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Avoid Asthma Attacks

Imagine a 10-year-old boy coughing and wheezing after prolonged exercise. He hasn't had any trouble before. How do we know whether it's asthma?

The basis for diagnosis rests on what his chest sounds like, and a test of his lung capacity. Not all people who wheeze have asthma and asthma isn't the only thing that can cause people to wheeze. But they're closely linked.

When asthma is diagnosed it's important to prepare to look after health in the long-term.

A 10-year-old child who wheezes after exercising is likely to have exercise-induced asthma. In addressing the problem, there's a need to either modify the exercise or use medication. Some exercises produce more wheeze than others. Swimming in an indoor heated pool in fairly humid air tends to soothe the lungs. Running outdoors on a cold day will produce a lot of irritation. Modifying the exercise might be all he needs.

If he enjoys outdoor sports, though, I think you should encourage him to continue. Maybe he'll have to compromise and take some medication prior to exercise to protect himself.

So medication prior to exercise is helpful?

For most exercise it is. The effectiveness of different medications varies from person to person. Some children might have a pufferlike Ventolin or Bricanyl. Others might use a medication called Intal. Medication needs to be adjusted to the person and the severity of the exercise. Treatment of asthma is a compromise between non medicinal measures - which are important and medicinal measures. It's always a balance between the two.

What non-medicinal measures-other than a bit of caution about the weather would you recommend?

For the 10-year-old boy with exercise-induced asthma, the outside weather, the degree of exercise and where he exercises might be important. Other than that, he doesn't have much under his control. The next step is medication.

Others will have to make different compromises and find different answers. It might be more than exercise-induced wheezing.

A 10-year-old boy who gets into trouble with exercise, certain foods, and weather infections will need to watch out for these trigger factors, too. His case is more complex and the measures he takes will vary from season to season.

Are children who have asthma like that able to go ahead with most activities?

In general, asthma in childhood tends to be modest. Between attacks more than 90 percent of children with asthma revert to normal lung capacity. They should be encouraged to keep themselves fit and to be as active as possible. But a small percentage of children do have persistent limitations.

Is shortness of breath apt to do any permanent type of damage?

In general, No - most asthma is reversible. It's a reasonable thing to push yourself to your limits as long as you know when to stop.

Does asthma tend to be hereditary or is it unpredictable?

Both. It runs loosely in families, but it's not strictly predictable as some genetically inherited diseases. Because one child in a family has asthma doesn't mean they'll all have it. And just because both parents have asthma doesn't automatically mean the children will have asthma. There's uncertainty about it.

What other factors will affect whether a child is susceptible to asthma?

An allergic family is the most common risk. Parents smoking will increase the risk of asthma in susceptible children. Other things are less predictable. For instance, it's thought that breastfeeding gives a newborn baby a degree of protection against later development of allergies. How long that lasts, or how effective it is, no one is certain. But if a new mother has a highly allergic family, and she's able to breastfeed, then it's certainly recommended - but not a guaranteed prevention.

So are there any lifestyle patterns that would help prevent asthma?

No. So far, we can't give any solid preventive measures. There's too much unpredictability. We don't understand, for instance, why some People grow out of it. We don't know the timing that makes it come and then remit. And we don't understand why some get it as adults and not in childhood.

Of course, these are independent of environmental trigger factors like pollution, smoking and occupational dusts and fumes. And many people must pay attention to dusts, exposure to pets and even' elimination' diets, to prevent lapses.

Does asthma disappear very often or is it usually there to stay once it arrives?

Children with mild, intermittent asthma, who really only have a couple of attacks per year have a 50/50 chance of growing out of it as they get older. The more frequent and troublesome the attacks are, the less likely they are to disappear.

The other form that may disappear is occupational asthma. People who work in certain high-risk industries may get asthma out of the blue. If they leave that industry, it can also disappear.

Most of us are ignorant of just what's involved. When we come across someone having an asthma attack what type of measure can we take?

First get them away from dust and smoke to somewhere with clean air. Make them comfortable - they're more comfortable sitting than lying. If they're looking for their medication you can help them out. And if they've run out of their own medication, somebody else may have some the same. It's perfectly appropriate to give somebody else's medication if it's the same. The final step is to get them medical attention.

If asthma prevents a child from participating in certain activities, there's going to be some psychological impact. What do you recommend to help him or her?

The illness causes problems in two ways. First, it's hidden. It's not like having a broken arm or a broken leg. And those who don't understand suffering are less sympathetic to a hidden disability.

Often other people's lack of support is just a matter of their ignorance. For instance, many teachers don't understand exercise-induced asthma. They might see a child well one moment and five minutes later during sport they're disabled. It could be misinterpreted as malingering. But it's a real illness. The child needs to develop psychological esteem, and it's hard to do that except by experience.

Second, one must learn to overcome the stigma of using medications, having to avoid certain situations, and dealing with people who still believe the myth that “you only have asthma if you're a very 'nervous' person.”

If you have asthma, you can prevent a lot of these problems by taking appropriate medication that allows you to lead an active, normal life. That's the sort of compromise needed.

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