Family Health Guide

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Asthma: At the Doctor

Your appointment will begin with a physical examination. Along with listening to your child’s breathing, the doctor will want to ask you about your child’s symptoms, what triggers them and makes them worse, if any medications have been tried. He’ll also want to discuss your family history of allergies and asthma. Although asthma is the most common cause of episodic wheezing and cough, there are other conditions, many of them rare, that produce these symptoms. They include:

  • Cystic fibrosis: a hereditary disease that changes secretions in the body and often causes frequent lung infections in young children. Parents may first notice coughing and excessive mucus, which can turn into pneumonia.
  • Congenital heart disease: a problem with the heart’s structure, present at birth, that affects its ability to pump enough blood to supply oxygen throughout the body. Some times babies appear blue or have low pressure shortly after birth.
  • Foreign-body aspiration: i.e., inhaling an object such as a raisin or pebble
  • Tracheomalacia: a malformation of the windpipe that causes breathing difficulties, which get worse with coughing, crying or respiratory infections
  • Primary immunodeficiency: inherited disorders of the immune system that leave babies and children vulnerable to repeated infections, like pneumonia, strep and bronchitis

After the exam and family history, your doctor will test your child’s airway function (if she is old enough, usually around age 5), most often with a device called a spirometer. A spirometer measures how much air a child can exhale after a deep breath and how fast he can breathe out. Doctors may instead use a peak flow meter on younger children because it has a larger straw for them to blow into and is therefore easier for them to use. The test is scored based on averages for children of similar height and sex.

If your child is not sick or wheezing at the time of your appointment -- say it’s just a checkup, but you raise the issue -- and her lung function test is normal, your doctor may use a chemical irritant called methacholine to bring on mild constriction of the airways. The airways of asthmatic children will react more quickly and dramatically to this “challenge test.”

When a child’s lung function tests indicates breathing problems, a doctor may do a “reversibility” test by giving your child a dose of a medication that relaxes airways, like albuterol, in mist form using a nebulizer. In most cases, children with asthma see immediate improvement. If not, your doctor may want to test your child for other conditions that could be making her asthma worse, such as hay fever, sinus infection or reflux.

Once your child is diagnosed, your doctor will develop a treatment plan based on how severe your child’s asthma is and what triggers it. Levels of asthma severity are:

  • Mild intermittent: Mild symptoms up to two days a week and two nights a month.
  • Mild persistent: Symptoms more than twice a week, but no more than once in a single day.
  • Moderate persistent: Symptoms once a day and more than one night a week
  • Severe persistent: Symptoms throughout the day and on most days and frequently at night.

Your doctor may also refer you to one or more specialists, including pediatric allergists or pediatric pulmonologists.