January 2004

We are sorry for any inconvenience we may have caused anyone in regards to the scheduling of influenza vaccine. The massive media attention paid to this year’s influenza epidemic caused many people who had never been vaccinated before to become vaccinated, resulting in a nationwide shortage of vaccine. This interrupted our orders from the manufacturer resulting in the postponement and even cancellation of appointments for vaccination. Once again we are sorry for any inconvenience this has caused.

Dr. Barenfeld

Asthma------------------------------------------------

Asthma has been recognized for more than 2000 years. The word comes from the Greek word for panting. It is very common, affecting more than 10% of U.S. children and is characterized by being a chronic disease of the breathing (bronchial) tubes of the lungs. Asthma is an intermittent disease, meaning that between “attacks” of asthma, children are completely well. Common triggers of asthma in children include viruses (common cold, influenza), allergens (pollens, molds, dust, animal dander), irritants (tobacco smoke, fireplace smoke, chemical fumes, perfumes), exercise and weather changes. Any one of these triggers may set off a chain of events in the lungs creating swollen, irritated, inflamed and mucus filled bronchial tubes. These changes lead to the common symptoms of coughing, wheezing and shortness of breath seen in an asthma attack.

Why do some children get asthma? We really don’t know. We do know that asthma tends to run in families. If both parents have asthma, at least one in three children will develop it. However, we see many asthmatic children without any family history of the disease. Asthma also tends to occur in children with allergies and eczema and in households with cigarette smoke. Asthma is not necessarily a lifelong disease. We see infants and young children with asthma who outgrow it later in childhood and we also see older children with no past history who suddenly develop asthma, especially exercise induced asthma.

The severity of asthma determines which of the available medications will be used. Some children with more severe asthma require daily medication to prevent attacks while those with milder forms will require medication only after an attack occurs. Asthma medications come in many forms including liquid, pill, aerosol inhaler and mist nebulization. With more widespread use of inhalers and nebulizers, they have become the mainstay for medication delivery, as they deliver medication directly to the lungs. Generally, inhalers are not used correctly in children younger than 6 or 7 years. In older children, inhalers should be used in conjunction with a spacer which is a medication storage chamber allowing for easier use of the inhaler. A nebulizer is an air compressor that runs electrically. It is used in those children who are unable to use an inhaler and in the hospital setting. Nebulizers can even be used in infants. Since nebulizers require an electrical outlet, they can’t be used outdoors. Some will run for a short time on batteries.

There are several different types of medications used to prevent and treat asthma. They can be used singly or in conjunction with each other depending on asthma severity. Bronchodilators may be given by injection, by mouth in liquid or tablet form, or via inhaler or nebulizer. Bronchodilators work by relaxing the muscles of the bronchial tubes, thereby expanding the bronchial tubes allowing for easier breathing. Bronchodilators are safe for long term use. The most common side effects are rapid heart rate and jitteriness. Steroids are extremely effective in the prevention and treatment of asthma. They can be given in the same manner as bronchodilators. Steroids work by decreasing the inflammation and mucus production in the bronchial tubes that occur in an asthma attack. Overall, steroids are more effective than bronchodilators in preventing and treating asthma. Many people have fears about taking steroids especially for long term use. These fears seem to be unwarranted. Long term oral intake of steroids can have significant side effects but inhaled steroids for asthma seem to be quite safe. The newest type of medication used in the prevention of asthma, and therefore used long term, are the leukotriene modifiers. These include Singulair and Accolate. Singulair, which comes as a chewable tablet for children as young as one year, is more commonly used in the pediatric age group. The leukotrienes have effects similar to steroids but have no steroid effects. They are not as effective as steroids or bronchodilators and are, therefore, typically used in combination with these other medications. They are quite safe with no significant long term side effects. Antibiotics will not prevent or treat asthma. However, they are used when a secondary infection such as sinus infection or pneumonia is suspected. Cough and cold medications, in general, should not be used in an asthmatic child. These medications prevent the cough and dry the mucus which is counter-productive in a child with asthma. Asthmatics need to cough up the mucus.

One question that is asked frequently, “Can my child with asthma play sports?” The answer to this is definitely yes. There are many athletes, including Olympic gold medalists, who have asthma. If your child complains of wheezing or shortness of breath while playing sports then he or she is not being treated appropriately. Your child should then be taking one or more of the medications previously mentioned.

The perception of asthma is that it is a severe, lifelong illness where sudden shortness of breath occurs, requiring frequent emergency care and hospitalization. For the vast majority of asthmatics this is not true. More typical, the child has infrequent episodes of mild wheezing following a cold which are easily treated with one of the medications previously discussed. As previously stated, many children “grow out” of their asthma.

One other point of interest is that when asking about a past medical history of asthma in the child or family, I frequently hear there is none. Yet upon further questioning I find out that the child or parent has had a yearly episode of bronchitis. Frequent bronchitis is asthma. Again, these episodes are infrequent, mild, and easily treated. It’s just that nobody called it asthma.

Lastly as I have mentioned in previous gazettes, all children with asthma should get a yearly flu shot.