Barbara Stipe, MD
Pediatric Hospital Medicine
Chester County Hospital; West Chester, PA
Published: November 17, 2014
Your preschooler is coughing nonstop and seems to be having difficulty breathing. Their doctor reports they hear wheezing and suspects it is Reactive Airways Disease (RAD), a term used when Asthma is the possible diagnosis but not yet confirmed.
You're shocked because your child has never wheezed or had shortness of breath before and there's no family history of Asthma. So, what is happening with the lungs and what does this mean for your child?
The tubes that go to the lungs (called "airways") resemble an upside down tree with a big trunk, large branches and then smaller branches. These airways deliver the oxygen we breathe to the lungs then carry out the carbon dioxide waste product when we exhale. Normally when we're exposed to cold viruses, allergens, irritants, cold air or significant weather changes, we cough, clear our airways and that's that. However, for children with reactive airways, the body views those substances as foreign invaders and overreacts, sending in white blood cells to fight them which make mucus that clogs up the airways and irritates the lining, causing swelling that creates even more blockage. Breathing in, we may now have some difficulty bypassing the blockage, but it's even worse with breathing out as the lungs and airways compress to expel the carbon dioxide. Some air may then get trapped, clogging the airways even further and the cycle continues until treatment is given.
With Asthma, the body's reactions include:
- Wheezing (the noise heard when air squeezes through narrowed airways)
- Coughing (caused by airway spasm due to irritation)
- Shortness of breath or labored breathing (visible as skin pulling in at the center of the neck, between the ribs and/or below the ribcage)
Asthma treatment typically consists of different medications:
- Bronchodilators are "rescue" medicines (Albuterol - generic name - is the most common) usually delivered via a pump or a nebulizer machine to calm the spasm and relax the airways, allowing them to expand so air can pass through more freely. Improvement is usually immediate, especially if given at the first sign of wheezing, but the relief is often temporary as the medicine does not relieve the airway swelling or reverse the body's overreaction.
- Steroids (typically Prednisone, Prednisolone or Dexamethasone), usually delivered as a liquid, pill or injection, reduce the body's white blood cell overreaction so that the airway swelling gradually shrinks. Steroids cause no long-term side effects when given in short 5 to 7 days bursts to treat Asthma flares.
- Since Asthma attacks can't be prevented 100% of the time, "controller" medicines, effective at preventing daily symptoms and reducing the need for steroids, emergency room visits and hospitalizations, work by continuously keeping down airway swelling so the body reacts less severely to an Asthma trigger. These medications are safe and effective when taken in proper dosages, but they must be used every day to be therapeutic.
Avoidance of triggers helps prevent Asthma flares, especially keeping your child's environment smoke-free (the most beneficial thing you can do), but eliminating dust, strong chemicals and fumes, insect droppings, molds and in some cases, pets, may help too.
There is no cure for Asthma, but many children outgrow their body's overreaction by age six. While we can't reliably predict which children will outgrow it, evidence suggests that those without a strong Asthma family history and no personal history of eczema or allergies, and whose symptoms are triggered mainly by colds, have the best chance.
This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.
Related Information from Chester County Hospital: