Many parents might leap to the conclusion that constant wheezing and coughing means their child is asthmatic, but diagnosing this common respiratory condition is not that simple.
Have you ever found yourself asking questions like, “My baby wheezes at night, is she asthmatic?” or “Why does my child seem to have difficulty breathing during playtime? Is it asthma?”, or other similar questions?
According to the World Health Organisation (WHO), asthma is the most common chronic non-communicable disease among children.
Symptoms often associated with asthma include shortness in breathing, chest tightness, coughing and wheezing.
More often than not, parents who observe these symptoms assume their child is asthmatic and are concerned about the long-term implication of the illness.
What you see isn’t (always) what you get
Diagnosing asthma, especially in young children and infants (those below the age of six), may be quite difficult.
This is mainly due to the fact that asthmatic symptoms are mimicked by those of various other health conditions.
For example, viral bronchiolitis, which presents with symptoms of coughing, wheezing and difficulty in breathing or vocal cord dysfunction (VCD), has most, if not all, the symptoms of asthma common in children and young adults.
In fact, even a common cold or respiratory infection can cause wheezing in children with particularly small airways.
Babies and infants are usually vulnerable to these and other similar viral infections, mainly because their immune systems have not yet fully developed.
Their protection comes mostly from their mother’s antibody-rich breast milk, and of course, through the national immunisation schedule and other optional vaccines.
Surprisingly enough, two-thirds of children with wheezing or other asthmatic-like symptoms, outgrow them as time passes by.
So, the good news is that most wheezing illnesses are transient and are expected to disappear as the affected children grow older.
Time will tell
As your child gets older (around five to seven years of age), defining asthma becomes much easier.
Diagnosis in older children may involve lung function testing (spirometry), a look at the medical history of the parents, and tests for evidence of allergy.
As mentioned earlier, diagnosing asthma in younger children and infants is more difficult as virus-associated wheezing is highly prevalent in this age group.
The following criteria indicates a higher likelihood for asthma in wheezing children:
·One or both parents have a history of asthma or eczema.
·The presence of an allergic response to triggers or irritants.
·The wheezing persists in the absence of an infection or cold.
Parents should be cognisant of the fact that doctors, specialists and paediatricians need to ascertain that the child has the specified criteria before actually diagnosing asthma, and that the process of diagnosis may take time.
An incorrect diagnosis may cause distress within the family and affect their daily lives.
Furthermore, a precise diagnosis (if indeed your child is asthmatic) helps the doctor to both plan and deliver the best possible options for a long-term management of the condition.
Ease the wheeze
A lot of children who have asthma develop their first symptoms before six years of age, and are not positively diagnosed until later on.
However, you won’t need to wait for six years to actually get your child’s first prescription and start treating the symptoms.
Doctors are aware that prolonged inflammation may cause permanent damage to the lungs, and thus, may prescribe anti-inflammatory medications in frequently wheezing children.
Under-diagnosis of asthma was a major concern of experts in the past, but with new knowledge on childhood wheezing illnesses, over-diagnosis and over-treatment are now the bigger problems.
Therefore, until a concrete assessment is made, doctors may prescribe inhaled asthma medications that are generally safe for infants and children, in order to see if their symptoms subside.
These medications are more commonly used intermittently or on a short-term basis.
The decision to use longer-term treatment regimens will have to depend on longer term observation of symptom patterns and identification of criteria that are more consistent with asthma.
So, don’t be too quick to jump to conclusions.
Doctors aren’t miracle workers and they can’t pull rabbits out of their proverbial hats willy-nilly.
Patience and continued emotional and psychological support for your child is more important.
That being said, you should also consider consulting a paediatric respiratory specialist regarding your child’s condition and get an expert’s feedback on managing these asthmatic symptoms.
Although asthma cannot be cured, its symptoms can be effectively prevented, and outbreaks and/or attacks properly controlled, following a good management plan.
The plan should be reviewed by you as parents, and anyone else taking care of the child.
Caregivers should understand the plan and be able to act accordingly in the event an attack does occur.
Datuk Dr Azizi Hj Omar is a consultant paediatric chest physician. This article is courtesy of Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners: Nutrition Society of Malaysia, Obstetric and Gynaecological Society of Malaysia, Malaysian Mental Health Association, Malaysian Psychiatric Association, National Population and Family Development Board Malaysia, Malaysian Association of Kindergartens and Association of Registered Childcare Providers Malaysia. It is also brought to you by an educational grant from GlaxoSmithKline Sdn Bhd. The opinion expressed in the article is the view of the author. For further information, please visit www.mypositiveparenting.org. The Positive Parenting E-magazine is also available on our website.