Is It Asthma?
How do you know whether your child has asthma? Children often start showing signs of this problem while they are still very young, but asthma can strike at any age. Asthma can be difficult to diagnose. There is no simple blood test or X-ray that can be done to confirm a suspicion of asthma. A sophisticated lung-function test can diagnose the problem in adults, but it is impractical to administer to children. The vast majority of young asthmatic children are diagnosed exclusively by clinical manifestation. In other words, a collection of symptoms suggests that the condition is present.
A Wheezy Proposition
Wheezing is a whistling sound that is produced by an asthmatic person who is breathing out. The wheezing sounds can be quite loud, or they may barely be audible without a doctor's stethoscope. Anyone can reproduce this wheezing sound by forcefully blowing air from the lungs with an open mouth. However, asthmatics frequently wheeze even when they are just breathing normally.
People generally associate wheezing with asthma, but that doesn't necessarily mean that any child who wheezes must have asthma. Many other conditions can cause wheezing, including a lung infection or an inhaled foreign object inside the lungs (such as a watermelon seed). Conversely, not everyone with asthma wheezes. Many children suffer from a form of asthma known as cough-variant asthma. These children rarely have wheezing when they have an asthma attack. Instead, they cough violently and repeatedly.
Essential
If your child has a chronic cough, he may actually be having recurrent asthma attacks. As a good rule of thumb, if a cough lasts for more than two weeks, you should have your child checked out by a doctor. Other conditions, such as a sinus infection or nasal allergy, may also trigger a chronic cough.
Besides the coughing and wheezing it causes, asthma can also manifest itself as difficulty in breathing during exercise or as a sporadic nighttime cough. Some children may describe a sensation of tightness in their chests, or they might experience a coughing attack when they are laughing. Any of these symptoms may indicate the presence of asthma.
Asthma is strongly related to other allergic conditions. Skin allergy, commonly known as eczema, tends to run in the families of children with asthma and nasal allergy. As mentioned in Chapter 10, skin allergy, nasal allergy, and asthma make up the triad of allergic conditions that are strongly hereditary. Doctors call these three conditions the “atopic triad.” Atopy is just a fancy medical word for allergy.
The heredity nature of atopy means that if one or both parents have these allergic conditions, the child has a greater chance of having asthma. If a sibling has allergy problems, the likelihood is also increased. This is why your pediatrician may inquire about the health history of other family members.
Trial of Medication
One of the best ways to confirm an asthma diagnosis based on clinical symptoms is to have your child try an asthma medication for a brief period of time (one to two weeks). If your child gets significant relief from an asthma medication, there is a strong probability that your child has asthma.
Even though it does not seem very scientific for a doctor to simply “try” a medication without first establishing a firm diagnosis, such a medication trial yields important information about the underlying reason for your child's symptoms. If the symptoms are completely unaffected by the asthma medication, then your child's chronic cough is most likely caused by something other than asthma.
Many parents are reluctant to let their child start using an asthma inhaler out of fear the child will never be able to stop. It is a common misconception that asthma medications are addictive. Another common belief is that once people start taking them, their lungs become dependent on the medications. Coming off the medications makes them suffer more because their lungs have been “weakened” by the asthma inhaler.
Question?
Can my child become addicted to his inhaler?
Many parents are afraid that once their child starts using an inhaler, he will become dependent on it. They fear that even if their child had no asthma problems before starting to use the inhaler, inhaler usage will ruin his lungs and transform him into an asthmatic. This worry is entirely unfounded.
Even though this belief is common, there is absolutely no basis for this way of thinking. Any physician will tell you that asthma inhalers are completely nonaddictive. These inhalers do not transform someone who is otherwise healthy into an asthmatic. As far as doctors are concerned, asthma is primarily a genetic condition. No one can develop asthma as a result of taking some medication. It's simply impossible. (See pages 206–210 for a complete discussion of asthma medications.)
