Understanding Asthma
What you need to know to curb your child’s
attacks.
By O.P. Jaggi, M.D., Ph.D.
PARENTGUIDE News April 2006
Asthma, generally speaking, manifests itself
in the form of a cough, wheeze and breathlessness.
Attacks may be mild or severe, short or long,
rare or frequent, and may come on as seasons
change or persist throughout the year. In
children, asthma usually presents itself as
a recurrent cough that occurs over weeks or
a season, and often worsens at night.
Some children are inherently susceptible to
allergic reactions such as asthma and sneezing
attacks. In their blood, they have an excess
of the protein immunoglobulin E (IgE). This
excess IgE reacts with an allergen that enters
the body as the child breathes in air. A reaction
occurs between IgE and the allergen, which
liberates chemicals that produce allergic
symptoms.
The excess IgE is an inherent process, but
the entry of an allergen is an environmental
phenomenon. If we can minimize the entry of
allergens in the body, we can minimize the
allergic reaction, as well as the allergic
disease. This can also be done with asthma.
Described below are characteristics of the
allergens that can cause asthmatic symptoms.
Read on to learn how to prevent their entry
in the body.
Pollens: Pollens are visible as fine, powdery,
yellowish substances that fall off flowering
plants. The pollens suspected of causing allergic
reactions are extremely light, float in the
air and are carried over long distances by
the wind. They come off certain trees, grasses
and weeds. The pollens of common garden flowers
such as roses and marigolds do not cause asthma,
as their pollens are heavy, large and sticky
and therefore do not float in the air.
The pollen level in the patient’s environment
can be controlled by keeping the doors and
windows of the house and car shut. Also, a
patient with a pollen allergy should generally
not go outdoors very early in the morning
when flowers are pollinating. Alternatively,
an ordinary face mask may be worn by the patient.
House Dust: House dust is one of the common
house allergens. It is produced indoors by
the breakdown of animal and plant material
present in the house. The allergenic agent
in the house dust is a specific mite that
subsists on this dust. The mite floats in
the air, is less than one millimeter in size
and can be seen only through a microscope.
It lives primarily in mattresses, but also
breeds in carpets and upholstered furniture.
The warm temperature of mattresses, especially
when a person sleeps on them, is ideal for
the mite’s growth. Waste products in
the form of minute pellets are excreted by
these mites; these are the main substances
to which allergic people react.
The most important area for dust control is
the bedroom, which is usually the child’s
most frequented room. Students sometimes report
fewer symptoms of asthma when they stay at
youth hostels or dorms. House dust in hostel
and dorm rooms usually has a lower concentration
of mites because of the austere nature of
the furnishings. Scanty furnishings also allow
for better and easier daily cleaning—
these are important things to consider when
planning an asthmatic child’s room.
Fungal Spores: Spores of different fungi present
in the air are the common indoor and outdoor
causes of allergies. Like pollens, these spores
are readily carried in the air for miles together,
as they are light and minute in size. The
peak periods for fungal spore concentration
are from September to November and February
to April. In the rainy season, the spore concentration
is low because the fungal spores are washed
down by the rain. The warm and humid environment
inside rooms and storage places is ideal for
fungal spore growth.
To limit mold growth in homes, walls should
be plastered and painted so that they remain
dry. All rooms and places inside the house
should have effective ventilation. Basements
should not be used for food storage.
Those who are allergic to fungi should avoid
manure heaps and places where greenery decays,
such as home gardens. Fields and areas where
grain is grown, processed or stored also have
a large number of spores of fungi, and should
therefore be avoided.
In hot climates, installing air-conditioners
reduces the amount of mold allergen in the
air by filtering it out and reducing humidity.
Domestic Pets: Pets like cats and dogs are
also common causes of allergies within the
house. The allergens themselves are found
in the animal’s skin flakes (danders)
as well as in their hair, saliva and urine.
These flakes become distributed throughout
the home where pets live. Due to the sticky
nature of the flakes, these allergens are
sometimes transported on people’s clothing.
This can be a real problem for allergy sufferers
when they are visited by their pet-loving
friends.
Dog allergies are less common, but
the source of the allergen is the same as
with cats. Because saliva is one of the most
important sources of the allergen, a dog’s
lick may set off a severe attack. Children
should avoid the offending pet in their house
and also the animals in the houses of other
people they visit.
Cockroaches: Cockroach infestation and allergy
is a common problem in many countries, including
the United States. These insects are usually
found around the kitchen sink, draining board,
cupboards, cabinet cracks and crevices. They
are found where food is available, either
in food-storage areas or around dust bins.
The source of a cockroach allergen
is probably the digestive enzymes present
in their fecal particles. It is difficult
to completely avoid cockroach infestation;
yet, it can be minimized by keeping food well-covered
and by washing and cleaning dust bins each
night.
Some Foods: Cow’s milk sometimes acts
as an allergen in infancy. To reduce the possibility
of developing a milk allergy, infants should
be breast-fed as long as possible. Breast
feeding seems to delay the onset and reduce
the severity of early wheezing.
Next to milk, wheat is the second most common
food allergen, and egg whites, raw eggs and
even the smell of an egg can cause a severe
allergic reaction. Fish and other seafood
are also potent allergic agents.
The importance of controlling the presence
of food allergens in the air is often underestimated.
Simple steps taken to eliminate these allergens
from the environment in and around the house
show encouraging results.
Contributing Factors: Besides allergens that
trigger allergic reactions, there are other
environmental factors that increase asthmatic
symptoms, such as respiratory viral infections,
air pollution by vehicular traffic, smoking
cigarettes or exposure to cigarette smoke,
physical exercise and emotional stress.
Respiratory viral infections are among the
most prevalent sources of asthmatic symptoms.
At times, these infections make an allergy-prone
child more susceptible to attacks from other
elements in the environment. Vehicular pollution
of air and cigarette smoke, for example, aggravate
the symptoms of the disease and damage the
lungs.
Some children display symptoms of asthma after
doing physical exercise. There is no reason
for them to avoid physical exercise or sports.
They should, however, understand their limitation
and take proper medication. Many athletes,
including track and field star Jackie Joyner-Kersee,
have asthma and have won world-class competitions
and even Olympic gold medals.
Be mindful that mental tension and asthma
are interlinked in many ways. A tense situation
can trigger an attack in a child with an asthmatic
tendency. Fear of an attack can itself trigger
an attack.
Diet and Daily Routine: An asthmatic child’s
diet should be light, nutritious and well-balanced.
It should not contain any items that the child
is allergic to. Spicy, heavy meals composed
of fatty and fried food should be avoided,
and so should very cold drinks, chutneys and
pickles, which can cause coughing. Parents
should make sure the child eats out as little
as possible and should encourage the child
to eat vegetables, fruits and soups.
Going to bed on a full stomach is likely
to aggravate symptoms of asthma. Ideally,
dinner should be eaten at least two hours
before bedtime. The child should be encouraged
to eat small, frequent meals.
A regular routine induces a feeling of well-being.
Children should get up at about the same time
each morning and go to bed at a regular hour,
not too late in the evening.
As much as possible, children should develop
the skills necessary for managing their health
problems independently. This helps them develop
a better control of their asthma. Also, by
taking greater responsibility for their own
disease, they begin to realize the importance
of their own behavior and lifestyle.
O. P. Jaggi, M.D., Ph.D., author of Positive
Options for Children with Asthma (Hunter House),
is a medical scientist whose deep commitment
to patient care for over 40 years has won
him wide recognition. He’s a founding
director of the Asthma, Chest and Allergy
Center in New Delhi, a fellow of The American
College of Allergy, Asthma and Immunology
and former dean of the Faculty of Medical
Sciences, University of Delhi, India.
