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My child coughs every time he runs – is he just out of shape? My child coughs for a long time after a cold – is this normal? My child coughs every time he is around cats – is he allergic?

Or could it be asthma?

But wait… He doesn’t wheeze! He is obviously not having an asthma attack! We don’t have any asthma in the family! How could it be asthma?

What is asthma?

Asthma is recurrent, reversible obstruction of the airways caused by two changes in the lungs:

  1. Tightening of the muscles around the bronchial tubes (bronchospasm) and
  2. Swelling of the lining of the airways (inflammation).

These changes make it hard to move air in and out and leads to cough, chest tightness, wheezing and shortness of breath.  Usually symptoms come on gradually, but if bronchospasm and inflammation occur suddenly, the symptoms are referred to as an asthma attack. Most children with asthma are symptom free with normal lung exams most of the time.  The frequency and severity of symptoms varies widely among asthmatic patients and even over time in any one patient.

What causes asthma in children?

We have been seeing a rise in the diagnosis of asthma for quite some time.  We’re not sure why, but we have some clues.  Genetics play a big roll- about half of pediatric asthma patients have a family member with asthma or allergies.  A personal history of eczema or allergies also increases the risk of developing asthma.  Environmental factors play a role too – most notably cigarette smoke exposure both prenatally and in childhood increases the odds of having asthma.

How is asthma diagnosed?

In some patients, it is easy- we hear wheezing and see difficulty breathing which resolve when we give treatments in the office.  In others, the diagnosis is a little tougher, since they may not be symptomatic in the office.  The story is important- where and when do symptoms occur, what helps relieve symptoms, what about the child’s past health, family history and environment may offer clues?  In children old enough to cooperate, a test called spirometry can confirm our suspicions.  In others, a trial of medication and follow up may be needed.

Now that you know the basics of asthma, we are ready to talk about how to treat asthma and how asthma might affect your child in the future. Check-in next week for these topics!

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