Dr Mark Rosenthal
MD MB ChB FRCP FRCPCH BSc
Consultant in Paediatric Respiratory Medicine
also specialist in Food Allergies & Disorders of Sleep
T: 0207 351 8832
A:The Royal Brompton Hospital, London, SW3 6NP
0207 351 8832
0207 349 7754
20% of all children have asthma at some point during their childhood up to 16 years of age and although the word asthma carries a lot of ‘baggage’ attached to it striking terror into the hearts of parents, in reality the huge majority of asthmatics are mild and easy to treat and personally if that was their only health issue in their lives I would say ‘great’ in comparison to other choices such as diabetes for example. It is very unusual to occur before the age of 3 years and typically occurs after age 4 years presenting with recurrent multi-trigger wheezing (a sighing or whistling breathing out sound) or coughing or a combination of the two. There are 4 main triggers: viral infections, exercise, emotion (crying, laughing etc) and specific responses most commonly to cats and cigarette smoke so asthmatics will have symptoms to more than one of these four triggers.
There is an increased risk of asthma in children whose parents smoke especially the mother, in those with a close positive family history of asthma, where traffic pollution is severe although this effect is not high, and in those with severe atopic disease such as problematic eczema or multiple food allergies remembering that 50% of all infants have a diagnosis of eczema to some degree in their first year of life. Nevertheless most asthmatics do not have eczema or food allergies!
There are no specific blood tests that diagnose asthma, it is diagnosed on careful history taking, examination and measuring lung function in those over 6 years of age with a spirometer. This is asking the child to blow for as hard and as long as they can into a machine to measure flow and volume. This is different from a peak flow meter found in many GP surgeries.
Treatment is usually quite simple. Most children will be prescribed a steroid inhaler coloured brown, orange or red) to prevent symptoms and a salbutamol type bronchodilator (a blue inhaler) to relieve symptoms or to take before exercise. A red (Symbicort) inhaler can also be used to prevent and treat symptoms (the so-called SMART regime). The mere mention of the word ‘steroids’ often leads to a lot of parental anxiety about side effects. NO medicine is absolutely free of side effects but inhaled steroids have been used for about 50 years now and overall have an outstanding safety record; children do not grow two heads or become a body builder! Long term studies show that several years of treatment reduces adult height in boys by 6-7 millimetres and about 12-14 millimetres in girls.
Inhalers come in two types, a metered dose inhaler (often called a puffer) and a dry powder device for older children usually more than 6 years. Puffers must always be used with a spacer as without it the dose the child gets is almost zero and is mostly eaten rather than breathed in. Spacers with a mask are used for children up to about age 3 years only and after that, the spacer goes straight into the mouth without a mask.
The biggest single problem in treating asthma is that the preventing steroid inhaler is not given regularly so it is no surprise the asthma is not being well controlled. It should be used twice a day but research shows that on average this inhaler is used only about half the times it is meant to be used. All children capable of taking the inhaler themselves (so aged more than 10-12 years) must still be watched taking it. Shouting into the bedroom ’Have you taken your puffer?’ and them replying ‘yeah’ is a complete waste of time! Other problems are parents continuing to smoke and deluding themselves that doing it near a window or at the back door is ok and the other issue is continuing to keep pets especially cats to which the child is manifestly allergic.
Many asthmatics especially boys improve during puberty although a proportion of them have returning symptoms as young adults. Whilst treatment is excellent, a cure continues to elude us.
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Appt: 0207 351 8830
215-227 Gt Portland Street
Appt: 0207 390 6504
Thursday Late Morning & After School
77 Wimpole Street
Appt: 0207 351 8832
Tuesday After School