Asthma in our Little Ones
Updated: Nov 1, 2022
Common in childhood, #asthma usually presents as wheeze, breathlessness, chest tightness and #cough, many times at night. Too often these symptoms are unrecognized or dismissed as the common cold, allergies, fatigue, or whatever else. The issue with asthma is more in having difficulty exhaling air as these individuals tend to have greater bronchial smooth muscle than the average person, which can put the child in grave danger if not well managed. Unfortunately, individuals with asthma also have an exaggerated response to stimulus which may be an allergen or exercise so their bronchospasms are much more intense.
There are a number of approaches beyond medications that can help improve the quality of life and reduce symptoms in asthmatic people, particularly identifying the underlying cause of inflammation. Avoiding exposure to environmental tobacco smoke is huge, as is avoiding food and drug triggers. Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are found among the main drugs that trigger asthmatic crises, particularly when administered in the first year of life as it alters the development of their intestinal microbiota.
Viruses, bacterial, fungus, parasites, aeroallergens, dust, pollen, suspended particles, chemical irritants, temperature or climate changes can also aggravate asthma. Diabetes and obesity also contribute, as may hormonal changes such as a woman's menses. Maybe the biggest impact though, to one's risk for asthma, is having not been breastfed. Vitamin D confers protection against the development of asthma.
We offer special testing for identifying food, dyes, and chemicals specific to each person and a detailed plan for eliminating exposure. Indoor and outdoor pollution and irritants can also be cause for respiratory reactions, as can excess weight. Genetics also play a role, which we can help identify and then work to reduce triggering those genetic expressions.
Medications are the primary method of managing asthma in both adults and children. This is tricky though because not only can the medication be a challenge to administer to children, but the type of treatment required to control symptoms can change over months. Further, understanding how significant the asthma symptoms are in children can be tough. Not only does their age make this a challenge, but as children and adults get more tolerant of their symptoms, the worse they suffer before seeking treatment which is why many end up hospitalized with uncontrolled asthma.
Asthma Action Plans are the mainstay of treatment and has been shown to reduce the number of missed school days, unscheduled visits to the clinic and emergency room, and even reduce hospitalizations. It's designed to empower the client. If your littles haven't been provided one by your practitioner, inquire immediately.
These Asthma Action Plans are stepwise approaches for how to manage medications and recognize symptoms early in their presentation. They also help identify the progression over time. We seek stabilization of symptoms at any particular level for three months, but a baseline must be known. I have yet to have a client present who is knowledgeable of their baseline peak flow. This is the target as symptoms progress, the objective measurement for which measurements during illnesses or while suffering symptoms are compared. Without this understanding, we're just guessing and pushing our luck with regards to exacerbations that could put a child in the hospital. When meeting with your practitioner, bring the Asthma Action Plan to each visit, as well as your asthma diary of symptoms and your asthma medications.
Rule of Twos
Obtaining perspective of the client or client's family on whether the client's asthma is well controlled can add to the clinical evaluation. This rule of two is an important one to understand, and to utilize by the practitioner in our consultations. We ask about the number of days per week, particularly in the last week, that client has experienced chest tightness, cough, shortness of breath, or wheezing or whistling in your chest. We also ask how many nights in the past week the client or child had chest tightness, cough, shortness of breath, or wheezing. We ask about peak flow readings at home, and if so, what those were readings. We want to know how many days in the past week asthma had restricted physical activity and how many asthma attacks since the last visit. We also want to know about unscheduled visits to an urgent care or emergency room since the last visit, or even with another practitioner.
Ultimate Goal of Asthma Treatment
The goal is to reduce #triggers and optimize health. A healthy immune system recognizes proper triggers but doesn't overreact. Controlling exposures to triggers while building the strength of the immune system is a challenge in itself, but add to that calming the nervous system and understanding the individual's response based on their #epigenetics, which not only writes the script for responding to triggers but also orchestrates our hormonal and chemical responses along with revealing the strengths and weaknesses of our detoxification, is a task typically beyond the expertise of most primary care practitioners. They simply are alloted the time in their consultations to even consider options beyond pharmaceutical management. We can though. This is our specialty. Our Epigenetics: Nature versus Nurture offers insight to genetic factors and asthma.
Rarely do I meet with a client who is suffering asthma symptoms and they don't also have allergies and eczema, or what we call the "clinical triad," in which atopic dermatitis, allergic rhinitis and asthma are present. In fact, these are typically present prior to asthma. The respiratory system, the skin, the mucosa and the digestive tract participate in this association, as a consequence of a complex immunological disorder.
Atopical dermatitis typically presents between birth and 6 months of age. Later, gastrointestinal disorders appear, mainly during the second year of life. Then, between three and seven years, there can be the initiation of disorders in the upper respiratory tract, culminating in the establishment of multiple asthmatic crisis between the ages of seven and fifteen years. Clinicians will speak of the "atopic march" which is the allergic progression mediated by IgE, beginning with atopic dermatitis and food allergies in infancy, followed by aeroallergen sensitization at preschool age.
Some of the Nerdy Stuff
Viral infections are an important factor in the causation for asthma in childhood. They activate that barrier between the outside world and the inside of us which needs protection. Rhinovirus (RV) is thought to be the most prominent virus causing childhood asthma, with the syncytial respiratory virus (RSV) following particularly in children younger than two years of age.
Fungus is also an important factor as it can cause rhinitis, asthma, and other respiratory diseases through the production of immunoglobulins, principly E and G. Microbial infections is an interesting phenomenon in that when our children are largely inside, their diets are void of organic fruits and vegetables, and they utilize a great deal of sanitizing products including even the dishwasher, they aren't exposed to a physiologic number of bacteria and endotoxins which favors the presence of the TH2 response, which ultimately increases atopic disease. On the other hand, when children are exposed to bacteria at a young age, allowed to play outside and utilize probiotics, they have reduced allergic sensitization partly because these actions enhance the gastrointestinal barrier.
Diabetes and obesity are yet additional factors which increase the risk of asthma. A diet high in saturated fats and deficient in polyunsaturated omega-3 fats, fiber, vitamins (especially A, C, and D), magnesium, and selenium has been related to inflammatory induction of the respiratory system and ultimately asthma. Over the last thirty years, vitamin D levels has diminished, particularly in pediatrics, which may be related to some degree to the increased incidence of asthma.
All the reasons above relate asthma and obesity, but as well, the accumulation of adipose tissue in the thorax adds to the narrowing of the airway creating asthma symptoms. Obesity also generates a state of systemic inflammation which also acts on the lungs, precipitating the initiation of asthma. Obese individuals with asthma experience more frequent hospitalizations and reduced response to glucocorticoids, meaning the require more to improve the control of their asthma which long term has significant secondary effects.
Diet, Vitamin & Food Supplements
Various studies have confirmed that food and nutrients can protect the airway from oxidative damage through different mechanisms. Some vitamins, for example, soluble vitamin C and fat-soluble vitamin E are considered an important defense against oxidative stress. Similarly, carotenoids, vitamin A, and lycopene have shown significant potential antioxidant effects. Interestingly, these studies also show asthmatics have lower concentrations of vitamin A, C and E, which may enhance their symptoms. The same happens when selenium levels are low, since this element is essentially for the enzyme glutathione peroxidase to function properly and to reduce the amount of H2O2, preventing the lipid peroxidation of the cell membrane.
Adults with low levels of antioxidants in their diet often have a low FEV1, FVC and more frequent asthmatic exacerbations. When they supplement themselves, the research does seem to support a better balance. Another known and relevant therapy is thiol antioxidants, which induce the conversion of glutathione. N-acetyl cysteine (NAC) treatment is also known to reduce the need of bronchodilators and the responsiveness of the airway. Furthermore, it has also been linked to its potential to significantly inhibit oxidative stress and lipid peroxidation.
Plants & Natural Extracts
Many asthmatics use plants alone or in combination with prescribed medications to try to reduce or control symptoms. A study with more than 3000 participants found that the anti-asthmatic effects of the plants Glycyrrhiza uralensis (licorice root), Angelica Sinensis, PInellia ternata, and Astragalus membraneceus (the latter two included in traditional Chinese medicine) were evaluated. The analysis confirmed that almost all plants, as a complement to routine therapy, improved the asthmatic control and lung function. Likewise, the frequency of acute exacerbations and the use of salbutamol decreased.
In addition to the examples above, there is support for the plants "Perpetual (Helichrysum stoechas), "Eucalyptus" (Eucalyptus globulus), "Rosemary" (Rosmarinus officinalis), "Ginger" (Zingiber officinale), and "Elecampane" (Inula helenium) that due to their aromas and relaxing effects, can also reduce asthma symptoms. The traditional consumption of these medicinal herbs is only on a weekly basis and for one month, such as in aqueous extracts or tea. Garlic is yet another, of course. No surprise there. Finally, research has shown resveratrol, a phenolic compound found in grapes, indicates reduced oxidative stress and can reduce the high levels of TNF-a and iNOS in the lungs of obese male mice.
Integrative Therapies for Asthmatic Controls
Other options for working to control this complex disease are additional dietary and nutritional therapies, additional herbal therapies, homeopathy, acupuncture, massage, yoga breathing exercises, relaxation and mind-body therapies, and Qigong. Hypnotherapy has shown effectiveness, as this modality can reduce stress and anxiety, which was especially effective in pediatrics.
Yoga showed a progressive improvement in lung function in both children and adults during the course of treatment. Mindfulness-based stress reduction is another mind-body approach with some promise of success. Relaxation, breathing techniques, and herbal products have been effective particularly among poor socioeconomic individuals with poorly controlled asthma.
Arteaga-Badillo, D. A., Portillo-Reyes, J., Vargas-Mendoza, N., Morales-Gonzalez, J. A., Izquierdo-Vega, J. A., Sanchez-Gutierrez, M., Alvarez-Gonzalez, I., Morales-Gonzalez, A., Madrigal-Bujaidar, E., & Madrigal-Santillan, E. (2020). Asthma: New integrative treatment strategies for the next decade. Medicina, 56(438).
Rance, K. S. (2011). Helping patients attain and maintain asthma control: reviewing the role of the nurse practitioner. Journal of Multidisciplinary Healthcare, 4, 299-309.