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January 4, 2009

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Asthma in Children

Introduction

Approximately 17.3 million Americans have asthma. The cost of illness related to asthma is around $6.2 billion per year in the United States. Each year, an estimated 1.81 million people with asthma require treatment in the emergency department with approximately 500,000 hospitalizations. Children younger than the age of 18 years account for 47.8% of the emergency department visits and 34.6% of the hospitalizations due to asthma exacerbations. The magnitude of the impacts of asthma in children is illustrated by the fact that asthma accounts for more hospitalizations in children than any other chronic illness. Moreover, asthma causes children and adolescents to miss school and causes parents to miss days at work. As might be expected asthma also accounts for more school absences than any other chronic illness.

Asthma is a disorder caused by inflammation in the airways (called bronchi) that lead to the lungs. This inflammation causes airways to tighten and narrow, which blocks air from flowing freely into the lungs, making it hard to breathe. Symptoms include wheezing, breathlessness, chest tightness, and cough, particularly at night or after exercise/activity. The inflammation may be completely or partially reversed with or without medicines.

Inflammation of the airways is linked to bronchial hyperresponsiveness, which means that the airways leading to the lungs can narrow when they are exposed to anything to which they are sensitive, making it hard to breathe. All children with asthma have airways that are overly sensitive, or hyperreactive, to certain asthma triggers. Things that trigger asthma differ from person to person. Some common triggers are exercise, allergies, viral infections, and smoke. When a person with asthma is exposed to a trigger, their sensitive airways become inflamed, swell up, and fill with mucus. In addition, the muscles lining the swollen airways tighten and constrict, making them even more narrowed and blocked (obstructed).

So an asthma flare is caused by 3 important changes in the airways that make breathing more difficult:

  • Inflammation of the airways

  • Excess mucus that results in congestion and mucus "plugs" that get caught in the narrowed airways

  • Bronchoconstriction (bands of muscle lining the airways tighten up)
Anyone can have asthma, including infants and adolescents. The tendency to develop asthma is often inherited; in other words, asthma can run in families.

Many children with asthma can breathe normally for weeks or months between flares. When flares do occur, they often seem to happen without warning. Actually, a flare usually develops over time, involving a complicated process of increasing airway obstruction.



Next: Symptoms of Asthma »

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