Welcome to The Art of Patients, I’m Dr Golly. Today we’re going to look at one of the more common, chronic breathing problems – asthma. How to recognise it, how to prevent episodes and what to do when treatment is needed.
Asthma is caused by excessive narrowing of the small airways within our lungs, as well as the overproduction of mucus. The word asthma has its origins in ancient Greek, from AZEIN, meaning ‘to breathe hard’ – let’s jump to the whiteboard and take a look at the lungs – and exactly what happens when asthma decides to attack… (turns)
OK, let’s think of our breathing tubes as an upside-down tree. The large trunk is the main breathing tube – the trachea – coming down from the mouth. From there it branches into 2 bronchi and they continue branching into tiny air tubes until they eventually finish with the smallest twigs, which are called bronchioles – these are covered by air sacs that looks like bunches of grapes – called alveoli. Here is where we get gas exchange via blood cells, allowing oxygen IN and carbon-dioxide OUT.
Asthma is when these lower air passages become swollen and inflamed, due to certain triggers. Bands of muscle that encircle these airways will become tighter, making the tubes more narrow, and creating a whistling noise, which we call WHEEZE. The wheeze occurs in airways of different sizes, making different types of noises, which is why we doctors refer to it as a polyphonic wheeze.
In addition to this wheeze, children will often also have a cough and breathing difficulties. In a more severe attack, your child will not be able to complete sentences, may become very distressed or exhausted and you may see their skin sucking in under their neck or between their ribs.
The common triggers for an asthma episode include: the common cold, exercise, weather change, food allergies, cigarette smoke and house dust mites, but each child is different and you will quickly discover what triggers your child’s breathing difficulties and how to avoid them if possible.
The most important part of management for any child with asthma, is to have an ASTHMA ACTION PLAN. Not only does this include a child’s regular medications, it also has clear instructions on what do to during an acute episode, or asthma attack. There are 3 types of treatments for asthma: relievers, preventers and controllers.
Relievers help to open up the tight airways and provide almost immediate relief. Relievers should always be used with a spacer and your doctor can teach you the right technique, to maximize the medication effect.
Preventers are either inhaled or swallowed medicines, to try minimize the use of relievers. If your child has asthma symptoms more than once a week, they may benefit from a preventer, which needs to be taken every day to be effective. Lastly, controllers are longer-acting, which are combinations of different asthma medicines. Be sure to review your child’s asthma medicines with your GP, to ensure they’re on the right combination, with minimal disruption to their lives.
After an episode, your child’s doctor may also prescribe an oral steroid for 2 or 3 days, to try reduce the inflammation within the airways. This is only a short-term change to your child’s regular asthma treatment. When it comes to spacer care, remember to dismantle it for cleaning. Then soak it in warm, soapy water and let it air dry, without rinsing or wiping the insides.
Remember that smoking in the family home increases the risk of asthma episodes and makes it more likely for your child to need a preventer.
During an asthma episode, remember the 4 by 4 by 4 rule. Give them 4 puffs of reliever via a spacer, with 4 breaths after each puff. Then wait 4 minutes and repeat again, 4 times. 4 puffs, 4 minutes, 4 times. If there is no improvement, call an ambulance and repeat these steps, until help arrives.
You’ve been watching another episode of The Art of Patients. I’m Dr Golly, I’ll see you next time.