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Pediatric Asthma

Updated: Nov 1, 2022

More and more children are suffering with #asthma today than when their own parents were children. Children of the 1980s doubled their death rate from asthma in just ten years, which was astonishing enough, but add to that the mass increase in environmental toxins we have faced in decades since, and now COVID, we can better understand why asthma has increased in incidence every years since the 1980's. Greater prevalence and worsening disability, with more frequent hospitalizations, is our current reality. Worse, yet like seemingly every other health concern in our nation, our black children are four to six times more likely to die of asthma than white children. As a functional medicine clinician, I have to ask "why?"

The more toxic our environment becomes with pollution in our air and water, herbicides and pesticides in our food, excess use of antibiotics and other medications in our water systems in addition to over prescribing, as well as the enormous production of processed foods and high sugar, the higher our body burden. We are our environment, so our gut microbiomes are quite often a bit toxic leading to inflammation and gut permeability, which sets the stage for food sensitivities and allergies. When our gut is out of balance, our body is inflamed - and vulnerable to dis-ease.

It's time to get serious about childhood asthma, which can be a bit insidious when you aren't more familiar. Your child may simply have a cough at night or be a noisy breather at times. What we realize though, is children - and essentially everyone with asthma - get a bit too comfortable with discomfort and tolerate these symptoms far too long. This leads to under treatment and ultimately, ongoing asthma attacks which aren't given sufficient attention until they lead to hospitalization with potentially fatal consequence.

Asthma is a chronic inflammatory disorder which produces sensitive airways which then limit airflow because of some sort of restriction in the airways, such as edema or excess mucous. Wheezing, coughing, chest tightness, and shortness of breath are common symptoms. This inflammation may be immediate in onset, or may be a bit delayed.

For those of us who appreciate the nerdier side of things, or for those who are working to understand their epigenetics and immunology, understand that asthma is a mast cell mediator response. Histamine, leukotrienes, prostaglandins, and thromboxanes are involved, causing the dilation of vessels, swelling, and the restriction of the bronchus airway. Leukotrienes have actually been targeted as the primary culprits in asthma, as they are known to be a thousand times more potent than even histamine in mediating the inflammatory response.

After this initial mast cell response, cytokines are released which prolong the inflammation and activate eosinophils, basophils, lymphocytes and further mast cells. Chronic inflammation may result in what we refer to as smooth muscle hyperplasia, but think of it like working your biceps out in the gym. When you consistently work out any particular muscle, it will increase in size but this ultimately leads to further restriction in the airway. Further, the more we use our muscles, the more responsive they become, but in the case of asthma, we don't want them to be hyperresponsive because then they overreact to any little thing, not necessarily all threats.

How do I know if my Child has Asthma?

Fifty to 80 percent of children with asthma develop symptoms before they are five years old. These symptoms vary widely from child to child, and for many, this may look like frequent upper respiratory infections. When parents report episodic or persistent coughing, this is a red flag for clinicians. Wheezing, shortness of breath, rapid breathing, or chest tightness is pretty conclusive. Often these symptoms are worse in the evening or early morning hours and can be associated with triggers such as exercise, allergies or being outside in the spring or fall.

Wheezing doesn't have to be present though to have asthma and to be at risk and having a wheeze doesn't always mean you have asthma. Often children with asthma have other symptoms such as atopic dermatitis (skin rashes) and rhinitis (runny nose not associated with upper respiratory infections), even during that first year. They may have had a lower respiratory infection that lead to hospitalization and ultimately, often suffer from diminished airway function by six years of age.

After a battery of questions to better understand the child's symptoms as well as the severity of the situation, pulmonary function tests will likely be ordered and potentially allergy testing to help confirm the diagnosis. Our practice likes to also understand the underlying genetics so that we can identify which aspect of the immune response may have weaknesses and as the research allows us, work to turn off those triggers.

Pulmonary function tests consists of inhaling into a tube before being offered a bronchodilator and again afterwards, to evaluate airflow obstruction and to determine the improvement achieved with medication. These are somewhat unreliable in preschool children, and certainly so in infants, so often children go undiagnosed during these early years. Certainly when testing is done, pediatric equipment should be utilized for proper readings.

A high percentage of these clients have reactive skin tests, which evaluate IgE, and our practice evaluates mediated release responses which is a larger view of the immune response and a bit more pervasive as symptoms can take 72 hours which makes identifying triggers quite challenging. Understanding your child's underlying epigenetics can be helpful as well, so you can individualize your treatment approach.

What does Treatment look like for Kids with Asthma?

Avoiding triggers is key, not just allergic (IgE) but all triggers to the immune system, even weather changes and emotional stress. Your provider should work with you in creating an asthma action plan and help you understand your options. Mindfulness is key, because again, asthmatic individuals get use to their restrictions and so exacerbations can be quite severe with seemingly little notice.

Supporting the immune system can help reduce upper respiratory infections, viral or bacterial, which can exacerbate asthma, and in more severe scenarios, the family may want to reconsider the presence of carpets in the child's room and living areas, even weekly washing of the bedding (organic preferred) and using specially designed mattresses and pillow covers, removing stuffed animals and similar objects from their room, and reevaluating the addition of pets to the family. Special furnace filters can be utilized for removing airborne allergens, and awareness of mold is crucial. Our active clients have access to our comprehensive Detoxification & Wellness program offering extensive information about environmental toxins and how to reduce your exposure.

However, as mentioned previously, after we address the potential for an emergency airway crisis and assess our potential for such, offering acute management, we then have to turn to gut health. Our overall goal is to reduce inflammation, which is often quite prominent in the guts of those with chronic conditions, but environment is important, as is emotional health, and even epigenetics.

While rescue and controller inhalers are an important part of asthma treatment, even life saving, these along with oral steroids are reactive treatments to reduce inflammation, not a proactive approach to identifying the root cause of the inflammation. Right? So this approach is a bit of a bandaid. It doesn't fix the problem.

After identifying and eliminating triggers, we work to replace nutrition that may be depleted, such as magnesium, omega-3 fatty acids, and vitamin D. Working to establish a healthy gut flora is important as is repairing the lining of the gut from long-term inflammation. Finally, addressing behaviors for balancing one's life is especially important, even at this young age. Deep breathing exercises, mindfulness, and even yoga can help children tune into their bodies, better identify early warning signs, and reduce their asthma flares long-term.

If your little one needs new eyes on their asthma action plan or want to join us for yoga, jump on our booking online page and lets connect.

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