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There’s nothing more important to parents than protecting their children from life-threatening situations, and for most of us, that part of our daily routine means not starting the car until everyone is buckled in, shouting reminders to wear a bicycle helmet, and delivering an occasional lecture about being careful around strangers. But for an increasing number of parents in Southern California and nationwide, it also means rehearsing with your child what to do if he or she suddenly can’t breathe. Childhood asthma is on the rise, and although modern medicine has made it easier than ever to prevent deadly asthma attacks, the sheer number of children with the illness and the amount of time children spend away from their parents at school, on field trips, and in after-school activities, has turned childhood asthma into something of a public health crisis. According to the California Department of Health Services, nearly 4 million people in the state of California suffer from asthma, and the largest population of sufferers are children between the ages of 12 and 17. In Orange County, approximately 65,000 children have the disease, as do nearly 400,000 children in Orange, San Bernardino, Riverside and Los Angeles counties combined. Nationwide between 1980 and 1996, asthma rates increased 73.9%, and by 2001, 8.7% of children in the United States had the disease. Physicians and researchers have many theories to explain this increase, but regardless of the causes of the disease, experts in the field agree that the fact that asthma can almost always be managed, but often isn’t, underscores the need for increased public awareness and increased support and education for families with asthmatic children. “We know so much about asthma that nobody should be dying from it,” says David L. Rosenstreich, an allergist and immunologist at the Albert Einstein College of Medicine. “It’s very troubling.” In 1994, 5,400 people died from asthma - an increase of 82% from 1989. Deaths among 5- to 24-year-olds doubled during the same five-year period, according to the Southern California Chapter of the Asthma & Allergy Foundation of America. And more than 33% of all absences from school each year are due to asthma. Live a full life Yet according to asthma experts, if managed correctly, children should rarely if ever miss school because of their asthma, and no one should die from the disease. In fact, when children consistently take their medications and use their inhalers, not only should their life not be in danger but they should be able to participate in almost all childhood activities. “The creed of anyone who is appropriately treating asthma right now is that there are very few asthmatics - and I mean very, very few - who shouldn’t be outside doing something every day,” says Afif El-Hasan, pediatric representative to the Kaiser Asthma Task Force in Orange County and a board member of the American Lung Association of Orange County. In fact, inactivity may actually predispose children to asthma, says El-Hasan. “We already know that physical activity is part of a normal immune function, and in the next few years, (research may show) that inactivity and obesity may actually cause problems like asthma.” Looking for causes For residents in one of the smoggiest regions in the country, an obvious place to lay the blame for the increase in asthma is air pollution. But as air quality has improved slightly in recent years (or at least stopped its precipitous decline), asthma rates have increased. The culprit may be urban sprawl. Like adults living in Southern California, children here spend a lot of time in cars on the freeway, and the minivans and station wagons they ride in share those lanes with diesel trucks. More cars and trucks mean more traffic jams, and when those big rigs idle alongside cars full of children, it’s not just the drivers who are breathing the fouled air, so are the passengers in the backseat. Diesel particles damage everyone’s lungs, but children are especially vulnerable. According to a recent study by the UC San Francisco School of Medicine and the Natural Resources Defense Council, diesel exhaust doesn’t just aggravate asthma, it may even cause it. School buses are another major culprit of diesel exhaust exposure in children. Other factors besides bad air also contribute to the increase in childhood asthma. One of them is television, or the “television theory of asthma,” which goes like this: Children who spend a lot of time indoors sitting in front of a television or computer increase their exposure to indoor air pollutants that can trigger asthma. Another theory is the “clean theory” or “infectious immune” theory. Because we raise our children in much more sterile environments than we used to (life on the farm was dirtier than life in the suburbs), children today are exposed to fewer contaminants than previous generations of children, and those contaminants may have stimulated their immune systems and made them more resistant to asthma. Whatever the cause, asthma can be difficult to diagnose. Certain symptoms are recognized by most of the population, such as shortness of breath and wheezing. But what about a recurrent or persistent cough? Or tightening of the chest? Coughs go along with all sorts of viral infections, and many young children might describe tightening of the chest as a stomachache. Another subtle signs of asthma is a constant clearing of the throat. A rule of thumb, say pediatricians, is that any persistent symptom should be checked out by a doctor. There’s a difference between a one-time episode of wheezing caused by a viral illness, for example, and a child who is consistently winded much more quickly than his or her friends, says El-Hasan. The former should pass and the latter should result in a trip to the doctor. Because allergies are a trigger for many asthma patients, knowing what your child is allergic to and avoiding it can be very helpful in managing your child’s condition. Installing an air filter, replacing drapes with blinds, and removing wall-to-wall carpeting can all help reduce indoor allergens that trigger asthma. Another common asthma trigger is the preservative sulfite, which is in dried fruits, fruit juices, vegetables and wines. Other foods that trigger asthma in some children are cheese and other dairy products, citrus fruits, tomatoes, seafood and corn. Exercise-induced asthma is also fairly common in children; typically, people with this type of asthma begin to wheeze when they overexert themselves; using an inhaler before exercising usually prevents an asthma attack. Swimming is a particularly good sport for children with severe exercise-induced asthma. Some children are frightened when they learn that they have asthma and others become angry or resentful. Children who are experiencing these emotions, and even ones who aren’t, might benefit from a week this summer at an asthma camp. A popular area camp is the Southern California Asthma Medical Program (SCAMP). SCAMP Camp is sponsored by the American Lung Association of Orange County. A list of other camps is available at www.asthmacamps.org/asthmacamps/, including two in Big Bear (click on the button, “Find a Camp Near You”). Asthma camp can help children understand the seriousness of their condition without being frightened by it. For younger children, organizations such as the American Lung Association offer asthma education programs at schools, through parenting workshops, and on public television. For example, Sesame Street’s “A is for Asthma” helps children as young as 3 learn to recognize the signs of asthma, how to prevent symptoms, and what to do in an emergency. “The whole point is that we want the children to have a good time and learn skills to deal with their asthma,” says El-Hasan. Doctors who treat children with asthma say the most common challenge to managing childhood asthma is getting children to take their medicine appropriately. Failing to do so may lead to a severe asthma attack and also to serious lung problems later in life. “Chronic asthmatics who don’t take their medication have allowed the inflammation in their lungs to persist,” says El-Hasan. “That may cause changes in the lungs that may not be visible for many years. This is a huge problem with teenagers.” So, let’s say your child forgets to take his medicine and has an asthma attack? Then what? During an asthma attack, the lining of the airways become swollen and produce thick mucus. The muscles around the airway tighten, narrowing the airway and making it more difficult to breath. According to the experts, when this happens, head straight to the emergency room - even if your child’s symptoms have been mild in the past. About one-third of fatal asthma attacks happen to people with “mild” forms of the disease, says El-Hasan, so when in doubt, seek help immediately. Meanwhile, take steps to lead a full, healthful life. Katherine Noble-Goodman of Redlands writes on health topics. Asthma’s big triggers The American Lung Association defines the following as triggers to asthma. Some children will be affected by one or two of the following, others by many of these factors: • Pollution, both indoor and outdoor • Pet dander • Smoke • Food allergies • Mold • Perfume, shampoo and other scented material • Pollen • Exercise |
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