Asthma Mythbusting

asthma inhalers
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Publish date

23rd July 2022

Author

Dr. Kate McCann

Asthma Mythbusting!

  1. “If the child isn’t wheezing, it’s not asthma”. Asthma isn’t always wheezing and your doctor may not use the word asthma! Asthma can look like cough, wheezing, chest tightness or pain, and/or difficulty breathing,  Very young children may have these symptoms but often the diagnosis of asthma isn’t used in early years.
  2. “There are good alternatives to inhalers/medication for asthma.” Asthma is a popular target for pseudoscience marketing.  None of these have a role in asthma:  Salt lamps/therapy***,any allergy test for “triggers” that involves hair, IgG, or posting anything away, any manipulative therapies to adjust/re-align, homeopathy, and restrictive diets.  The only recognised qualification to advise on dietary restrictions in Ireland is an INDI/CORU registered dietitian.
  3. “That’s not an “asthma attack”?  The term “asthma attack” is somewhat confusing because it does not distinguish between a mild increase in symptoms and a life-threatening episode.
  4. “The goal is to get your child off inhalers.”   The goal is to keep your child’s asthma controlled so they can breathe, sleep, and play comfortably. Prescribed medications, used as directed, are safe for children. Uncontrolled asthma is not safe.
  5. “It’s just asthma.”  Asthma can be serious and uncontrolled asthma can be very serious in both adults and children.
  6. “My GP won’t see my child for 2 weeks for asthma.” Your GP secretary can’t find a slot?  Make sure they understand it’s not just a routine appointment for a cough but clearly state the reason for the appointment is “uncontrolled asthma in a child.”  The practice will almost always either find you an urgent appointment, re-direct you to ED or CHI urgent care.
  7. “Social media groups are good advice for asthma.” Sometimes, but crowd sourcing health advice – or diagnosis of asthma – from social media comments shouldn’t be your first choice.  Try https://www.asthma.ie/home for excellent trusted advice.
  8. “You can’t do anything about asthma” Asthma control is 3 parts: Controlling and avoiding asthma triggers 2. Regularly monitoring asthma symptoms (and sometimes peak flow) 3. Understanding how/when to use medications to treat asthma
  9. “You just need to get rid of what is causing the asthma.” Sometimes, yes.  Cigarette smoking, for example, should not be in, near, or around the home of a child with asthma. Other triggers can’t be avoided such as genetics, weather, pollen, or exercise/vigorous play.
  10. “GP gave me and inhaler so they can’t do any more.” I actually hear this from my adult patients!  Asthma control can be tricky and docs can always do more for asthma. Uncontrolled asthma is not safe – so we really want to.  There can always be adjustments to inhalers, tablets such as Singulair, nebulizers, steroids.  It may take a few visits to get good control – don’t be afraid to ask for another appointment.

Bonus:  “Inhalers just don’t work.”  See 10.  The other likely cause is poor technique – it’s tricky!  Your GP practice nurse or chemist can be good resources to help with this. Many children use spacer devices (we have ones with panda bears.)

***https://emdoc.ie/2022/03/15/the-pseudoscience-behind-salt-therapy/

Read more from the reader’s archived questions on asthma:

Uncontrolled asthma is dangerous. Get your child assessed and re-assessed until under control.

“my 5 year old boy has had chest problems for a number of years, he gets reacurring chest infections, croup, and has in past couple of years been diagnosed with asthma, in particular the past few weeks has been bad, more so at night, he has a chesty cough but gets so bad at night he starts to vomit, he hasn’t or myself been getting much sleep, doc has him on steroids and antibiotics and antihistamine and inhalers have been upped, this is his second course in the past 3 to 4 weeks, after his first course it improved but returned again a few days after, where should I go from here?”

When it comes to asthma control, we have 2 break it into two parts: 1) Immediate control of current symptoms and 2) addressing risk factors to reduce attacks long term. The first is always takes priority.

When a child is having an “attack” or an exacerbation of asthma, the asthma is not controlled. Here is a common list of questions to assess control:

  • Has asthma awakened your child at night or in the early morning?
    ●How often are using rescue inhaler to relieve symptoms of cough, shortness of breath, or chest tightness?
    ●Have you needed any unscheduled care for your asthma, including GP or ED?
    ●Has child been able to participate in school and play as desired?
    ●If measuring your peak flow, has it been lower?
    ●Any side effects from asthma medications?

Signs that your child has an attack that needs medical attention: Wheeze, uncontrolled cough in an asthmatic, visibly using chest muscles to breathe, so breathless that s/he can’t complete a sentence, no improvement with blue/rescue inhaler, any distress.

Uncontrolled asthma is dangerous. I can’t state this enough. Do not wait to work on eliminating triggers (or to get the number for the man with the “cure”.) Ring GP and state that as reason for needing assessment. If s/he truly can’t see you, s/he may recommend ED assessment. Do it. It’s that important.

No matter how many steroids or inhalers or nebulizer or antibiotics your child is on, if they can’t breathe properly, get him/her re-assessed.

So, second point: Long-term, look for eliminating triggers that can cause attacks/exacerbations. This is long journey. And if you want to take your child for “the cure”, it goes here.
●Commonest triggers include weather, pollen, season, and viruses. Can’t do much there.
●Post-nasal drip can definitely contribute; worth following up on in the case above. But won’t make immediate impact.
●Eliminate all smoking from family home (not just “around the child”), Exposure to secondhand cigarette smoke is the single most common external risk factor for the development and progression of asthma symptoms in children. Full stop.
● Stress
●Asthma symptoms that occur after prolonged time indoors in periods of inclement weather should raise a suspicion of sensitivity to indoor exposures to allergens (Happy Hunting, Mammies!) : Nitrogen dioxide (from gas stoves),Particulates and smoke from wood fires, pellet stoves, or kerosene space heaters, Propellant cleaning sprays,Perfumes, hair sprays,Paint,Room deodorizers,Cleaning products with strong odors, cockroaches, any furry animals. Big one: Mold and the housedust mite. Clean those rooms. Experienced asthma-mammies here might want to give some advice about cleaning removing common dust-traps from asthmatic child rooms/house.

A child with wheezing always needs prompt GP assessment. 

“I have few questions about child wheezing. Wheezing always means asthma? We all in the house have cold virus and my daughter now caughing with dry cough and have weezing. sshe is 9 years old. How doctor can say its asthma wheezing or just virus? Last year she had same cold , cough and wheezing and doctor told me its asthma, but cough and wheezing gone after week. so im confused now and dont know what to do?”

Always bring a child with wheezing to a doctor. Whether or not they are diagnosed with asthma. Just because it isn’t “asthma” or is “just a virus”, they can still get into trouble.

Let’s talk virus-associated wheezing.

Virus-induced wheezing is common in the first few months to years of life. 30% of children younger than two years of age will have wheezing with viruses, flus, and colds. This worst between age two and six months.

Typically, babies present with classic cold symptoms that progress to coughing, wheezing, and, occasionally, trouble breathing over a period of three to five days. It settles gradually over approximately two weeks. These episodes can be treated bronchodilators (inhalers) and steroids. Do not give cough bottles or antihistamines unless directed by your GP.

The child is then symptom-free. But in 50% of those babies, the wheezing comes back with next virus illness. Most of these young children will stop having virus-induced wheezing after age 3, some will go on to develop asthma.

Never underestimate asthma/potential asthma in a child. If your GP thinks your child needs an inhaler, NEVER stop an inhaler without talking to your GP.

“Hi this is very long winded but looking for an opinion on inhaler use. my son of 2years 5 months who has only been sick once before now was in A&E 5 weeks ago with a cough and a [wheeze] that just appeared over night. He was given 2 antibiotics, a steroid and an inhaler(if wheeze came back). This week I brought him back to the gp as he had a chesty cough and runny nose. He said he had allergic rhinitis which was causing him to have airway and chest problems. He priscribed the same as what he got from A&E four weeks previous. He advised I give him the inhaler every night long term and an antihistamine. I have been giving him honey which seems to really help and I have a steamer in his room for a few hours at night and also a salt lamp.
My question is do you feel the inhaler is really nessasary? He can have a terrible runny nose throughout the year but I always put it down to teeth as it never developed into anything more till now. He drinks a lot of milk too, should I reduce his milk intake? He has a slight bit of excema on his shoulders too.”

My opinion here is going to be very strong: Never underestimate asthma/potential asthma in a child. If your GP thinks your child needs an inhaler, NEVER stop an inhaler without talking to your GP.

If you are an experienced asthma mammy who is comfortable with step-up and step-down regimes that you and the GP or asthma nurse have worked out, that is one thing. Otherwise, always see your GP to have your child re-assessed before stopping or changing inhaler treatment.

Asthma, allergy, and eczema commonly go together. Work with you GP to manage all three.

Do not stop giving your toddler milk, unless advised to by your GP and under guidance of a INDI-certified dietician (not a nutritionist!) as your child will need dietary management as milk is so critical to toddler nutritional needs and development. The old wives’ tale about milk increasing mucus production in colds/etc. – False. It has been studied; it doesn’t actually work. If it makes you, as an adult, feel better to avoid dairy for 2-3 days during a cold, no problem. But don’t withhold it from young children.

Honey and steam are soothing and relieving for symptoms of a viral cough and simple cold. It does not and cannot treat wheeze, asthma, or difficulty breathing. Salt lamps are a current health fad, though popular at moment, have failed studies to prove they work. In fact, in other countries, there are laws/restrictions against claiming salt lamps/caves treat or prevent any disease.

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