How to kill your asthmatic child second of two parts

By Dr. W. Gifford Jones

July 5, 1992

Why are more adults and children dying from twitchy asthmatic airways? Last week I recorded that for years doctors believed that spasm of the bronchial tubes was the only problem faced by asthmatics. And that excessive use of "little puffs" from bronchodilators to relieve bronchial spasm could trigger serious asthmatic attacks and sometimes death. This week, what parents should know about the treatment of asthma in children. And why some parents are inadvertently helping to kill their child.

Dr. Soren Pederson of the Department of Pediatrics, Kolding, Denmark recently told me that the common error in treating asthmatic children is underestimation of the severity of the disease.

One pitfall is that parents often become used to their child's symptoms and underestimate them. So it's important for doctors to probe deeply to find out if the child is suffering from nocturnal asthma, wheezing during sleep or from morning tightness in the chest.

Professor Pederson claims that 6 out of 10 children do not receive optimal care. It's because in the past there was too much reliance on bronchodilators to ease spasm. And this medication does nothing for the underlying inflammation in the bronchial tubes that trigger asthmatic attacks.

Pederson adds that children using bronchodilators may seem, on the surface, to be well-treated. But when these children are given inhaled steroids to ease the underlying inflammation they feel much better. In fact, once placed on this medication, they do not want to go back to other treatment.

Inhaled steroids provide another benefit. Several studies show that the number of acute admissions to hospital has gone down since the use of this medication. And that the use of inhaled steroids is by far the most effective long-term treatmen of asthma in children.

Pederson notes that potential risk of side-effects is often cited as the reason for not using inhaled steroids as first-line treatment in children. But this argument no longer holds water. Inhaled steroids have now been used for 25 years with no evidence that daily doses of 400 micrograms or less are associated with clinically important side-effects.

How are parents killing their children? Dr. Louis-Philippe Boulet, Head of the Asthma Clinic, Laval University, in Quebec City says he finds it unbelievable that many parents simply refuse to get rid of the family cat or dog or other animals.

According to Dr. Boulet children's asthma can often be solved by quickly packing off the cat. But the longer children are exposed to animal dander the greater the chance they will develop chronic and severe asthma.

When Professor Boulet repeatedly asks parents if they've got rid of the cat, they invariably say "No". So on subsequent visits he continues to ask the same question angrily. Sooner or later parents claim they did get rid of the cat, but often that's not the case. He suspects they say this just to please the doctor!

A key problem for all asthmatics is lack of continuity in heath care. This, of course, is important with many other diseases. But it is even more vital in the treatment of asthma.

Dr. Boulet is adamant that someone must educate the patient as to what to do in different situations so he or she can feel more confident in managing asthma. Asthmatics who rely on walk-in clinics will see a variety of doctors who may change the therapeutic approach. The result is that patients get terribly confused about their medication. This can set the stage for disaster if an asthmatic gets into trouble at the wrong place at the wrong time.

The Laval Clinic promotes the use of "the action plan". This is a written guideline that has been discussed in detail by the doctor with the patient.

If the patient is on a trip and his asthma gets worse, instead of going to the emergency room and seeing a doctor who does not know him, he knows what to do from his own action plan.

DR. Boulet does not unduly criticize the expertise of walk-in clinics or emergency room doctors. It's simply that patients know best how they react during exacerbation and what medication is required to rectify the problem by following the predetermined guidelines.

It's important to remind everyone that it is possible to live an active life with asthma when well controlled. Nancy Hogshead, an asthmatic, won three gold medals and one silver in the 1984 Olympic Games. And I'd bet her parents got rid of the cat!

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod