Asthma in Children

What is asthma?

Asthma is a chronic (long-term) lung disease. It affects your airways, the tubes that carry air in and out of your lungs. When you have asthma, your airways can become inflamed and narrowed. This can cause wheezing, coughing, and tightness in your chest. When these symptoms get worse than usual, it is called an asthma attack or flare-up.

How does asthma affect children?

Asthma often starts during childhood, usually before age 5. Many children have asthma - it is the most common chronic disease of childhood. It can cause children to miss school and end up in the hospital. But treatments can help manage asthma.

What causes asthma in children?

The exact cause of asthma is unknown. Genetics and environment likely play a role in which children get asthma.

An asthma attack can happen when your child is exposed to an asthma trigger. An asthma trigger is something that can set off or worsen asthma symptoms. Different triggers can cause different types of asthma:

• Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
  • Dust mites
  • Mold
  • Pets
  • Pollen from grass, trees, and weeds
  • Waste from pests such as cockroaches and mice
• Nonallergic asthma is caused by triggers that are not allergens, such as
  • Breathing in cold air
  • Certain medicines
  • Household chemicals
  • Infections such as colds and the flu
  • Outdoor air pollution
  • Tobacco smoke
• Exercise-induced asthma happens during physical exercise, especially when the air is dry

Asthma triggers may be different for each child and can change over time.

Which children are at risk for asthma?

Certain factors raise the risk of asthma in children:

• Being exposed to secondhand smoke when their mother is pregnant with them or when they are small children
• Genetics and family history. Children are more likely to have asthma if one of their parents has it, especially if it's the mother.
• Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
• Having other diseases or conditions such as obesity and allergies
• Often having viral respiratory infections as young children
• Sex. In children, asthma is more common in boys. In teens, it is more common in girls.

What are the symptoms of asthma in children?

The symptoms of asthma in children include:

• Chest tightness
• Coughing, especially at night or early morning
• Breathing problems, such as shortness of breath, rapid breathing, or gasping for air
• Feeling tired
• Dark circles under the eyes
• Being irritable
• Wheezing, which causes a whistling sound when they breathe out
• Trouble eating or sucking (in infants)

These symptoms can range from mild to severe. They may happen often or only once in a while.

When children have an asthma attack, their symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. Warning signs of a severe attack include severe coughing, serious breathing problems, and turning very pale or blue in the face, lips and/or fingernails. If your child has those symptoms, get medical help right away.

How is asthma in children diagnosed?

It can be hard to diagnose asthma in children, especially if they are young. Asthma has similar symptoms as other childhood conditions. And some children may not have asthma symptoms very often, so it may seem like they are having respiratory infections instead.

Your child's health care provider may use many tools to diagnose asthma:

• Physical exam
• Medical history
• Chest x-ray
• Lung function tests, including spirometry, to test how well the lungs work. Younger children are usually not able to do these tests.
• Allergy skin or blood tests, if you have a history of allergies. These tests check which allergens cause a reaction from your immune system.

If you have a young child who cannot do lung function tests, the provider may suggest doing a trial of asthma medicines. The trial involves giving your child the medicines for several weeks to see whether the symptoms get better.

What are the treatments for asthma in children?

If your child has asthma, you will work with their health care provider to create a treatment plan. The plan will include ways to manage your child's asthma symptoms and prevent asthma attacks, such as:

• Strategies to avoid triggers. For example, if tobacco smoke is a trigger for your child, you should not allow anyone to smoke in your home or car.
• Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to have for your child at all times. It may also include other types of medicines which work quickly to help open your child's airways.
• Control medicines. They work by reducing airway inflammation and preventing narrowing of the airways. Not all children will take control medicines. Whether or not your child needs them depends on how severe the asthma is and how often your child has symptoms.

If your child has a severe attack and the short-term relief medicines do not work, get medical help right away.

Your child's provider may adjust the treatment until the asthma symptoms are controlled.

Bell's Palsy

Bell's palsy is the most common cause of facial paralysis. It usually affects just one side of the face. Symptoms appear suddenly and are at their worst about 48 hours after they start. They can range from mild to severe and include:

• Twitching
• Weakness
• Paralysis
• Drooping eyelid or corner of mouth
• Drooling
• Dry eye or mouth
• Excessive tearing in the eye
• Impaired ability to taste

Scientists think that a viral infection makes the facial nerve swell or become inflamed. You are most likely to get Bell's palsy if you are pregnant, diabetic or sick with a cold or flu.

Three out of four patients improve without treatment. With or without treatment, most people begin to get better within 2 weeks and recover completely within 3 to 6 months.

NIH: National Institute of Neurological Disorders and Stroke

Botox

Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum. It's the same toxin that causes a life-threatening type of food poisoning called botulism. Doctors use it in small doses to treat health problems, including:

• Temporary smoothing of facial wrinkles and improving your appearance
• Severe underarm sweating
• Cervical dystonia - a neurological disorder that causes severe neck and shoulder muscle contractions
• Blepharospasm - uncontrollable blinking
• Strabismus - misaligned eyes
• Chronic migraine
• Overactive bladder

Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves. The effects last about three to twelve months, depending on what you are treating. The most common side effects are pain, swelling, or bruising at the injection site. You could also have flu-like symptoms, headache, and upset stomach. Injections in the face may also cause temporary drooping eyelids. You should not use Botox if you are pregnant or breastfeeding.

Cancer

Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor. Tumors can be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body.

Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for where they start. For example, lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis. Symptoms and treatment depend on the cancer type and how advanced it is. Most treatment plans may include surgery, radiation and/or chemotherapy. Some may involve hormone therapy, immunotherapy or other types of biologic therapy, or stem cell transplantation.

NIH: National Cancer Institute

Cancer Immunotherapy

Immunotherapy is a cancer treatment that helps your immune system fight cancer. It is a type of biological therapy. Biological therapy uses substances that are made from living organisms, or versions of these substances that are made in a lab.

Doctors don't yet use immunotherapy as often as other cancer treatments, such as surgery, chemotherapy, and radiation therapy. But they do use immunotherapy for some types of cancer, and researchers are doing clinical trials to see whether it also works for other types.

When you have cancer, some of your cells begin to multiply without stopping. They spread into the surrounding tissues. One reason that the cancer cells can keep growing and spreading is that they are able to hide from your immune system. Some immunotherapies can "mark" your cancer cells. This makes it easier for your immune system to find and destroy the cells. It is a type of targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells. Other types of immunotherapies work by boosting your immune system to work better against cancer.

You could get immunotherapy intravenously (by IV), in pills or capsules, or in a cream for your skin. For bladder cancer, they might place it directly into your bladder. You may have treatment every day, week, or month. Some immunotherapies are given in cycles. It depends on your type of cancer, how advanced it is, the type of immunotherapy you get, and how well it is working.

You may have side effects. The most common side effects are skin reactions at the needle site, if you get it by IV. Other side effects may include flu-like symptoms, or rarely, severe reactions.

NIH: National Cancer Institute