The truth about asthma and children

Everyone knows at least one or two people who have asthma. In the past, if you were a child with asthma you were allowed to sit at the side of the field and watch as the other children played during PE (physical education). The perception was that children with asthma were “weak”.

This is not the solution, says paediatrician Datuk Dr Azizi Omar.

According to him, all children should exercise.

“Every child must exercise for their mind and their body. They must exercise to be fit. The objective of treatment is to help them lead a normal life and that includes doing exercises. If a child cannot exercise that means that the treatment is not sufficient so we have to adjust our treatment. We shouldn't be discouraging the child from exercising,” he says.

In his experience, Dr Azizi says about 50% or 60% of children diagnosed with asthma will get better by the age of seven to 10. The rest will get better for a while and then get it again and some of those will get better eventually. While there are no actual statistics for Malaysia, Dr Azizi says the number of severe asthmatics is quite small.

Who gets asthma?

Dr Azizi says almost everybody is to some extent exposed to factors that can cause asthma where both genetics and the environment play an important role.

“When we talk about genetic tendency we also mean environmental triggers. Even people without a family history of asthma for instance can develop asthma if they are exposed to these triggers over a long period of time. So we have to look at it as almost everybody being susceptible to getting asthma even though those with a family history of it are at higher risk.

“In our population we know up to 10% of Malaysian children have asthma,” he adds.

There are no statistics to gauge if more Malaysian children are asthmatic today than in the past.

Diagnosing asthma

There are a lot of complicated issues involved with regards to asthma in children. It's a bit different from asthma in adults which is more straightforward.

Dr Azizi explains that the diagnosis of asthma in children is not so clear-cut because younger children may be wheezing for other reasons.

“A child who wheezes may not actually be asthmatic. A child who coughs very persistently, consistently and recurrently may not be asthmatic. So, there are a lot of issues in terms of diagnosis. A lot of children who cough at an early age, at three years and below, may actually be coughing because of a viral infection. You may wheeze two to three times a year and not even be asthmatic,” he says.
 

Dr Azizi stresses that not all children who wheeze are asthmatic.

“In the past, when we started talking about asthma in this country we were worried about under-diagnosis. Doctors and parents were told to be aware of asthma and to diagnose quickly. Now, we are worried about overdiagnosing asthma. We are worried a little bit now that asthma is being overdiagnosed. The more studies there are conducted on asthma, the more we realise how complicated the issues are.

“Quite commonly a child who wheezes frequently due to a fever and viral cold for instance is not asthmatic. The child can be asthmatic,” he says.

Dr Azizi explains that a child who wheezes because of many forms of triggers – viruses, cold, smoke, dust, exercising – is more likely to be a real asthmatic. This means that this child may sometimes wheeze because of a cold, or when they exercise or because of the dust in the air.

Are there any complications if a child who is not asthmatic is given treatment for asthma?

“It's not such a fearful thing if the child is not really asthmatic and is treated for asthma. It's just that we don't want to overtreat people. It is important to diagnose correctly.

“While we think medication for asthma is safe and doesn't actually harm the child that much, we still do not want to unnecessarily put the burden of treatment on the child if they are not asthmatic,” he explains.

“At the same time, a lot of children cough. Persistent cough and chronic cough is quite often interpreted as asthma by doctors. This is an issue that I want to highlight – if a child coughs persistently particularly without wheezing, without a history of breathlessness or wheezing after exercise or during the night, and the lungs are usually clear then we should be a bit more careful about diagnosing it as asthma.

“The child may not actually have asthma. The child may have other reasons for the cough. Or if the lungs are giving other signs, then it is better to do further investigation or perhaps refer the child to a specialist. A lot of such children are perhaps wrongly diagnosed as having asthma and are overtreated.

“This is a call from us respiratory specialists in children to make doctors and caregivers a bit more well informed about childhood wheezing.

“Only when the child grows older and gets to seven or eight years old can we look back at the history and determine if that child is actually asthmatic.”

Diagnosing asthma in children may take years and involve monitoring what triggers off the symptoms.

Is it a life-long illness?

According to Dr Azizi, children with asthma can be treated and their asthma can be easily controlled.

“From my perspective, having been a professor working in the university and having been working in a private hospital for 13 years now, I think we are still fortunate because the majority of our asthmatics are not really that severe. There are some severe asthmatic children here but in terms of numbers they are not really that big. So we can usually treat asthma cases here quite well,” he says.

Anyone can get asthma and at any age.

The symptoms include wheezing, coughing, chest tightness and breathlessness.

Usually there is a pattern to what triggers the coughing and wheezing. For example, when they exercise or eat something, the symptoms become more obvious.

“Certainly the younger the child, the harder it is to spot some of these symptoms. For younger children usually you would spot it when they have a persistent cough. Sometimes the child is breathless and may not be feeding. Smaller children may not be as active and there may be coughing at night.

“If the child isn't diagnosed, then they may be coughing and wheezing for a long time; they are less active and it could become chronic. But if you have an acute attack – severe wheezing and difficulty in breathing – then that's quite obvious. Normally by that point the parents will bring the child to the hospital,” says Dr Azizi.

He explains that asthma is considered a chronic illness and the treatment is on two-pronged. One is the treatment of the illness which is chronic and the other is treatment of the acute attack.

The level of treatment should fit the severity of the symptoms or the attack.

Most of the medication that is available in the world is available here and there is sufficient medication to treat asthma in this country. However, parents need to be educated on how to utilise the medication.

“They are quite simple but we do need time to train parents to use them. For instance, patients and parents need to be trained properly how do the inhalation therapy.

“The corticosteroids which are prescribed are modern medications, well-studied and well-researched; they are very safe.

“There are no long-term effects from inhalation of corticosteroids.

“If you're taking oral steroids over a long term, that's different. Of course, there are side effects from that. But the current mode of treatment is inhalation of steroids which are in small doses and given correctly have no side effects or minimal side effects. So, do not fear these medications,” he explains.

Allergy shots?

Although asthma is associated with allergies – house dust mites, pollen and many other things – the majority of children usually are not that severely affected by allergens.

Dr Azizi says that a lot of studies have been done on food allergies and it has been found that food allergies are actually not common.

“Parents should not prevent their children from eating eggs, or taking cow's milk. These are good foods which should not be avoided unless it is proven through testing that your child is allergic to them.

“Of course, you can be allergic to pollen and dust mites but in general in this country it's not too much an issue, I think.

“Allergy shots are not commonly given in Malaysia. If an allergy shot needs to be given, it needs to be done by a trained allergist and we do not have many of them in this country, either.

“So, I wouldn't advocate children getting allergy shots,” explains Dr Azizi.

Diet

While food allergies is not common in Malaysia, Dr Azizi stresses the importance of a nutritious diet.

He advises parents to train their children not to eat junk food.

“Although it doesn't cause severe epilepsy or death or life-threatening asthma, I feel that in general we should advise parents not only to avoid environmental triggers like cigarette smoke in the house or other forms of pollution, but also to avoid junk food and food with colourings and additives; not only for asthma in general but also for good health.

“I believe that in our country this type of food does play some role, albeit indirectly, in causing asthma. They cause other issues related to allergies like skin problems, allergic rhinitis, rhinosinusitis which may also trigger asthma and make asthma more difficult to treat. They may also lead to chronic cough which may be confused with asthma.

“I think parents need to be more aware that good food is what we must go for and that they should not stop giving their children milk. There's a myth about milk causing phlegm. It's a myth.

“Obesity is another issue. The obese child is more prone to getting asthma and if they're asthmatic they're going to have more severe asthma. A balanced diet, good nutrition and awareness of what is in your food is important. I think a lot of times I can make people better by changing their lifestyle and getting them to take healthy food,” he says.

The indoor environment

Also important is the indoor environment where the child is.

While it is difficult to eradicate house dust mites, Dr Azizi suggests parents minimise their children's exposure to dust. Parents, he says, need to be aware that dust mites love items which are damp like old pillows and soft toys.

Washing soft toys won't help. They have to be boiled.

How about keeping pets?

“Some people may have problems with pets. I don't think it's a very important issue unless you are severely affected by your pets. If you've had a cat for a long time, you don't want to get rid of the cat.

“To me it's not so much an issue. In my experience, I find not too many people are severely affected by their pets. I never advise people to get rid of their pets.”

Dr Azizi says the use of the air-conditioner is actually better than using a fan because a fan tends to blow around the dust in the room and sleeping under a fan will stimulate the nostrils to sneeze.

He advises those using an air-conditioner to direct the air away from where they are sleeping; let the aircond cool the room without directly blowing towards you.

Parents are reminded that asthmatic children are not weak.

“Their system is not weak; it is just sensitive. That means their system is over-reacting to the environment. Some people ask for supplements to strengthen their system. You don't need to do that because your system is not weak.

“Just take good food,” advises Dr Azizi.