WHAT IS ASTHMA ?

The word asthma originates from an ancient Greek word meaning panting. Essentially, asthma is an inability to breathe properly. When any person inhales, the air passes into the lungs through progressively smaller airways called bronchioles. The lungs contain millions of bronchioles, all leading to alveoli, microscopic sacs where oxygen and carbon dioxide are exchanged. Asthma is a chronic condition in which these airways undergo changes when stimulated by allergens or other environmental triggers that cause patients to cough, wheeze and experience shortness of breath (dyspnoea). Asthma appears to have two primary stages : hyper-reactivity (also called hyper-responsiveness) and the inflammatory response.

Hyper-reactive Response

In the hyper-reactive response, smooth muscles in the airways narrow excessively in response to inhaled allergens or other irritants. It should be noted that the airways in everyones lungs respond by constricting when exposed to allergens or irritants, but people without asthma are able to breathe in deeply to relax the airways and rid the lungs of the irritants. When asthmatics try to take those same deep breaths, their airways do not relax and the patients pant for breath. Smooth muscles in the airways of people with asthma may have a defect, perhaps a deficiency in a critical chemical that prevents the muscles from relaxing.

Inflammatory Response

The hyper-reactive stage is followed by the inflammatory response, in which the immune system responds to allergens or other environmental triggers by delivering white blood cells and other immune facts to the airways. Although designed to fight infection, in excess these immune factors can cause significant damage. These so-called inflammatory factors cause the airways to swell, to fill with fluid, and to produce a thick sticky mucous. This combination of events results in wheezing, breathlessness, inability to exhale properly, and a phlegm-producing cough. Inflammation appears to be present in the lungs of all patients with asthma, even those with mild cases, and plays a key role in all forms of the disease.

WHAT CAUSES ASTHMA IN CHILDREN ?

Factors contributing to the worldwide increase of Asthma.

Asthma has dramatically risen worldwide over the past decades and experts are puzzling over the cause of this phenomenon. The mechanisms that cause asthma are complex and vary among population groups and even individuals. Many asthma sufferers also have allergies, and researchers are investigating the events that occur in both these conditions. Not all people with allergies have asthma, however, and not all cases of asthma can be explained by allergic response. Other contributing causes are being investigated. Asthma is most likely a result of genetic susceptibility, which probably involves several genes and various environmental triggers, such as infections, dietary patterns, air pollution, and allergens. Some experts observe that children are spending more time indoors watching televisions, playing video games, or using the computer so that they are overexposed to indoor allergens. The trend of making homes more energy-efficient may result in dust mites being trapped inside them. Other facts for the increase in asthma cases may include the increased survival of low-birth-weight babies (who may be more susceptible to asthma). Asthma related disorders, including allergies, sinusitis, and ear infections, are also on the rise, suggesting that airborne or environmental factors are at work, and many experts believe asthma is actually undiagnosed.

Immune Factors Involved in the Allergic Response.
In people who have asthma caused by an allergic response, various airborne allergens or other triggers set off a cascade of events in the immune system that lead to inflammation and hyper-reactivity in the airways.

It should be noted that asthma is no reason to avoid exercise. About 10% of US athletes who participated in the 1996 Olympics were asthmatic. (Similar results were reported in the 1984 Olympics). Some studies are indicating that long-term exercise may help control asthma and reduce hospitalization. Asthmatic children should be encouraged to swim and play sports, such as baseball, that will present less difficulty for them. Intense activities lasting less than two minutes, such as sprinting or competitive swimming, are less problematic than longer exercises. Summer sports causes less stress than winter ones. Thorough warm-up period before vigorous exercise can help considerably in limiting bronchial narrowing and obstruction. Parents of children with exercise-induced asthma should consult their physicians for an exercise program suited to their specific conditions.

Homoeopathy is a system of medicine which has proved to be a tremendous success in improving the bodys immunity level. Infact, it enhances the bodys immunity in the most natural way. Thus giving power to the body to fight the diseases.

Homoeopathy treats Asthma with a broader and long term curative view. During the course of H treatment if my patient needs bronchodilators, inhalers or nebulizers, I dont stop them because my first aim is to give relief to the child during acute difficulty in breathing.

Each child or individual is born with a predisposition and interacts with the environment to evolve a disposition. The disposition constantly tries to strike a balance with the environment. Certain dispositions under environmental stresses have a tendency to develop asthma in childhood when the balance between the childs health and environment is lost the immunity goes down and diseases enter the body. Expression of diseases depends upon the sensitivity of the individual and the inherent predisposition. Thus in homoeopathy we treat each individual on his predisposition like previous illnesses, allergies, family history, temperament, constitution his (childs) likes and dislikes, activities, educational or emotional stress.

Asthma with Inflammatory Response
Asthma could be prevented or its intensity reduced by controlling the infection and the commonest infection is sore throat. Child complaints of sore throat with a sensation of something stuck in it. This sensation doesnt disappear on swallowing, in fact swallowing is very painful and pain extends to the ears. At times there is loss of voice with rattling in the chest and profuse yellowish greenish expectoration. Child feels very cold and wants to be covered. All the above complaints are worse in chilly dry weather or drinking chilled (iced) drinks.

Choking cough and sore throat gradually leads to difficulty in breathing. To prevent this (asthma attack) start the child on Hepar Sulph 200, 5 pills every 2 hourly. Hepar Sulph will immediately control the infection and thus prevent an asthma attack.

Merc. Sol. Throat problem starts mainly due to dust, environmental gases and every change of weather. At first the cold settles in the eyes and nose and then the throat feels sore with a dirty coated tongue and foul smell from the mouth. Tiny ulcers form in the mouth and throat causing inflammation and pain.

Merc. Sol 200, 5 pills 2 hourly will improve the throat condition and thus prevent an asthma attack.

There are number of homoeopathic medicines for the above conditions depending upon the signs and symptoms of the child.

Genetic Factors.
We homoeopaths pay great attention to family history. If there is a family history of asthma, skin disease (Eczema), tuberculosis, cancer we take these factors in account while prescribing medicine. There are specific polycrest (Broad acting) medicines which try to minimise the bad effects of weak genes and improves the quality of those genes. A Homoeopath always gives the correctly indicated Poly crest remedy (once the acute attack is over) to improve the immunity of body and remove or minimise the effect of genes for asthma.

Reduced Incidence of Common Childhood Infectious Diseases. Another theory for the dramatic increase in childhood asthma appears to be a contradiction. It blames the higher rate of asthma on childhood immunizations that have nearly eliminated certain infectious diseases, such as measles and whooping cough. Experts postulate that in some children who are vaccinated against these diseases, TH2 cells remain active and trigger the inflammatory events leading to asthma. Of some support for this theory are studies reporting that being a part of a large family reduces the risk of childhood asthma; children with many siblings are exposed to infections, which might increase immune factors that impede allergies.

We come across a number of children with chest allergy after they have been vaccinated. Specially whooping cough and measles vaccines have at times given long term side effects such as cold, cough, throat infections which may lead to asthma.

In Homoeopathy we have special vaccines to reduce side effects for these vaccines and reduce their toxicity.

Pertussin vaccine 200, 5 pills once a week for 6 weeks will reduce repeated cough attacks if developed after whooping cough vaccine.

Morbillinum 200, 5 pills once a week for 6 weeks should be given when the child develops chronic cold, cough and throat infection after Measles vaccine.

Many more Homoeopathic vaccines are used to minimise side effects of vaccines.

Other Contributing Medical Conditions

Hyperacidity or Gastroesophageal reflux disease (GERD), the cause of heartburn, is common in many asthmatic patients and is widespread among children with hard-to-control asthma. GERD may trigger asthma in many cases by spilling acid into the airways that trigger a hyper-reactive response. GERD may be suspected in patients who do not respond to asthma treatments, whose asthma attacks follow episodes of heartburn, or whose attacks are worse after eating or exercise. In such cases, treating the heartburn may also resolve asthma.

Nowadays hyperacidity in children is on an increase because of the junk food they eat. Nux Vomica tries to reduce the harmful effects of junk food, helps in digestion, decreases the amount of extra acid produced, sour and bitter eructations, nausea and vomiting. Nux Vomica tries to help the body by removing junk food effect via rectum. Nux Vomica 200, 5 pills 4 times help.

Sinusitis : Almost half of children and adults with allergic asthma have sinus abnormalities, and in various studies between 17% and 30% of asthmatic patients develop true chronic sinusitis. The presence of sinusitis, however, does not appear to increase the severity of asthma.

WHY DO CHILDREN GET ASTHMA ?

Asthma has dramatically increased worldwide over the last few decades. It is rising most rapidly in children under age four; according to a 1999 study the prevalence of asthma in young children increased by 160% between 1980 and 1995. At least five million American children are thought to have asthma today, almost half of whom may be undiagnosed, elevating asthma to the status of an unrecognised epidemic. Results from one survey indicated that more than 7% of American children between the ages of five and 14 have asthma. About half of all cases of asthma develop before the age of 10, and another third before age 40. Among younger children, asthma develops twice as frequently in boys as in girls, but after puberty it may be more common in girls.

Coexisting allergies

About 75% to 80% of children with asthma have allergies and studies indicate that the more indoor allergens a child is allergic to, the higher the risk for severe asthma. About 8% to 10% of children with asthma also have food allergies; these children also appear to have a high risk for very serious reactions to such food. In infants and toddlers, allergy to egg appears to be a major predictor of asthma. Asthma and non-seasonal or seasonal allergic rhinitis (hay fever or rose fever caused by pollen allergies) often coexist together. However, although most people with asthma have a history of allergic rhinitis, only 1% to 20% of children with allergic rhinitis actually develop asthma. The connection between allergies and asthma is likely be a common cause rather than one causing the other.

Certain food items like milk, egg and nuts plays a very major allergic role. To reduce these allergic reactions certain homoeopathic medicines like Aethusa, Calcarea Carb, Sepia, Ipecac, Sulphur, Thuja can be used according to each individuals symptoms and signs.

Issues Surrounding Birth

Infants of low birth weight are at higher risk for lung problems and asthma. One study suggests that children born in winter are at greater risk for asthmatic allergies to cockroaches than children born at other times of the year. Children who are fed exclusively breast milk (rather than other milk) for at least their first four months of life are significantly less likely to develop asthma than other children.

Wheezing in Infancy

A few studies indicate that the risk for asthma is high in children under five who wheeze, have frequent chest colds, or have a chronic cough. It should be noted that half of all children and infants wheeze at some time, but few develop asthma. Most babies who wheeze still have underdeveloped airways, which become normal as they grow. Clues to a risk for future asthma may be persistent wheezing, a rattling sound when infants cough, rapid breathing, and frequent respiratory illnesses. Wheezing infants who develop asthma are apt to have a family history of allergies and asthma. They may also have mothers who smoke. Research is underway to determine which wheezing babies are at risk for future asthma and which ones arent.

Other Risk Factors

Damp Homes : Studies from different parts of the world reported that children who live in damp homes have a much higher risk for asthma than those who dont. Damp homes or damp climate can cause lots of difficulties to asthma patients. For allergy to damp climate there are number of homoeopathic medicines, few are as under :-

Natrum Sulph :- This individual is very sensitive to rainy season, near the sea, in general water in any form. The child develops cold, cough at times wheezing during change of weather from dry to wet, by eating certain plants or fruits growing near water (sea, river) living in damp houses, basements.

It starts with nasal cold with thick yellow discharge from nose. Gradually a cough develops with rattling of mucus in chest along with wheezing and difficulty in breathing.

Calcarea Carb : Child is chubby, there is a tendency towards lots of perspiration specially around the neck, child wets the pillow during sleep and catches cold during cold rainy season and feels very chilly specially palms and feet are icy cold. Nose feel dry and stuffy with tiny blister like ulcers in nasal cavity, discharge from the nose is foul smelling, yellowish thick. There is dry troublesome cough especially at night with hoarseness of voice. Feels suffocated at night with tightness of chest.

Day Car Centres :- Some experts note that more young children are in day care, where respiratory infections are common, and a 1999 study found a direct link between attendance at day care centers and an increased risk of asthma later in childhood, with earlier infections playing an important role. It should be noted that some studies suggest that immunizations that reduce the incidence for early childhood diseases may affect the immune system and increase the risk for asthma. More research is needed to resolve these apparent contradictions.

Obesity: In both adults and children the incidence of obesity has been increasing in parallel with the rise in asthma over recent years. Studies report a strong association between the two conditions, but it is not clear if one causes the other. Some experts suggest that excess weight pressing on the lungs can cause a hyper-reactive response. Others believe that asthma itself results in low physical activity rates with subsequent weight gain.

Mental Health:- Research indicates that poor mental health of parents and children are significant predictors of more severe symptoms in childhood asthma.

WHAT ARE THE SYMPTOMS OF ASTHMA IN CHILDREN?

The primary symptoms of asthma are coughing, wheezing and shortness of breath (dyspnoea). In children with asthmatic symptoms, it is particularly important to first consider as a possible cause inhaled foreign objects such as peanuts, viral infections such as croup and bacterial infections, which may be accompanied by high fever and progress rapidly. Any child who has frequent coughing or respiratory infections should be checked for asthma.

Asthma is classified as mild when a child experiences one or two brief episodes weekly. In moderate asthma, the episodes occur more than twice weekly, and severe asthma is marked by continuous symptoms. Of great concern are studies reporting that people, including children, with life-threatening asthma, become insensitive to symptoms and may not recognise dangerous indicators. Asthma is usually worse at nigh, and attacks often occur between 2 and 4 a.m. Asthma occurs primarily at night in as many as 75% of asthma patients. This night time propensity is due to a number of reasons:-chemical and temperature changes in the body during the night increases the inflammation and narrowing of the airways, delayed allergic responses can occur from exposure to allergens during the day, and toward the early morning, the effect of inhaled medications may wear off and trigger an attack. Some evidence suggests that sleep itself may play a role in the worsening of asthma at night; further research is needed.

The classic symptoms of an asthma attack are coughing, wheezing, and shortness of breath (dyspnea). Wheezing when breathing out is virtually always present during an attack. Usually the attack begins with wheezing and rapid breathing and, as it becomes more severe, all breathing muscles become visibly active. Irritation of the nose and throat, thirst and the need to urinate are common symptoms and may occur before an asthma attack begins. Some people first experience chest tightness or pain or a non-productive cough that is not associated with wheezing. Chest pain, in fact, occurs in about three quarters of patients; it can be very severe and its intensity is unrelated to the severity of the asthma attack itself. The neck muscles may tighten and talking may become difficult or impossible. The end of an attack is often marked by a cough that produces a thick, stringy mucus. After an initial acute attack, inflammation persists for days to weeks, often without symptoms. (The inflammation itself must still be treated, however, because it usually causes relapse.)

Asthma symptoms vary in severity from occasional mild bouts of breathlessness to daily wheezing that persists despite taking large doses of medication. Without effective treatment during an attack, exhaustion may worsen respiratory function, and in rare cases, a life-threatening situation can occur. As the chest labours to bring enough air into the lungs, breathing often becomes shallow. Lacking sufficient oxygen, the skin becomes bluish, the flesh around the ribs of the chest appears to be sucked in, and the patient may begin to lose consciousness.

HOW SERIOUS IS ASTHMA IN CHILDREN

Severity of Acute Attacks

Asthma is the third major cause of hospitalization in children under 15. Asthma is especially serious in children, particularly those younger than five, because their airways are very narrow. These immature airways have less reserve for air exchange and respond as well as adults to bronchodilators (drugs that open the airways). Underestimating the severity of an acute attack poses the greatest threat to children with asthma. Unfortunately, one study of children found that nearly 40% of them were unaware of asthmatic symptoms when they occurred. Sadly, the hospitalization and fatality rates among children and young adults with asthma are on the rise; these figures almost doubled between 1980 and 1993. African American children have more than six times the death rate of Anglo-Americans in the age groups of four and under and 15 to 24 years. Factors associated with an increased risk of death from asthma in children include previous life threatening episodes of asthma in children include previous life threatening episodes of asthma, lack of adequate and ongoing care, and significant behavioural problems. Death in children from an asthma attack is, fortunately, still rare. In the US, about 500 children die each year out of an estimated 5,400 deaths from asthma; the elderly account for 90% of these deaths.

Long Term Outlook

Although bronchial responsiveness improves in many children when they reach adolescence, the improvement is usually not complete, and asthma may flare up again and remain a problem throughout adulthood. Half of asthmatic children achieve remission after age 16; in half of these, however, asthma flares up again in middle age. Children whose condition is serious enough to require steroids are less likely to outgrow their asthma than others. There is now some evidence that severe asthma can cause long lasting damage and possibly permanent scarring. Many experts urge introduction of anti-inflammatory medications early on in children with severe conditions. Children adapt well to living with asthma, however, and even with severe asthma they can function as well as healthy children in virtually all areas of life.

Readers are advised that the medical advice offered in this column pertains to generalised treatment of condition. Kindly consult your doctor before self-medication.