Other Asthma-Related Conditions
While your child's provider may suggest ways to treat her asthma through medication, another route her provider might take is looking for underlying conditions that can cause asthma symptoms to increase. In addition to allergies mentioned earlier in this chapter, other medical conditions exist that could prevent your child's asthma from getting better.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease — better known as GERD, acid reflux disease, or heartburn — is a major asthma trigger for children and adults. Studies have show that the presence of GERD symptoms may be higher among children and adolescents who have asthma. Research is ongoing, though, on whether reflux can cause asthma, or whether asthma can cause reflux.
With GERD, stomach acid and undigested food can wash back into the esophagus from the stomach when a valve (called a lower esophageal sphincter) fails to hold it back.
Sometimes this acid can travel back up the esophagus and then down the airways, causing them to contract. This may cause wheezing, hoarseness, congestion, sore throat, and coughing that does not respond to asthma medications. Sometimes, a child may complain of a sour taste in her mouth or you may notice frequent burping. Other times, no symptoms seem to be apparent.
Fact
GERD usually occurs after meals or when lying down — which means it is more likely to occur at night. Preventing GERD includes elevating the head of your child's bed, encouraging her to avoid spicy food, restricting caffeine use, eating smaller meals, and not eating snacks before bedtime.
Medications such as antacids, antihistamines that block stomach acid release, and medications (proton pump inhibitors) that lower stomach acid production are prescribed for older asthma patients.
Since GERD is hard to diagnose, check with your health care provider about what to do if you suspect that your child may have GERD that is triggering her asthma. Also check before you use any over-the-counter medications designed to help heartburn since they may not be for use by children.
Sinusitis
Another often overlooked but common childhood condition that may aggravate asthma is sinusitis. Sometimes it may be acute (occurring once) or chronic (continues to occur). Up until recently, sinusitis — or inflammation of the sinuses — usually was not considered by health care providers when examining young children.
Symptoms of sinusitis are: pressure in the area of the affected sinus behind the top of the nose in children who are older than six years, nasal congestion, postnasal drip, cough, sore throat, and thick and often green nasal discharge. She may sleep poorly at night and also have bad breath.
Diagnosing sinusitis in a child can pose some challenges — particularly if it is not clear whether it is related to an infection (caused by bacteria), or if it is related to a common cold (caused by a virus), or allergies causing congestion.
Several theories have been raised regarding why untreated sinusitis aggravates asthma. One is that children tend to breathe through their mouths when their noses are stuffed up. This means the air moving into their chests has not been warmed up through their noses, which could trigger asthma symptoms when crossing a child's inflamed airways. Another theory is that mucus in the sinuses may back up and spread down through already inflamed airways.
Essential
Studies have shown that sinusitis can exist among children as young as one year. The common cold or viral upper respiratory illnesses, allergies, and factors in the environment (such as tobacco smoke or mold sensitivities) are common triggers for the development of sinusitis.
When diagnosed, sinusitis may be treated in one of several ways, using nasal washes, steroidal nasal sprays, or antibiotics (when necessary for bacterial infections).
