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ASTHMA &
ALLERGIES

CAUSES: DIAGNOSIS:
It is extrinsic and intrinsic in children, triggered by many A good history and clinical exam can pick up wheezing as-
factors. sociated respiratory disorders till 5.5 years. Not everything that
1. Mostly viral infections trigger attacks in young infants and wheezes is asthma and foreign body aspiration needs to be kept
children. in mind (crushed beans, particles, nuts).
2. Irritants like tobacco smoke, perfumes, sprays, fumes, By 5.5 years of age an asthma challenge test can be per-
cotton linters, paints, detergents. formed in the physician’s office through spirometry. There is
3. Drugs like Aspirin, Beta blockers, NSAIDS. about 12 percent improvement of FVC, FEV1 and the FEV
4. Emotional stress and child trauma from Adverse Childhood /FEV1 ratio after albuterol treatment. It is safe and can be
Experiences (ACE). done in a physician’s office or by a pulmonologist. Allergy test-
5. Viral infections. ing helps patients to understand and to avoid triggers in older
6. Pollen, house dust, mites, roach dust, pet dander, certain children. Intrinsic asthma is individual sensitivity and manifests
foods, molds. as coughing or wheezing with multiple triggers.
7. Hot and cold weather fluctuations, barometric pressure
differences like heat and humidity, mouth breathing.
8. In 75-80 percent of reoccurring wheezing after RSV, there
will be a family history of allergy or atopy of some kind. MANAGEMENT: GOALS:
1. To have quality of life and be active in sports and physical
activities.
2. Minimize ER visits, prevent school absenteeism.
SYMPTOMS: 3. Avoid chronic coughing, nocturnal and post viral.
A whistling sound during expiration is the 4th stage of 4. Avoid permanent reorganization of the airways with inflam-
asthma and when airways are at 50 percent of their normal di- mation by 6-7 years of age, that leads to Chronic Obstruc-
ameter. Air flow in and out is compromised. tive airway disease (COPD).
1. Chronic cough: Nocturnal, Exertion induced, Post viral 5. Compliance on using medicines by patient and the family
2. Chest tightness with or without exertion. through self-education is important.
3. Wheezing after exertion, unable to cope with physical
activities.
4. Chest retractions, active neck muscles movement to
respiratory distress. This stage is an emergent situation and
needs an ER visit.
5. Children without cough, with compromised airways can
collapse during physical exertion.

PATHOGENESIS:
Infants and young children have small airways, become very
narrow with slightest inflammation from a viral infection and
wheezing follows immediately. RSV infection usually triggers
the first wheezing episode in infants 6 months to 3 years. In
vulnerable children with family history of allergies, 75-85 per-
cent of infants have reoccurring wheezing after every viral
URI. Maternal antibody protection is lost by 6 months. There-
fore, persistent post viral cough and reoccurring wheezing is
common 6 -48 months. Airways grow by 6 years of age, instead
of wheezing cough is a symptom of asthma.

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