Asthma

• Asthma is a condition caused by chronic allergic inflammation of the airways which affects up to 10-15% of children, with this number constantly on the rise.
• All asthma patients should undergo lung function screening for sign of airway obstruction to diagnose whether asthma is the true cause, or to analyze the severity of their condition.
• It is imperative that a person suffering from an asthma attack be taken to hospital to receive medical attention immediately because the effects of such an attack could have potentially life-threatening consequences.

Asthma is a condition that causes chronic allergic inflammation of the airways, which also includes both bronchial hyperresponsiveness, bronchospasms and narrowing of bronchial airways. It occurs due to the intermittent contraction of smooth muscles located in the airways, although patients may not suffer any feelings of breathlessness or abnormalities, meaning some can take part in daily activities like any others. Doctors who carry out standard health checks on symptomless patients may not be able to tell whether that patient has asthma or not, so they must instead undertake a thorough analysis of their medical history or use other screening tools if they want to accurately diagnose the condition.

• Genetics: If parents or siblings have asthma, children will have a higher chance of developing the disease.
• Environment: Environmental triggers include allergens such as house dust mites, dog or cat dander, cockroach and in-house cigarette smoking.

• A dry and frequent coughing with some clear white phlegm
• A wheezing sound when breathing esp. at the time of asthma attack
• Tightness in the chest
• Breathlessness, difficulty or rapid breathing

These symptoms are particularly more pronounced during the nights or early mornings, as well as when exercising or having respiratory infection.

Since patients with asthma have airways that are more hypersensitive than normal to triggers, when they are exposed to these triggers, their airways will tighten and contract, causing them to narrow. Patients will have coughing, and difficulty breathing or a wheezing sound.

Breathlessness, difficulty breathing and wheezing all occur as a result of the inflammation affecting the airways, which leads to blockages in the respiratory system that causes those airway muscles to contract frequently. The tissue beneath these airway passages becomes swelling with sticky mucus forming, resulting in reduced lung function efficiency which, in turn, causes asthmatic patients to feel more dyspnea much more quickly than other people.

In some cases, the difficulty breathing and wheezing may resolve spontaneously or improve with medication esp. bronchodilators. In cases of severe bronchial constriction, the patient will experience far more intense symptoms, which require hospitalization or emergency room treatment, as the very severe airflow limitation, inability to breath and lack of oxygen can be fatal if left untreated.

Two out of every 3 asthmatic children also suffer from other allergic conditions and, when these children experience symptoms associated with the nasal passage, leading to an increase in their symptoms of breathlessness. However, if nasal symptoms can be managed effectively, it can result in a reduction of the breathing difficulties caused by their asthma.

• Allergens, such as dust mites, cat and dog fur, cockroaches and pollen.
• Respiratory tract infections
• Changes in weather, such as cold or extremely dry air
• Exercise or intense laughter
• Frequent mood changes or stress
• Consuming medications, such as aspirin, NSAIDs and beta-blockers for treating high blood pressure

Asthma is a condition that is continuously on the rise, especially in young children who are likely to experience coughing, difficulty breathing, wheezing and a tightness in the chest. Doctors depend on detailed medical histories when making a diagnosis, as well as a full body check-up, allergy tests and lung function screening. Such screening involves the use of a spirometry device, while a similar screening can be performed with a peak flow meter. Whichever of the aforementioned techniques are used, patients are required to be fully cooperative, therefore, these methods are usually only used for children aged over 6 years. However, the ever increasing rates of asthma occurrences in early childhood mean that the limitations placed on diagnosis by spirometry or peak flow meter testing have necessitated the following forms of screening to be developed:

1. Forced oscillation technique (FOT) Spirometry

This is a form of lung function screening that assesses the resistance strength of the airways as it has been found that asthmatic patients have a higher upper and lower airways resistance than other healthy individuals. The test can be performed by letting the child to inhale regularly before exhaling with tidal breathing into a special device. The test takes a mere 20 seconds per cycle, making it both simple and convenient. Hence, this form of screening has begun to be used on children aged 3 years and above as the data gleaned from such a test can support an initial diagnosis for children suspected of being asthma.

1. Fractional concentration of exhaled nitric oxide screening

This device offers analysis of exhaled nitric oxide levels in children or adults. It enables doctors to analyze the extent of airway inflammation as there will be a heightened nitric oxide reading in exhaled air from allergic and asthmatic patients. This method can be used to support early childhood asthma diagnoses and is a useful tool for monitoring the condition after treating with asthmatic medication esp. inhaled corticosteroids. Thus, fractional concentration of exhaled nitric oxide screening is a simple and convenient tool, which is suitable for children aged 3 years and above.

• The doctor will discuss the medical history such as any coughing, shortness of breath or wheezing, and whether these symptoms come and go or whether they include a more severe or chronic cough, especially at night or accompanying respiratory infection.
• Physical examination to hear breathing sound, check stiffness of the airway or check wheezing sound from both lungs.
• Laboratory:
  • Allergy testing: This test should be carried out as some patients may be sensitized and allergic to some allergens as the precipitating causes of asthma in the patients, therefore, all sensitized allergens can be avoided.
  • Spirometry is used for children aged 6 years and older to measure volume and speed of airflow. If there is airway stiffness, the exhale speed will be reduced. In the case that there is any respiratory obstruction or airway constriction, a bronchodilator inhaler will be administered to the patient with the exhale speed checked. If the reading shows a 12% improvement, a patient will be diagnosed with asthma.

(All asthma patients should undergo spirometry testing in order to determine whether they indeed have an asthma or not, and if so, the level of its severity will be identified)

– Peak Flow Meter is used as a simple lung function test that patients can perform at home to measure how well they can push out the air. It helps as a quick assessment the severity of asthma.

– Bronchial Provocation Test is a procedure to determine airway sensitivity. This method is used for patients who have suffered from asthma but the lung function tests shows normal.

To begin this test, the patient undergoes a Spirometry Test, and then inhales a stimulant, such as Methacholine. Repeating the Spirometry if it has not dropped by 20%, the patient will be given a stepping higher dose of Methacholine. The test is repeated until the reading drops by 20%. The doctor will interpret with a graph.

– Additional investigations such as a chest x-ray can be used to rule out other diseases that have similar symptoms as the asthma.

Back in those days, people used to perceive asthma as not treatable because the cause of the sensitivity of the airways to the allergens were not known so the treatment only included giving bronchodilator medications.

However, there have recently been huge developments in what we now know about asthma, and these have meant that the treatments available now are more effective than ever, resulting in asthmatics being able to lead completely normal lives. Such treatments are outlined below:

1. Both patients and their caregivers must have a proper knowledge and understanding of asthma and asthma medication, and must cooperate with the physician in the treatment process.
2. Patients must avoid asthma stimulants and triggers, particularly allergens, house dust mites, pet dander and in-household tobacco smoking.
3. Patients must understand the asthma assessment, and that lung function tests are an important part of continued assessment. If patients have a Peak Flow Meter at home, they can better evaluate and track their condition.
4. There are 2 types of asthma medications:

• Controllers are medications that must be used regularly to control the disease, even when no symptoms are present. Inhaled corticosteroids is the main type of medication used specifically to treat asthma, and these are also known to be the safest form of medication due to the very low dosage used. They may, however, have some side effects, such as hoarseness and a sore throat or even thrush or yeast infection in the mouth, which is preventable by rinsing the mouth out with clean water or saline solution after every spray. However, the side effects associated with growth are minimal due to the small amounts of medication used, as well as the use of the spray method of introduction into the airways, rather than through oral or injected routes.
• Reliever drugs are only suitable when symptoms of breathlessness present themselves, with the potential side effects of such medication being palpitations and trembling hands.

Inhalers are the best option because they focus on the affected area, is highly effective in small doses, meaning that there are much fewer side effects than for orally administered medication. Currently, said inhalers are the main form of asthma treatment being used.

Treatments for infant asthma cases as recognized by JCI USA from 2012 onwards

Samitivej Hospital has been receiving continuous accreditation by the CCPC Childhood Asthma Program under the guidance of the Joint Commission International (JCI), U.S.A. for the past 7 years, parents can be confident in the quality of our highly specialized care, which we provide to every one of our asthmatic children. That care extends to our complete range of medical professionals, including pediatricians specializing in asthma and allergies, who work alongside expert pediatricians in the field of respiratory disease to create the most effective individualized treatment plans.

Moreover, during the 3^rd trimester, from July to September, in each of those 7 years, Samitivej Children’s Hospital has organized an “Asthma Camp” which welcomes families and anyone interested in the progress of our asthma patients to join in with the activities. The Asthma Camp includes lessons, the latest treatment news, and potentially dangerous environments to avoid, as well as a self-care workshop on how best to use medicated inhalers, with advice on managing and training the lungs also available. All of this is used to reinforce treatment behaviors and provide additional training for those with asthma on how to protect themselves against asthma attacks, including using the latest technology designed to treat and monitor childhood asthma cases, such as:

1. The Asthma E-Care program: Asthma E-Care is a software developed to help treat asthma patients, which patients are able to log in to through this website

They can then access their treatment schedules to check for any doctor appointments, including when their medication should be taken. There is also a space to record when they have used their inhaler and a place to put the results of any peak flow meter tests carried out at home. The patient’s doctors also have 24-hour access to these records and video clips instructing patients how to get the most out of their inhalers are also available. All of this is designed to increase treatment planning efficiency during consultations, while some doctors may also use the portal to ask their patients important questions about their management of the condition, in order to ensure that they are using the medicine as advised, and that are not missing any important doses, all of which will increase the overall efficiency of the treatment process. The rights to this service are exclusively reserved for Samitivej Hospital childhood asthma patients.

2. Our nebulization room has been created as an exclusive space in which our childhood asthma patients can receive their inhalant medication. The nebulization room has been designed with children in mind and includes a colorful cartoon character-based interior to ensure a child-friendly atmosphere. We hope that this room will reduce any fear or anxiety the children may feel about visiting hospitals, as well as enabling the utmost efficiency in terms of the provision of inhalant medication.

Aside from the nebulization chamber, our specially designed treatment room consists of another 2 fascinating tools to assess asthma severity:

• A fractional concentration of exhaled nitric oxide assessment device
• Forced oscillation technique (FOT) spirometry

3. The AR application is a game about asthma and allergies designed for children and their parents to play. It is a fun and exciting way to learn about these conditions through play.