your peak flow zones, which are based on the colors of a traffic light. The green zone signals that your asthma is in good control, the yellow zone signals caution and is a sign to use quick-relief medicine to relieve symptoms, and the red zone signals a medical alert that means you should contact your doctor about changing the dose or type of medicine.

TO MANAGE A BAD EPISODE

At the first sign that your asthma is out of control, you will need to take action right away. It is important to know the warning signs that tell you when emergency medical care is needed:

  • Monitor throughout the day if you feel any comfort from taking your medicine. If there in no sign of some relief and it's is becoming harder to breath seek emergency assistance.
  • Stay calm, refer to your asthma management plan, take your medicines as prescribed.
  • If your symptoms get worse, call 911 and get help right away.

TIPS FOR CORRECT USE OF "AS NEEDED" MEDICINE

For "as needed" medicines, give them within five minutes after symptoms begin. It takes less medicine to stop an episode in the early phases of asthma rather than later on.

If your doctor agrees, give the medicine at the first sign of a cold or influenza even if you don't hear wheezing or coughing. Continue giving medicine until all signs of the cold or influenza are gone.

TIPS FOR CORRECT USE OF PREVENTIVE MEDICINE

For medicines taken daily (to prevent asthma), these should be given even if your child does not have symptoms. The medicines reduce airway swelling and make it less likely that another episode will occur.

Controlling Your Child's Asthma

HOW DO YOU CONTROL ASTHMA?

First, it is important that you and your child understand what control means. To completely control asthma is to reduce its frequency and severity, so that the asthma does not interfere with normal activities.

The degree of control varies with each child as some children with severe asthma are extremely difficult to control.

Control of asthma begins by learning which trigger factors are important to your child. Since no two children with asthma are alike, an individualized comprehensive evaluation must be made of your child to determine his or her trigger factors. The child's history is by far the most important part of the evaluation.

Your physician may recommend that you see a lung or an asthma/allergy specialist to help him with this evaluation. Skin testing may be required to determine which allergens may be important. Special diets and careful challenges with suspected foods usually will detect food allergies.

Other laboratory studies, including pulmonary function studies, may be requested by your physician. Pulmonary function studies are performed to determine the severity and reversibility of your child's airway obstruction.

After the evaluation, your physician will outline those factors that are important in your child's asthma and prescribe an individual treatment program.


WHAT IS THE TREATMENT PROGRAM?

Treatment includes:

Avoidance of Trigger Factors

Asthma Medications

Allergy Injections When Indicated

Team Approach/Patient Education

1. Avoidance

Avoiding trigger factors can make a great difference in your child's condition. If your child could avoid exposure to all of his or her allergies (such as house dust, molds, pets, etc), he or she might still have asthma; however, the severity would be lessened.

Trigger factors, such as viral respiratory infection and running, could still provoke asthma symptoms. Whenever possible, your child should avoid such trigger factors as cigarette smoke and other inhaled irritants.


2. Medications

Medications that control asthma are available. The amount, frequency and duration of medications depend on your child's asthma.

Some children only have asthma episodes a few times a year associated with colds, while others have episodes daily during spring and fall when there is increased exposure to outdoor allergens.

Some children wheeze only with exercise, while others wheeze daily for no apparent reason. Several different approaches might have to be tried before the proper medication program is achieved (see the "
Asthma Medication Groups For Kids" section).

Fortunately there are many excellent medications with few side effects. Asthma can usually be controlled with safe effective medications.

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3. Allergy Injections

Scientists still do not agree on whether allergy shots are useful in asthma. Hyposensitization, allergy shots, immunotherapy or desensitization are synonyms for injection treatments which reduce sensitivity to those unavoidable allergens.

Small quantities of proven allergens are given in gradually increasing dosage until the child is able to better tolerate his or her allergies. This form of therapy has been shown to decrease the allergy antibody level and to increase the protective or blocking antibody level.

Usually a one-year series of allergy injections is prescribed to determine their effectiveness. Hyposensitization is not always recommended.

If proven effective, injections are then continued on a schedule determined by your physician. Allergy injections are no substitute for avoidance of allergens or medication. You must continue allergen avoidance measures even when your child's asthma is controlled or the problem may again worsen.

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4. Team Approach/Patient Education

Emphasis is now placed on improved patient/parent education and goal setting. Physicians and nursing staff are spending more time teaching patients about the subtleties of asthma management. Major emphasis is placed on peak flow monitoring as a guide to treatment and a way to better understand the dynamics of asthma.

Peak flow monitors are inexpensive devices which measure the peak air flow and thus reflect the degree of airway obstruction. Sometimes patients are unaware that they are gradually getting worse.

By recording the peak flow two or three times daily, the patient and doctor can better determine the need to increase or decrease medication.

When the peak flow fluctuates a great deal, this indicates poor control and need for adjustment of medication. When the peak flow drops and responds poorly to inhaled bronchodilator medication, additional treatment is needed. This should be done by the patient only when a course which has been determined by the physician is to be followed, otherwise the physician must be consulted.

Frequently, three or four visits are required just to teach these fundamental principles. This may be done in a group setting or with a nurse who specializes in asthma care. Through this process the patient and/or parents are empowered to control asthma during most situations.

With improved asthma management, emergency room visits are much rarer because children and their parents stay ahead of problems. Parents learn when to call their physician, day or night, which can prevent many hospital visits.

There are many other aspects of asthma management that should be taught to the child and parents to better prepare them to deal with asthma directly and efficiently. By better understanding their treatment program, they can comply much better and this is a major step toward asthma control.

The physician, nurse, child and parents should set specific goals and follow up on these each visit. With this type of team approach, asthma usually comes under excellent control so that sleep and activities are rarely interrupted by asthma. Most children with asthma can fully participate in sports and not be bothered by unwanted medication side effects.



WHY DOES ASTHMA TREATMENT FAIL?

If the parents or caregivers do not understand the problem, they surely cannot carry out the treatment program. It is your responsibility to read and reread the materials provided by your physician.

Allergy management is often important for the continued control of asthma. Frequently, parents forget about allergy avoidance measures when the asthma is controlled with medication or allergy injections.

You might buy a new pet or furniture to which your child is or becomes allergic. You might forget about house dust and mold control in the home. Continuation of avoidance measures is crucial for good control in the allergic child with asthma.

Poor compliance with other treatment measures (routine medicines, allergy injections, follow-up visits) also leads to uncontrolled asthma.

1.) Some studies demonstrate that only 50% or less of patients take their inhaled corticosteroid as prescribed.

2.) Inhaled corticosteroids control airway inflammation very effectively, but take weeks to be maximally effective. For many reasons parents and their children perceive that the medication "doesn't do anything." They prefer the "quick relief" they get from their bronchodilator inhaler. They need to learn that the inhaled corticosteroid medication is safe and will work, but they need to use it daily as prescribed by the doctor.

Although seldom fatal, deaths from asthma do occur. Inner city children with asthma, especially African-Americans, have a three to five times greater asthma mortality rate. Many cases of fatal asthma appear to be related to under-medication. Many of these deaths are probably avoidable.

Also, research into asthma fatalities indicates that children with recurrent, acute, severe asthma episodes and those with major psychological problems, especially depression, are at increased risk of death from asthma. This should be discussed with your physician.

Do not hesitate to ask questions about anything that is not completely clear. It is important that you fully understand your child's condition and its management.

Your child should be taught about his/her asthma treatment program. Older children should be responsible for their own treatment program as much as possible. They should recognize and learn to avoid their triggers, and know about their medication, its use and how to administer it.

Working together with your child and your doctor can help to insure the effectiveness of asthma treatment.


CONCLUDING COMMENTS

Frustration and despair will accompany the many problems of the chronically ill child. Always try to avoid the negative aspects and remember that the majority of children will improve as they grow older.

Take a positive approach to your problem, for learning asthma control can be a stepping-stone for your child's personal development. Your child will gain confidence as he or she learns to control the asthma.

Qualities such as self-discipline and personal responsibility are frequently learned through struggles with any chronic illness.

Encourage physical activity within your child's limits. Fortunately, the vast majority of children with asthma can participate in most activities, including track, basketball and soccer. The very few children with extremely severe asthma may wish to participate in an activity such as swimming, which is the least likely to provoke asthma symptoms.

Other activities which do not involve prolonged running will also be tolerated better. Encouragement and praise in these activities will kindle an inner desire for personal development in these and other activities.

REMEMBER:

Maintaining control is the key. When your child's asthma is controlled, you will seldom notice asthma symptoms. Don't be satisfied until your child's asthma is controlled, thus allowing full physical, mental and emotional development.

ABOUT CHILDHOOD ASTHMA

Asthma is one of the most common chronic diseases of childhood.

In 2004, an estimated 4 million children under 18 years old have had an asthma attack in the past 12 months, and many others have "hidden" or undiagnosed asthma.1 Asthma is the most common cause of school absenteeism due to chronic disease and accounted for an estimated 14 million lost school days.2

Even though asthma cannot be cured, it can almost always be controlled. For this reason, the American Lung Association has chosen control of childhood asthma as one of its top priorities.

The better you and your child understand asthma and its treatment, the better you will be able to control it.

HOW DO NORMAL LUNGS FUNCTION?

Lungs allow oxygen to enter the body in exchange for its waste product, carbon dioxide. As the air passes through the nose and mouth, it is rapidly warmed and moistened to avoid injury to the delicate lining of the airways.

The nose and airways also trap large particles (dust, pollen, molds, bacteria) and chemicals (smoke, sprays, odors), which could cause serious injury to the lungs.

The air is then transported through smaller airways. These airways branch like a tree, so that millions of small airways can carry oxygen to the tiny air sacs called alveoli.

The airways have a delicate cellular lining (mucosa), which is coated with a thin layer of mucus, as is present in the nose. Foreign particles are trapped by the sticky mucus and eventually removed from the airways through the normal cleansing process.

The process is assisted by the movement of tiny "whip-like" structures called cilia which move the mucus and trapped foreign particles up toward the mouth and nose where they are coughed and sneezed out or swallowed.

Bundles of muscles surround the airways, and the contraction of these muscles allows airways to selectively direct the flow of air.

WHAT IS ASTHMA?

Asthma is an inflammatory condition of the bronchial airways. This inflammation causes the normal function of the airways to become excessive and over-reactive, thus producing increased mucus, mucosal swelling and muscle contraction.

These changes produce airway obstruction, chest tightness, coughing and wheezing. If severe this can cause severe shortness of breath and low blood oxygen.

Each individual suffers a different level of severity. Virtually, all children with asthma, however, do enjoy a reversal of symptoms until something triggers the next episode.

WHAT IS THE CAUSE OF ASTHMA?


Inflammation of the airways is the common finding in all asthma patients. Recent studies indicate that this inflammation is virtually always causative in the asthmatic condition. This inflammation is produced by allergy, viral respiratory infections, and airborne irritants among others.

Childhood asthma is a disorder with genetic predispositions and a strong allergic component. Approximately 75 to 80 percent of children with asthma have significant allergies.3

Studies indicate that allergic reactions produce both immediate and late phase (delayed) reactions. Research indicates that approximately half of the immediate allergic reactions to inhaled allergens are followed by a late phase reaction.

This late phase reaction produces more serious injury and airway inflammation. This airway inflammation leads to irritability or hyperresponsiveness of the airways. In addition, prolonged airway inflammation can cause scarring.

WHAT ARE THE SIGNS AND SYMPTOMS?

Wheezing, though characteristic of asthma, is not the most common symptom. Coughing is noted especially with even "hidden" asthma when wheezing may not be apparent to the patient, his or her family or the physician.

Any child who has frequent coughing or respiratory infections (pneumonia or bronchitis) should be evaluated for asthma.

The child who coughs after running or crying may have asthma. Recurrent night cough is common, as asthma is often worse at night.

Infants who have asthma often have a rattly cough, rapid breathing and may have an excessive number of "pneumonias," episodes of bronchitis or "chest colds." Obvious wheezing episodes might not be noted until after 18 to 24 months of age.4

Chest tightness and shortness of breath are other symptoms of asthma that may occur alone or in combination with any of the above symptoms. Since these symptoms can occur for reasons other than asthma, other respiratory diseases must always be considered.

In a young child the discomfort of chest tightness may lead to unexplained irritability.

Remember: Any child who has frequent coughing or respiratory infections (pneumonia or bronchitis) should be evaluated for asthma.

WHAT ABOUT HIDDEN ASTHMA?

Until rapid breathing, wheezing and coughing become obvious, the condition of many children with asthma will go undetected. These children with asthma usually suffer some degree of airway obstruction; and unless it is brought under control, the children may suffer respiratory illness more frequently than necessary.

Hidden asthma, however, can produce so few recognizable symptoms that even the physician might not be able to distinguish abnormal breath sounds with his or her stethoscope but it may cause subtle problems such as limitation of physical activity. Pulmonary function testing usually reveals these cases of airway obstruction.

WHAT USUALLY TRIGGERS ASTHMA?

Episodes of asthma often are triggered by some condition or stimulus. Common triggers of asthma are:

Exercise

Running can trigger an episode in over 80 percent of children with asthma. Bronchodilator medications used before exercise can prevent most of these episodes. With proper control of asthma, most children with asthma can participate fully in physical activities.

There might be exceptions, such as prolonged running, especially during cold weather, allergy season or illness from a "cold." Swimming seems to be the least asthma-provoking form of exercise. However recently there has been concern about excessively chlorinated pools precipitating asthma episodes.

Infections

Respiratory infections, including the flu, frequently trigger severe episodes of asthma. Research indicates that these infections are most frequently produced by viruses, rather than bacteria. Antibiotics are of no benefit for viral infections and thus may be of little value in an asthma episode. It is important for all children with asthma to get vaccinated for the flu each year. American Lung Association Research has shown that the vaccination itself will not precipitate an attack.

Bronchodilator medication, good hydration, and when indicated, corticosteroids are required to control an asthma episode triggered by viral infections. Therefore, a parent should not be surprised if the physician does not prescribe an antibiotic when a child is having a respiratory infection and asthma. On the other hand, the doctor may decide to use an antibiotic if he or she suspects bacterial infection, such as sinusitis or bronchitis.

Note: Chronic sinusitis in childhood due to bacteria can be a very stubborn chronic trigger for asthma. Treatment for 10 days with antibiotics may not be effective. In these children, sinus x-rays are frequently required to diagnose the underlying condition.

Antibiotic treatment for 3 to 4 weeks or longer may be required to completely eradicate these infections. Asthma may also be triggered by an ear infection or bronchitis which would also require antibiotic therapy.

Allergy

Asthma symptoms of many children with asthma are triggered by allergies. Allergic children suffer reactions to ordinarily harmless material (pollen, mold, food, animals).

During an allergic reaction, chemicals such as histamine are released from specialized cells. This may produce swelling of the lining of the airway, excessive mucus secretion and muscle contraction in the airways. In this way, an allergy can provoke an asthma episode.

The allergens involved are common indoor inhalants (dust mites, feathers, molds, pets, insects (especially roaches), outdoor inhalants (molds and pollens), or ingested foods (milk, soy, egg, etc.). Foods are much less frequent causes of asthma. These allergens may produce low-grade reactions which are of no obvious consequence: however, daily exposure to these allergens may result in a gradual worsening of asthma.

Allergy may be the cause of unrecognized or hidden asthma. Minor allergic reactions can be more important than more obvious or severe reactions, in that an allergic person tends to avoid exposure to allergens that have caused severe reactions, while ignoring the minor allergens.

For instance, if your child is highly allergic to cats and develops severe wheezing when he or she is around them, you'll probably avoid cats at all costs. But what about your dog that sleeps with your child and doesn't cause obvious wheezing? This could be an important factor. If so, skin testing usually will reveal any reaction the child has to the dog. The child would then do better with both the cat and dog removed from his or her environment.

Irritants

Cigarette smoke, air pollution, strong odors, aerosol sprays and paint fumes are some of the substances which irritate the tissues of the lungs and upper airways. The reaction (cough, wheeze, phlegm, runny nose, watery eyes) produced by these irritants can be identical to those produced by allergens.

Cigarette smoke is a good example, because it is highly irritating and can trigger asthma. Most people are not allergic to cigarette smoke; that is, there is no known immunologic reaction. Nevertheless, this irritant can be more significant than any allergen.

Secondhand smoke can cause serious harm to children. An estimated 400,000 to one million asthmatic children have their condition worsened by exposure to secondhand smoke.5

Irritants must be recognized and avoided. Cigarette smoking certainly should be avoided in the home of any child with asthma. It has been shown that when the parents of a child with asthma stop smoking, the child's asthma often improves.

Weather

Children with asthma have cited a number of climatic conditions as trigger factors. Many identify cold air as triggering asthma. Pulmonary function studies demonstrate that breathing cold air provokes asthma in most children with asthma.

Precautions may be necessary to avoid inhalation of cold air, such as wearing a special ski mask designed for this purpose. A heavy scarf, worn loosely over the nose and mouth, will also help avoid cold air induced asthma.

The weather affects outdoor inhalant allergens (pollens and molds). On a windy day more allergens will be scattered in the air, while a heavy rainfall will wash the air clean of allergens. On the other hand, a light rain might wash out pollen, but actually increase mold concentration.

There does not seem to be one best climate for all children with asthma, and moving to a new area to reduce asthma severity often is met with disappointment in the long run, even after initial improvement.

Emotions

A common misbelief is that children with asthma have a major psychological problem that's caused the asthma. Emotional factors are not the cause of asthma; however,emotional stress can infrequently trigger asthma.

A child's asthma might only be noticeable after crying, laughing or yelling in response to an emotional situation. These normal "emotional" responses involve deep rapid breathing which in turn can trigger asthma, as it does after running.

Emotional stress itself (anxiety, frustration, anger) also can trigger asthma, but the asthmatic condition precedes the emotional stress. Therefore, a child's asthma is not "in his or her head," as many people believe.

Emotions are associated with asthma for another reason. Many children with asthma suffer from severe anxiety during an episode as a result of suffocation produced by asthma. The anxiety and panic can then produce rapid breathing or hyperventilation, which further triggers the asthma.

During an episode, anxiety and panic should be controlled as much as possible. The parent should remain calm, encourage the child to relax and breathe easily and give appropriate medications.

Treatment should be aimed at controlling the asthma. When asthma is controlled, emotional stress will be reduced and other emotional factors can then be dealt with more effectively. Any chronic illness, especially if uncontrolled, can have associated secondary psychological problems. More severe psychological problems require a specialist to help the child and his or her family.

REMEMBER

Asthma is...

  1. An inflammatory condition of the airways caused by allergens, irritants and respiratory infections.
  2. Triggered by many different stimuli (trigger factors) that activate an over-reactive airway system.

Is reversible and controllable (with only a few rare exceptions.)

Tuesday, April 10, 2007

A C A : Antibodi Antikardiolipid

Keguguran berulang dengan tanpa sebab yang jelas bisa jadi karena antibodi antikardiolipid (ACA). Antibodi itu juga bisa menyebabkan stroke dan infark jantung pada usia muda. Demikian diungkapkan pakar hemostasis dan trombosis Prof Dr dr Karmel L Tambunan SpPD KHOM dari Bagian Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia (FKUI) dalam jumpa pers menjelang Kongres Nasional Perhimpunan Hematologi dan Transfusi Darah Indonesia (PHTDI) IX, Selasa (4/9), di Jakarta.

Kongres itu, menurut Ketua PHTDI dr Zubairi Djoerban SpPD KHOM, akan diselenggarakan tanggal 7-9 September 2001 di Semarang. Selain diikuti anggota PHTDI dari seluruh Indonesia, juga akan dihadiri para ahli dari Kanada, Australia, Selandia Baru, Inggris, Belanda, Perancis, Thailand, dan Singapura.

Pembicara lain dalam jumpa pers adalah Prof Dr dr A Harryanto Reksodiputro SpPD KHOM, dr Djumhana Atmakusuma SpPD KHOM, dan Kepala Unit Transfusi Darah Palang Merah Indonesia dr Auda Aziz.

"Antibodi antikardiolipid mendorong terjadinya trombosis atau pembekuan darah dalam pembuluh darah. Jika terjadi di plasenta, bekuan darah akan mengganggu pasokan zat gizi dan oksigen bagi janin sehingga terjadi keguguran pada usia kehamilan tiga atau empat bulan. Jika tidak keguguran, biasanya janin tidak berkembang atau meninggal dalam kandungan," urai Tambunan.

Dalam tiga tahun belakangan ini, lebih dari 240 pasien yang mengalami keguguran berulang, ada yang empat kali keguguran, dirujuk. Setelah diobati, 95 persen membaik dan bisa mempunyai anak.

"Stroke" dan "infark" jantung

Sindrom antifosfolipid yang diakibatkan ACA ini jika terjadi di vena akan menyebabkan emboli pada paru, di arteri jantung menyebabkan infark jantung, di otak menyebabkan stroke, di pembuluh darah mata menyebabkan buta, dan di pembuluh telinga menyebabkan tuli.

Kasus yang ditemui Tambunan antara lain, pemuda berusia 18 tahun mengalami infark jantung dan wanita berusia 22 tahun mengalami stroke. "Jadi infark jantung dan stroke bukan lagi monopoli orang lanjut usia," kata Tambunan.

Selain itu, bentuk sindrom antifosfolipid adalah migrain yang tak kunjung sembuh. Setelah diobati dengan antikoagulan atau antipembekuan darah, ternyata migrain sembuh.

Penyebab sindrom ini ada dua, primer -yaitu genetik- serta sekunder akibat infeksi virus termasuk toksoplasmosis, infeksi bakteri, atau disebabkan obat-obatan. Jika penyebabnya faktor genetik, obat harus diminum seumur hidup.

Selama ini faktor risiko trombosis yang umum diketahui adalah kadar kolesterol tinggi, diabetes, asap rokok, homosisteinemia, serta tingginya faktor pembekuan darah dalam tubuh.

Faktor-faktor itu merangsang proses pembekuan darah berlebihan jika terjadi perlukaan pada dinding pembuluh darah. Trombus atau gumpalan darah yang menempel di dinding pembuluh darah bisa terlepas dan menyumbat pembuluh darah. Jika tak segera diobati, bisa menyebabkan kematian.

"Perokok, termasuk perokok pasif, berisiko lima sampai sepuluh kali mengalami trombosis dibanding bukan perokok. Oleh karena itu, di negara maju merokok dilarang di tempat umum," ujar Tambunan.

sumber : kompas

Tuesday, April 3, 2007

Early Warning Signals

You and your child can become experts in spotting the early signals of Asthma. Maybe you're experts already! As one alert parent said to her child: "Asthma may not be a friend, but if it's an enemy, at least it isn't sneaky. It always gives a warning."

Every child with asthma has a built-in early warning system that signals when symptoms are on the way. Those signals can be seen, heard, and felt. Every child has his or own pattern of signals. But parents and children can make keen observation a habit and learn how to recognize those patterns -- the body's messages to get going and head off those symptoms before they get bad.

WHAT TO LOOK FOR:

  • Anxious or scared look
  • Cough, especially at night
  • Unusual paleness or sweating
  • Flared nostrils when the child tries to get some air
  • Pursed lips breathing
  • Fast breathing
  • Vomiting
  • Hunched-over body posture; the child can't stand or sit straight and can't relax
  • Restlessness during sleep
  • Fatigue that isn't related to working or playing hard
  • The notch just above the child's Adam's apple;when some children are having an asthma episode, this notch sinks in as they breathe in
  • Spaces between the ribs; these areas may sink in when the child breathes in

WHAT TO LISTEN FOR:

  • Coughing when the child has no cold
  • Clearing of the throat a lot
  • Irregular Breathing
  • Wheezing, however light
  • Noisy, difficult breathing

HOW TO LISTEN:

  • Put your ear to the child's back and your hand on his or her chest. You'll feel the chest go up as the child inhales, drawing in air, and you'll feel the chest go down as the child exhales, releasing air.
  • Listen for squeaking or any unusual noises. They may mean asthma, bronchitis, or a chest infection. Only a doctor can tell for sure. So regard any noisy breathing as a signal that help may be necessary.
  • Note: If the child is having symptoms and there are no chest sounds, it's a sign of a bad, fixed chest that requires medical attention. Call your doctor immediately.

WHAT TO DO IMMEDIATELY:

  • Reassure the child by your tone of voice, your attitude of being able to manage and your confidence. All these qualities are catching. Your child will take cues from you and relax.
  • If the doctor has recommended a medicine when signals appear, use it. (Don't give the child a special dose unless the doctor said to.)
  • Encourage normal fluid intake. Excessive fluid intake may be counter productive.

ADDITIONAL STEPS TO TAKE:

  • Help your child relax
  • If you can find out what triggered the symptoms, remove it -- or the child from the area
  • Your experience and judgement can help you decide what further measures to take in addition to calling the doctor.

FIVE EMERGENCY SIGNS

Having any one of these signs means medical care is needed. Call your doctor or get emergency medical care if your child exhibits any of these signs.

Wheeze, cough, or shortness of breath gets worse, even after the medicine has been given time to work. Most inhaled bronchodilator medications produce an effect within 5 to 10 minutes. Discuss the time your medicines take to work with your child's doctor.

Child has a hard time breathing. Signs of this are:

  • Chest and neck are pulled or sucked in with each breath.
  • Struggling to breathe.
  • Child has trouble walking or talking, stops playing and cannot start again.
  • Peak flow rate gets lower, or does not improve after treatment with bronchodilators, or drops to 50 percent or less of your child's personal best. Discuss this peak flow level with your child's doctor.

Lips or fingernails are gray or blue. If this happens, GO TO THE DOCTOR OR EMERGENCY ROOM RIGHT AWAY!