Asthma: Watch for subtle signs

Published 12:01 am Sunday, March 27, 2011

Each year, about 500 children are hospitalized for asthma at Seattle Children’s Hospital, and most are under the age of 4.

Yet the symptoms of asthma aren’t always obvious. About a third of kids with asthma go undiagnosed, said Dr. Ted Carter, who directs clinical services for the hospital’s pulmonary division.

“It is the most common respiratory disease I see at Children’s — probably one in every 20 children has asthma,” Carter said.

However, its effects on children can range from mild coughing to life-threatening breathing problems.

The triggers for pediatric asthma differ by age, said Dr. Jack Stephens, a pediatrician at The Everett Clinic.

Colds, flu and respiratory illnesses are the most common triggers for the youngest children, such as toddlers and those who haven’t reached school age, he said.

Once kids reach school age, the triggers are usually allergies or physical activity, he said.

“So a typical scenario would be a middle school student who feels fine until they play soccer or basketball and then starts to cough and wheeze,” Stephens said.

With either age group, asthma symptoms can come on unexpectedly, he said.

One of the clues parents should look for is if their child is coughing at night, especially if the coughing interrupts the child’s sleep or causes the child to throw up, Stephens said.

Families often aren’t aware of the risk of asthma if there’s no family history of it, he said. But a family history of allergies, whether to medications, food or environmental causes such as pollens, has been linked to an increased risk of the disease.

“Families only think of asthma as wheezing,” Stephens said. Coughing, problems with exercise and chest tightness also are signals, he said.

For example, one student who was a talented athlete could complete well in running sprints, but when he had to do longer distances, he had to stop because he was out of breath, Stephens said.

Asthma is caused by a swelling of mucus membranes and a constriction of the bronchial passages, the airways leading to the lungs.

With mild attacks, children won’t have noticeable symptoms when they are sitting, but will when they’re running. More severe cases will make the child feel as if they’re breathing through a straw, Stephens said.

Recurring problems with pneumonia without fever could be a sign that a child has asthma, Carter said.

Different medications are used to treat the disease, depending on the severity of symptoms, he said.

Some medications help prevent the onset of symptoms. Others help relax the muscles that can trigger attacks.

After an increasing number of reported cases of childhood asthma in the 1980s and 1990s, its prevalence has remained relatively stable since 2000, Carter said.

Asthma often is detected in children before age 5 but symptoms can begin at any time in childhood, and even when they become adults, he said.

And children sometimes see a marked reduction in symptoms or simply “grow out” of the disease as adults.

“It’s unrelated to medication treatment,” Carter said. “It all has to do with whatever is the trigger of asthma as become quiescent.

“It’s unpredictable — who gets better and who doesn’t,” he added. “Usually, the less severe the asthma is, you won’t have trouble as an adult.”

Asthma attacks

The symptoms:

• Coughing
• A wheeze or whistling sound on breathing out

Possible triggers:

• Viral respiratory infections
• Contact with animals, especially cats
• Tobacco smoke
• Pollens
• Air pollution, such as from a wood stove

More information: Go to www.seattlechildrens.org/medical-conditions/symptom-index/asthma-attack.

Source: Seattle Children’s Hospital