Consultancy Corner: Challenges of pediatric asthma

Challenges while managing paediatric asthma are many. It is cough, especially nocturnal cough during sleep, which is the commonest symptom than wheeze. As the main symptom is not wheeze, parents always think the reason for cough is infection rather than a manifestation of asthma and this knowledge gap needs to be addressed. 

For most of the illnesses when doctors arrive at a diagnosis, they investigate and either rule in or rule out a particular condition. But in childhood asthma the diagnostic test is spirometry. It is technically difficult for the child to undergo the test, unlike an adult. Also, it is not available everywhere, not even in many metropolitan cities. 

Often, a child would have been suffering for months together with loss of school days, restriction of physical activity and poor quality of life before the parents approach a doctor. 

Most often, they don’t believe the doctor first. But once the doctor explains why it is nothing but childhood asthma, they are worried about the stigma attached to the diagnosis. After that, they are worried about the long term implications, food restriction, and the fear whether it will spread to others in the family and the financial implication it causes to the earning members of the family. With each passing day, as our economy develops, our pollution levels also increase. The number of vehicles on the road has increased dramatically and along with that, an increase in particulate matter from the exhaust. With a boom in apartment com plexes in metros without a comparable improvement in waste management, change in the lifestyle of people and increase in the number of smokers, environmental pollution increases adding on to factors affecting the health of the population, especially younger ones. 

People are not aware that indoor air pollution occurs even with daily activities of household. This includes the pollutants from gas stove especially if exhaust fans are not switched on or windows are not opened  every time deep frying happens or a dosa is made. Also, if any of the family members smoke inside the house, it leads to second hand (passive) smoking of all members especially kids in the household. Increasing use of air conditioners with closure of windows all through the day, room fresheners, usage of synthetic bedspreads, carpets on the floors and compressed wood furniture, all collectively add to indoor air pollution. 

However, growing awareness among parents with the widespread use of internet to get relief for ailments online brings the parents earlier to doctors. But the number of children with asthma is showing an increasing trend. 

I see an average of at least two new children with asthma in everyday practice. Parents of children whose asthma is brought under control bringing more parents whose children have asthma— the chain keeps on increasing. To offer children relief from the symptoms and allow them to enjoy their childhood like their peers gives immense satisfaction to all health care professionals dealing with children with asthma.