Navigating Childhood Asthma: Insights From a Pediatric Pulmonologist
Q&A With Irina Dralyuk, MD, Cedars-Sinai Guerin Children’s
As the seasons transition from warm fall nights to cool and wintry evenings, children with asthma often experience a rise in wheezing or chest tightness, because weather changes and cold temperatures are often asthma triggers.
And for approximately 4.2 million children coping with asthma or other respiratory conditions, seasonal weather changes can pose severe, persistent, and potentially life-threatening risks. According to the National Institutes of Health, asthma is the most prevalent chronic childhood disease.
Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children's, emphasizes the importance of controlling asthma in children through all seasons, as poorly managed cases can lead to serious complications.
“Every asthmatic will have their own sets of triggers,” said Dralyuk. “For some kids, it could be changes in the weather, allergies or dust, while others may be more sensitive to viral episodes like respiratory syncytial virus (RSV) or influenza that can lead to an exacerbation of their asthma.”
Ahead of the American Academy of Pediatrics 2023 national conference Oct. 20-24 in Washington, D.C., Dralyuk spoke with the Cedars-Sinai Newsroom about pediatric asthma and offers guidance on treatment options.
What is asthma?
Asthma is a chronic condition affecting individuals of all ages, characterized by a recurring pattern of respiratory symptoms. These symptoms can vary in frequency, severity, and duration, and they differ from one patient to another. At its core, asthma involves heightened airway sensitivity to specific triggers, leading to a pronounced response known as bronchospasm. This heightened response can manifest as symptoms like coughing, wheezing, and shortness of breath, albeit in unique combinations for everyone.
What are the signs of asthma in children?
You may observe a child who coughs in specific situations, experiences wheezing, or develops shortness of breath. These situations can include weather changes; cold temperatures; vigorous physical activity; exposure to dust, strong odors, certain animals; excitement; or emotional responses. Suddenly, you may notice the onset of respiratory issues in such scenarios.
What treatment options are best for children with asthma?
Treatment options for asthma vary based on the condition's severity and insurance coverage. There are several approaches available, with two primary categories: rescue medications and controller medications. These represent the initial steps in managing asthma.
In cases of acute symptoms, where there's bronchoconstriction or airway tightening, we turn to a class of drugs known as bronchodilators. One well-known medication in this category is albuterol. It acts swiftly, providing rapid relief during asthma attacks or acute symptoms. Albuterol's effects are short-lived, but it effectively opens up the airways by targeting the smooth muscles.
During emergency room visits, albuterol is often administered to children, either through a nebulizer or an inhaler.
For individuals with exercise-induced bronchospasm, bronchodilators like albuterol can be beneficial before physical activity. However, as a more comprehensive management approach, inhaled corticosteroids play a vital role. They serve as the cornerstone of asthma treatment for individuals with mild, moderate, or severe asthma.
Can my child play sports, exercise or participate in recess if they have asthma?
I want to emphasize that asthma should not deter individuals from engaging in physical activity; however, it's crucial that they exercise comfortably and safely. If they experience breathing difficulties during physical activities, they should stop immediately.
It's essential for schools to be aware of students' asthma conditions. Physicians can provide documentation for this purpose, ensuring that the school is informed. If a young student cannot self-administer medication, school staff should be trained in its proper use.
It's vital that schools avoid pushing asthmatic students through their symptoms. There's a misconception that they should "push harder," but for asthmatics, it's essential to stop, catch their breath, take their prescribed medication, and restore their breathing capacity before resuming physical activities.
Our goal is for students to be active and participate in sports once their asthma is well-controlled.
For students with symptoms during physical activities, we advise taking albuterol 15 minutes before the activity, with teachers and coaches aware of this plan. If symptoms persist during practice, students should know they can take a second dose as needed.
How can parents support children with asthma at home?
There are several steps you can take at home to manage your child's asthma effectively. A knowledgeable healthcare provider, whether a general pediatrician or a pulmonologist, can assist parents in this endeavor to minimize the need for emergency room visits and prevent severe asthma episodes. The primary goal is to maintain optimal asthma control.
First and foremost, ensure that your child is following the appropriate maintenance medication regimen. This step is crucial, especially for children with severe, persistent asthma. Even with meticulous efforts to manage environmental factors at home, it can be nearly impossible without the right medication.
Some factors, like weather changes and the risk of catching viral colds, cannot be entirely controlled. While good hygiene practices can help reduce the risk, children may still contract colds when attending school. Pollution levels, another uncontrollable factor, can also impact asthma symptoms, especially in places like Los Angeles, which presents unique challenges for asthma management.
While certain factors are beyond our control, it's essential to emphasize the importance of being on the correct controller medication to maintain baseline inflammation control, tailored to the child's asthma severity level.
Understanding your child’s asthma triggers is crucial for providing specific assistance.
For example, while weather may not affect one child, dust could be a significant trigger. Therefore, it's essential to adopt a precise approach to household dusting, such as starting with wet dusting before proceeding with dry dusting. Additionally, regularly replacing air filters and monitoring whether activities like using the air conditioner or heating system worsen the child's symptoms are important. It's also necessary to consider the impact of pets in the home—does the child have allergies to specific types of pets, and how severe are these allergies? If the allergies are moderate and manageable, there may still be viable options.
When to seek emergency care?
If a child is breathing rapidly with deep, gasping breaths or exhibiting shallow breathing, and if they're unable to speak in full sentences, these are all concerning signs that warrant immediate attention. I strongly advise against disregarding these symptoms; it's crucial to consider them as indicators for seeking emergency medical care. Additionally, while wheezing can be a common asthma symptom, it's important to recognize that it's not the only factor to monitor. If you observe a combination of frequent wheezing, persistent coughing, and the child struggling to catch their breath, these signs can collectively signal a serious situation. Waiting until the child appears extremely fatigued is a risky delay; instead, it's advisable to call 911 promptly.
Read more on the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them