Asthma in children? No reason to panic

Nina's big dream is to one day become as good a figure skater as her idol Denise Biellmann. To achieve this, the nine-year-old spends almost every free minute on the ice. However, Nina has to take regular medication to prevent her from suddenly losing her breath during training. This is because Nina not only shares a love of figure skating with the former world champion, but also the chronic lung disease asthma.

What is asthma?

Bronchial asthma, usually referred to as asthma for short, is the most common chronic illness in childhood. In Switzerland, around one in ten children is affected. The term asthma comes from the ancient Greek and means shortness of breath. «That's a pretty apt description of what it's all about,» explains Prof. Jürg Hammer, Head of the Department of Pneumology and Intensive Care Medicine and Deputy Head of Paediatrics at the University Children's Hospital Basel. "This is because asthma is an obstruction, i.e. narrowing, of the airways that leads to breathlessness but is potentially reversible, i.e. it can go away again."

Asthma differs from other lung diseases, such as chronic obstructive pulmonary disease (COPD) or bronchitis, primarily due to its episodic occurrence, interrupted by symptom-free phases.

To understand what actually happens in asthma, you can visualise the two lungs as two upturned trees that extend from the trachea as a figurative tree trunk into the right and left side of the chest. The «branches» of the lungs are formed by the large bronchi, which branch out into the ever smaller bronchioles and finally end in the alveoli.

This is where the inhaled oxygen is released from the air into the blood and used air is transported back into the lungs in the form of carbon dioxide for exhalation. In order for inhalation and exhalation to function properly, the pathways from the windpipe to the alveoli must be clear.

«In asthma, however, the bronchial tubes react to certain stimuli with an inflammatory response, which causes the airways to swell and narrow,» explains Jürg Hammer. «In addition, the mucous membranes secrete thick mucus, which is difficult to cough up, and the bronchial muscles tense up.»

«A seizure usually subsides on its own, but can also become a life-threatening emergency.»

Jürg Hammer, pulmonologist.

This makes breathing much more difficult, which can lead to acute breathlessness. Typically, dry coughing fits as well as whistling and humming noises when exhaling , which are technically known as «wheezing» , also often occur .

«An asthma attack usually subsides on its own, but in severe cases it can also become a life-threatening emergency,» explains the pulmonologist. «If asthma is not treated, the chronic inflammation in the bronchial tubes worsens, which can lead to long-term damage to the lung tissue and thus to a deterioration in lung function.»

Asthma is caused by hypersensitive bronchial tubes that react to harmless stimuli that have no effect on healthy people. Why the bronchial system of some people reacts so hypersensitively is still not fully understood. «We assume that genetics, i.e. heredity, plays an important role in the development of asthma,» says Jürg Hammer. «For example, children whose father or mother is asthmatic have a higher hereditary predisposition to also develop asthma than children who do not have a family history of asthma.»

Allergic and non-allergic asthma

The number of trigger factors is high and varies from person to person. In order to be able to make at least a rough categorisation, asthma is divided into two forms. Depending on the type of trigger factors that are in the foreground, we speak of allergic asthma and non-allergic asthma.

«Typical examples of trigger factors for allergic asthma are flower and grass pollen, animal dander, house dust mite faeces and mould spores,» explains Jürg Hammer. «Viral and bacterial infections, on the other hand, are among the triggers for non-allergic asthma.» However, there are often mixed forms in which the combination of several stimuli leads to asthma.

What is the connection between asthma and allergies?

There are also a number of so-called non-specific stimuli that further increase the constriction of the bronchial tubes in both forms of asthma and co-provoke an asthma attack. These include physical exertion, cold, fog, pollutants in the air, strong odours, active and passive smoking, but also stress, crying and laughter.

«In school-age children, infections and physical exertion such as sport, running and romping around are the main asthma triggers,» emphasises Jürg Hammer. «But allergies almost always play a role too.» Many children with asthma are also allergy sufferers. This can lead to what is known as a «change of floor», when children who react to pollen with hay fever, for example, later develop asthma symptoms in response to the same allergen.

Diagnosing asthma in children is not easy and involves several steps. «If asthma is suspected, the paediatrician responsible will first take a detailed medical history,» explains Hammer. «This is a doctor-patient consultation that the doctor usually conducts together with the parents.» Among other things, the doctor will ask about the type, duration, timing and frequency of the symptoms, as well as any other existing allergies and the presence of allergies and asthma in the family.

A lung function test measures the condition and performance of the lungs.

Other topics include environmental pollution to which the child is exposed, for example through air pollutants such as passive smoking. This is usually followed by a physical examination and listening to the lungs. A lung function test is also carried out. For this, the child must blow vigorously into a device when instructed to do so. This allows the condition and performance of the lungs to be measured.

«As the patient's cooperation is particularly important for the lung function test, the measurement is only really reliable from around late pre-school to school age,» emphasises lung specialist Jürg Hammer. As a rule, an allergy test is also carried out on the skin to find out whether sensitisation, i.e. a still symptom-free precursor to an allergy, has already taken place in the body. Alternatively, specific antibodies can also be detected with a blood test.

Two types of medication

If bronchial asthma is diagnosed, the aim of any treatment is to eliminate the disruptive asthma symptoms as far as possible. «To date, asthma cannot be completely cured, but with the help of modern treatment options, asthma can now be controlled so well that asthmatics can generally lead a completely normal life,» emphasises Jürg Hammer. The focus of any therapy is treatment with special asthma medication, which is usefully supplemented by certain behavioural measures.

There are basically two types of medication available for drug therapy: long-term medication and on-demand medication. Doctors also refer to these as controllers and relievers. «Controllers are long-term medications that have to be taken permanently in order to reduce the chronic inflammatory processes in the airways in the long term,» explains doctor Jürg Hammer. «Asthma attacks and symptoms occur less frequently and less severely as a result.»

Glucocorticoids, better known to many as cortisone, have proven to be particularly effective here. In order to keep the dosage as low as possible, the active ingredient is usually inhaled as a spray or in powder form, allowing it to reach its destination directly without affecting the rest of the body.

«Relievers are on-demand medications that are only used for acute symptoms to quickly clear the constricted airways,» says specialist Hammer. «Relievers are also inhaled as a spray and can also be taken as a preventative measure if, for example, a particular physical exertion is imminent.»

Every asthma is different. Some children have symptoms several times a day, while others only have them every few weeks. «The choice and dose of asthma medication depends not only on the severity of the condition, but also on how well the child responds to the chosen therapy,» explains Jürg Hammer. «The success of the treatment must therefore be reviewed at regular intervals and the dose of medication flexibly adjusted upwards or downwards accordingly.»

This is done gradually, always with the aim of using only as little medication as necessary to achieve the greatest possible freedom from symptoms. If this goal is achieved, the doctor speaks of «well-controlled asthma». If, on the other hand, symptoms return, this is referred to as «uncontrolled asthma», in which the medication must be increased again accordingly.

Always have the emergency plan to hand!

As asthma can always lead to an unforeseen emergency situation, the doctor always draws up an individual emergency plan in addition to the treatment plan. According to Jürg Hammer, this plan lists and explains the dosage of emergency medication and all acutely necessary behavioural measures step by step. The child should always carry the emergency plan with them. In addition, all important carers such as parents, teachers etc. should be given a copy.

Asthma is a chronic disease that must be taken seriously. However, thanks to modern treatment options, asthma is no longer considered life-limiting. «Well-controlled, children with asthma can basically do everything that healthy children can do,» emphasises Jürg Hammer: «Even competitive sport is possible.»

«Half of the affected children become symptom-free between adolescence and young adulthood.»

Jürg Hammer

Over time, children also develop a very good sense of how high a dose of medication they need to take in order to avoid symptoms. Basel-based lung specialist Jürg Hammer concludes: "Fortunately, many children's symptoms improve as they get older and their bronchial tubes grow, so that around half of affected children are symptom-free by adolescence to young adulthood."

Supplementary behavioural measures - what you can do yourself

In addition to drug therapy, those affected can contribute a great deal to the success of the therapy themselves through correct behaviour:

• Auslöser meiden: Alles, was die Bronchien Ihres Kindes reizt, verschlimmert die Beschwerden. Versuchen Sie deshalb Ihr Kind anzuleiten, mögliche Asthmaauslöser wie bekannte Allergene, Zigaretten­rauch usw. konsequent zu meiden. Leider ist das nicht immer möglich. «Insbesondere bei Allergenen, denen man schwer ausweichen kann, wie Gräserpollen, kann es Sinn machen, eine sogenannte Desensibilisierung durchführen zu lassen», betont Asthmaexperte Jürg Hammer. «Dabei wird das Immunsystem nach und nach an das Allergen gewöhnt.» Darüber hinaus rät er Betroffenen, sich regelmässig gegen Grippe impfen zu lassen, da Infekte ebenfalls eine schwere Verschlimmerung der Beschwerden hervorrufen können.

• Sport und Bewegung: Früher wurden Kinder mit Asthma in der Schule vom Sportunterricht befreit. Heute weiss man, dass Sport und regelmässige körperliche Akti­vität gerade auch für Asthmatiker gesund und wichtig sind. Denn Sport stärkt auch bei Asthmatikern die Lun­genfunktion und hilft nachweislich, das Asthma besser kontrollieren zu können. «Da körperliche Anstrengung aber auch einen Anfall auslösen kann, sollten Asthmatiker darauf achten, sich vor dem Training ausreichend aufzuwärmen und vorbeugend bronchienerweiternde Medikamente zu inhalieren», rät Hammer.

• Atemtechniken: Droht ein Asthmaanfall, können bestimmte Atemtechniken helfen, besser Luft zu bekommen. Als hilfreich gilt z.B. die sogenannte Lippenbremse, bei der die Luft hörbar durch die locker aufeinander­ liegenden Lippen ausgeatmet wird. Auch bestimmte Körperhaltungen können bei beginnender Luftnot helfen, die Atmung zu erleichtern. Speziell für Lungenkranke entwickelt ist auch das Atemtraining Buteyko, bei dem Asthmakranke lernen, dau­erhaft weniger tief einzuatmen. Diese Technik soll helfen, die Beschwerden so effektiv zu lindern, dass deutlich weniger bis gar keine Medikamente mehr benötigt werden.

• Asthma-Patientenschulung: Für kleine Asthmapatienten, deren Diagnose frisch gestellt wurde, gibt es ausserdem spezielle Patienten­schulungen, in denen Kinder zusammen mit ihren Eltern lernen, wie sie mit der Krankheit im Alltag besser umgehen können. Neben dem richtigen Inhalieren und Medikamen­tenschulungen wird hier auch Hintergrundwissen zur Krankheit kindge­recht vermittelt. Die Kurse werden von der Schweizer Lungenliga angeboten und können vom Arzt verordnet werden.

Those affected can find help here:

Swiss Lung League
www.lungenliga.ch > Asthma in children

Swiss Society for Paediatric Pneumology
www.sgpp-sspp.ch

Allergy Centre Switzerland
www.aha.ch > About allergies > Asthma

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