ASTHMA & ALLERGIES in children ( Scientific practices)

Asthma prevalence is increasing world over .The mortality has reduced to some extent though the morbidity has not, in spite of wonderful scientific advances. It is possible to prevent the mortality and keep the disease under control making the lifestyle comfortable provided people follow the treatment and avoid the myths.
There is nothing the Asthmatics can miss out on provided they keep their disease under control by scientific practices.The Asthmatics winning gold even in Olympics is on record .In spite of this several children keep suffering mainly due to myths prevalent even amongst doctor parents.
Many doctor couples bring their little ones to me who are on several antibiotics , cough syrups , antihistaminics and off and on on steroids for the chronic cough of several months duration. Children had several Xrays , CT scans and lab reports of all kinds. some of them are also halfheartedly empirically been treated for TB.
I explain to them that there is an entity called Cough variant Asthma and child needs inhalers to manage that and not antibiotics etc etc..
In spite of being doctors it is difficult to convince them. They are not ready to accept the label ASTHMA "just for chronic cough".They are not ready to accept everyday use of inhalers.They are not willing to accept that cough syrups are not needed and even unnecessary vitamins etc are a burden on the system.
It is not surprising at all that after the cough disappears the parents are each day worried about stopping the inhalers.The fears are two , child will become addicted to inhalers and these are steroids.I pull out scientific literature to show to the parents that inhalers even though they were steroids they were safe even in long term use.They would not retard growth. In fact the disease free state would result in better growth and development and also proper puberty.
They are not ready to give the child cold water ,more fluids and even curd , banana , rice , oranges, lime and , chocolates freely. I have to again convince the parents that there is no doubt that FOOD ALLERGY can be there but there is no general rule to avoid definite food for all asthmatics. If at all there is a doubt tests are possible. They immediately jump to give the blood sample.
It was again difficult to convince them that Allergy tests need not be a battery of standard tests for everyone.Which test to apply and what to test would depend upon detailed history by a qualified doctor.
Their next request is to ask for a certificate so that child could be excused PT and Games as the grounds are dusty.I had to convince them hard that Exercise is to be encouraged . Another couple asked for a certificate so that bus could come to their doorstep so that child did not exert to walk up to the bus stop. Another couple had made the child swallow the entire book of pharmacology.
How difficult it was to convince them that different salts meant for Asthma, treatment are meant for different stages of Asthma and they may do more harm than good.
Some children are forced into advanced breathing exercises in the name of Yoga , which results into exercise induced Asthma attacks. Yoga is undoubtedly beneficial for healthy people and useful in Asthmatics as an adjunct to pharmacotherapy and should be done under supervision.
Asthma can manifest in many ways and even chronic cough can be due to Asthma , at the same time all that wheezes may not be asthma. Therefore expert advise is needed.
Detailed history and clinical examination by expert clinches the diagnosis and not the blood sent to some lab for allergy tests.
Once diagnosed treatment is simple and aims at making patient independent and to have good quality of life.Inhalers are the cornerstone of Asthma management.
They are needed as long term management.
The rescue inhalers are for emergencies only , and can be guided by simple measurement by peakflowmeter.Preventive inhalers are needed even when you feel you are alright. Inhalers are state of art research molecules which do not retard growth even on long term use. Stopping the inhaler at your own will can be harmful.
Pushing oneself into emergency and using nebulisers again and again is really harmfulInhaler is the surest and safest device foe drug delivery into the airway , but salts needed are different for different purposes.
The steroids in inhalers are the state of art molecules of research which give benefits without side effects.Leukotrein inhibitors , antihistamines and mast cell stabilisers are needed only for specific situations. every medicine is needed by every patient.
Allergy tests are needed only for difficult asthmatics , occupational Asthmatics , seasonal Asthmatics where immunotherapy is planned and also for patients in whom food allergy is suspected.
Tests are never useful if done by remote , just by sending blood sample to a particular lab. This causes more confusion and have to be discouraged.
obsession of avoiding dust and white food articles , and many more compulsions result in personality disorders in children besides resulting in nutrition deprivation.Frequent monitoring is needed.
Parents must not be anxious to stop the inhalers. Parents must not focus on stopping food based on myths for growing children.If at all food has to be avoided it must only be after Allergy to food is proven by Double blind placebo controlled food challenge rather than just by blood test.
Its heartening to see children achieve full growth , puberty ,excellence in academics, music and sports if they follow the scientific treatment for Asthma. and keep away from myths.