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Asthma. I love asthma. No, not having asthma – treating asthma. I love learning about asthma. I love teaching about asthma. I’ve published articles in the Journal of Asthma. I once won an award about research on singing with asthma. I even got to present my research on asthma at a national conference. Now let me educate you a bit on asthma.
I like to describe the lungs as upside down trees, with bigger air tubes leading to smaller and smaller air tubes. These air tubes are surrounded by a thin layer of muscle. In asthma, this muscle gets really angry, really easily. Breathing in air that is too cold, or working too hard during exercise can irritate this muscle. A little common cold virus sneaking in and bopping around inside, or a pollen particle climbing along the tube can really annoy this muscle. When this muscle gets angry, annoyed, and irritated it tightens up. If the muscle gets angry enough, it starts sweating, and liquid builds up inside the tube. When a tube tightens up, the inside of the tube gets smaller. A smaller tube filled with liquid makes it more difficult for air to move through. This is what causes the difficulty breathing, and wheezing we experience with asthma.
Fortunately, (another reason why I love asthma!) we have excellent medications that can help. Inhaled albuterol surfs its way all the way down to that lung muscle and tells it to chill, relax, just take a deep breath (pun intended). The muscle often needs to be told a couple of times (a few puffs), but usually obeys albuterol and loosens up, making the airway tubes bigger again, which makes breathing easier. When using the inhaler directly into the mouth, the medicine is only able to reach the mouth. Albuterol has no idea how to communicate with the tongue and teeth, so eventually gives up and does not do its job. It needs to get all the way down into the lungs where it can work its therapeutic magic, and to do that it needs to be given with a spacer and mask.
Now we know how to stop the airways from constricting, but there is still liquid inside. That is where steroids, such as prednisone and dexamethasone, come in. These medications are a bit slow, and don’t work for a couple hours, but are great at cleaning up all that liquid inside the tubes. Usually, they take about 5 days to clear it all up.
Sometimes lung muscles are too sensitive, or it is impossible to stay away from the allergens that anger them, and they are constricting too often and too easily. These lung muscles need daily reminders to calm down. Inhaled steroids, such as Fluticasone and Budesonide, among others, can do this job. They only work little by little when taken every single day to help calm the muscles from tightening. They are considered daily preventative medications, and won’t work like albuterol does during an actual asthma attack.
If your child has a persistent night time cough, you may want to talk to their pediatrician about asthma. Coughing, feeling chest tightness and shortness of breath, and chest pain can be signs of an asthma attack, and you should give albuterol every 3-4 hours to help open up your child’s lungs. If this is not helping and symptoms persist, it is time to see the doctor. In a severe attack, you can see your child’s ribcage outlined when they breath – looks like the skin is sucking in between the ribs, and they will be breathing faster. If this is the case, you should give albuterol and head in to see your child’s doctor ASAP.
Now, maybe you still don’t get as excited about asthma as I do, but hopefully you understand a bit more about what is going on in a child’s lung during an asthma attack!
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