When weather turns cool and the kids are cooped up in school, parents often find themselves facing colds. Most kids recover with plenty of rest and fluids, but some kids get really sick.
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One thing parents shouldn’t ignore is wheezing — a whistling sound during exhalation — with colds. Recurrent wheezing may signal asthma, and the earlier it’s diagnosed, the better, says Fred Royce, MD, a pediatric pulmonologist at Cleveland Clinic Children’s Hospital.
Asthma is airway inflammation that develops at any age. The reasons behind the inflammation aren’t fully understood. But when inflammation increases, the muscles surrounding the airways tighten, and other problems develop. The result: wheezing, shortness of breath, chest tightness and/or a dry cough.
In between, the asthma symptoms often disappear — but in most people, inflammation remains. “Asthma is usually present even when there are no symptoms,” explains Dr. Royce.
In children, the most common trigger for asthma is a cold or viral lower respiratory tract infection. In teens and adults, the principle triggers are allergies (to inhaled substances such as molds, ragweed or animal dander, for example).
Exercise can also make asthma flare, as can rapid changes in temperature and humidity. “Halloween is a classic time,” says Dr. Royce. “Kids step out of a heated house and into cold, dry weather, which worsens airway inflammation. If asthma is not under good control, they’ll be in trouble.”
Controlling the ‘fire’ in the lungs
Dr. Royce often tells parents that “airway inflammation is like having a small fire burning in your lungs. You always have embers. When there are flames, you have an asthma attack.”
To keep the “flames” down, doctors prescribe controller medications such as:
- inhaled corticosteroids (the best drugs for controlling inflammation)
- long-acting bronchodilators (drugs that keep the airways relaxed and open)
- leukotriene antagonists (drugs that help in controlling inflammation)
“When your child gets a cold or a virus, it revs up the inflammation and ‘flames’ develop,” says Dr. Royce. That’s when your child may need to start on rescue medications — fast-acting bronchodilators such as albuterol.
“When there are lots of flames (when the inflammation is severe), the airways go into spasm and tighten up,” he adds. “Then you have to get the ‘hose’ out.” In other words, kids may need a short course of high-dose oral corticosteroids, such as prednisone or prednisolone, to control their asthma attack and stay out of the emergency room.
“The name of the game is keeping the fire, or inflammation, down,” stresses Dr. Royce.
No need to fear inhaled corticosteroids
Inhaled corticosteroids are the most effective asthma controller, says Dr. Royce. “They land in high concentrations in the airways, but the dose absorbed and distributed throughout the body is very, very small — a drop in the bucket. Large, comprehensive studies have documented their safety.”
Many parents think that when kids start to feel better, they can set the corticosteroid inhalers aside. Not so, says Dr. Royce: “A month or two later, they’ll start having trouble again. The ‘embers’ smolder between asthma flares, so you must continue to control the fire.”
One way to keep kids with asthma out of serious trouble is to protect them against influenza by scheduling a yearly flu shot. “One study shows fewer asthma flares when you have your flu vaccine,” he says.