When Asthma Attacks

This week’s guest columnist is Dr. Lindsey Guidry, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

I was testing for my karate black belt, trudging through the last stretch of a two-mile run. The morning was cool and crisp, which seemed fine for exercising. Except the dry cold air made my lungs feel raw. Then they began to burn like fire. I crossed the finish line and doubled over, gasping for what seemed an eternity. My mom brought me my inhaler and after a few puffs, the burning eased and my respirations began to slow. A sense of relief washed over me- I could breathe again!

This was an attack of exercise-induced asthma: if I’m ever in a ninja fight, better have my inhaler!  Almost 10% of kids have some form of asthma. Asthma is airway narrowing in the lungs. When airways get smaller, it’s harder to suck air through them.  When the narrowing gets really bad, air begins to whistle through those tight passages, making that wheezing noise characteristic of attacks.

Kids with asthma have lungs that are extra-sensitive to irritants. Many things can irritate the airway lining, like cigarette smoke, cold viruses, pollens and mold spores, and dust.  In my case cold, dry air triggered narrowing. The American Academy of Pediatrics warns that climate change and increasing air pollution contribute to increasing national asthma rates. Severe weather events like forest fires, droughts, heat waves, and hurricanes are becoming more common, and giving lots of kids trouble with their breathing.  Increasing smog, soot, and other particle pollutants from cars and factories aren’t helping.

What does an asthma attack look like?  Mild asthma results in irritating coughing that doesn’t go away in a few days, like a regular cold would.  Moderate attacks cause a feeling of chest tightness and trouble breathing with exertion, like when walking up stairs, playing, or testing for karate.  When kids’ attacks get really bad, they visibly struggle to breathe, panting away with skin puckering between their ribs as they try to tug air in. Older kids may get a little panicky like I did; younger kids will be fussy. Time to get help!

Asthma, and asthma treatments, have been with us for millenia.  The ancient Greek physician Hippocrates (writer of the physician’s Hippocratic Oath) coined the term “aazein,” meaning “to pant.”  The Greeks had some reasonable asthma treatments, like adding ephedra (an epinephrine-like drug) to red wine; or smoking stramonium, an atropine analog. They also had whackier ideas, like adding owl’s blood to the wine too.

Today’s treatment is more science-based.  As we mentioned above, asthma is the lung’s response to irritants like dust, smoke and pollution, cold viruses, and allergens. First, muscles in the airway lining tighten up, constricting air passage to keep out what’s irritating. After continued insult, the airways become inflamed and swollen, further impinging air movement. Finally, the lungs secrete mucus to wash out the irritants. This mucus gets dried out and sticky with heavy breathing, further clogging things up.

The first pillar of asthma care is albuterol, a medication that relaxes the muscles in the airways. Albuterol is breathed in by nebulizer or inhaler. Initial management of an attack is 2 to 6 puffs of the inhaler, with a “spacer” (a wide plastic tube) attached. These puffs can be repeated in 20 minutes if the first round doesn’t ease symptoms. If that doesn’t work, get seen!  While most prescriptions for albuterol inhalers call for 2 puffs, it takes 6 puffs to deliver the amount of medicine in a nebulizer treatment.

The second pillar is steroids. Steroids are anti-inflammatories, to quiet that airway swelling and mucus production. The most common steroid is prednisone, which comes as tablets, or liquids for kids who can’t swallow pills. Prednisone is not an “anabolic steroid.”  Kids don’t grow hair, hulk out, or have “roid rages.” Given in short courses, it’s quite safe. Myth-buster: injected steroids don’t work faster than when they’re swallowed; getting “cortisone shots” is unnecessary (yay kids!).

Have plenty of your child’s medication on hand in the winter when cold air, viruses, and dusty indoor living make it more prevalent. Be aware of outdoor air quality conditions that might trigger asthma, like cane burning, humidity, and high pollen counts. Finally, the American Academy of Pediatrics asks everyone to advocate for pollution and carbon control; to help your child, and the whole world, breathe easier.

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