Reaching Equilibrium With Asthma

Jan Hofmann is a regular contributor to Orange County Life

Take a deep breath in. Don't let it out.

Now take another breath in. Don't let it out. Breathe in again--but not out. Can you breathe in one more time? Probably not.

That's how it feels to have asthma, explained Mary Lanuti, a nurse and respiratory therapist, at the American Lung Assn. of Orange County's "Parent Seminar on Childhood Asthma" Saturday. "The problem isn't that you can't get any more air in," she said. "The problem is, you can't get it out."

That's because during an asthma attack, the multitude of tiny, balloon-like air sacs of the lungs fill with air, as they do in normal breathing. But then, before the air can come back out, the lung muscles tighten down, constricting passages and trapping the air inside, Lanuti said. Meanwhile, the inner linings of the breathing passages swell, further cutting off the flow of air. And those swollen walls secrete mucus, which adds to the problem by clogging airways.

"The tissue becomes like skin scratched with sandpaper," said Dr. Jeremy E. Kaslow, a South County allergist. With breathing restricted, asthmatics typically begin to wheeze, cough and gasp for air, he said.

Some of those in the audience knew firsthand what asthma feels like. Others understood nearly as well, having dealt with their children's asthma. And because the problem tends to be hereditary, a few participants fell into both categories.

The lung association estimates that 9.6 million Americans suffer from asthma. About a third of that number are children, and asthma is one of the leading serious chronic diseases of children under 18, the cause of more hospitalizations than any other chronic disease.

And asthma accounts for one-fourth of the days missed by schoolchildren, according to Dr. Charles E. Groncy, a Fullerton allergist who also spoke at the seminar.

Although medical science is making progress against many diseases, asthma is stubborn. The number of deaths and hospitalizations caused by asthma is going up, not down, and doctors aren't sure why.

Fortunately, asthma is treatable, and its episodes are often preventable, which means asthmatics and their families can often reach a workable equilibrium with the disease.

Twenty years ago, asthma was considered an emotional more than a physical disorder, Groncy said. Now, however, it is recognized as purely a physical condition--a form of chronic lung disease--for which emotional excitement can be only one of many triggers. Other triggers include reactions to allergens (such as pollens, feathers, molds, animals, foods and dust), vigorous exercise, infections, drugs, cold air, and dust and vapors from household products, air pollution, cigarette smoke and other sources.

Although asthma can be outgrown in some cases, even those who no longer have attacks are still vulnerable to relapses, the doctors said. Asthma can also appear at any age, as Dr. Mark H. Ellis, an Irvine allergist, can attest: He developed asthma himself as an adult, after he was already treating the disease in children.

"Asthma affects everybody in the household," said Dr. Frank Carden, a pediatric psychologist at Childrens Hospital of Orange County. "The family is affected financially because the child keeps getting sick and they're constantly having to go to the doctor. There's a constant search for somebody who can solve the child's problem, and that gets expensive, even if you have insurance. You get relatives who say, 'Why don't you find somebody who can take care of it?' And when you finally get the diagnosis of asthma, it can tear apart your whole life. You have to replace the furnace and install air conditioning and take up the carpet and look out for the dust, and you can't go on vacations like you used to.

"The mother is usually the primary caretaker, and she may have to quit her job because of the child's illness. They have no social life because they can't find a baby-sitter who can deal with the asthma. Communication breaks down because Dad's working more to make up for Mom's lost income. And the child may be waking up at night with problems, which means the whole family sleeps less. People can get emotionally drained from all this."

The best way to deal with the emotional problems caused by asthma is to normalize things as much as possible, Carden said. "Go on those vacations. Let the kids get involved in activities. Work with the school to minimize problems. And if you feel you need help, talk to a psychologist."

Other advice for dealing with childhood asthma:

* Prevent asthma in infancy and early childhood by breast feeding and delaying the introduction of solid foods until eight or nine months, and then introduce only one new food at a time. "Mothers should also avoid foods that cause allergies while they are breast feeding," Groncy said.

* Reduce the child's exposure to cigarette smoke.

* Some asthmatics do better in dry areas, while others react better to living near the beach.

* Keep the thermostat up to 70 or higher if an asthmatic child reacts badly to cold air at night.

* Dust the child's room twice a day if possible.

* Become familiar with at least one name in each category of asthma medicine and learn which types of medicine are used to treat which symptoms, Ellis said. "Preventive medicines aren't usually best for acute attacks," he said.

* Don't be afraid to call the doctor if you're concerned, but first, take the child's temperature, get a peak flow reading if you have a meter and the child is old enough to use one, and be ready to tell the doctor what medicines the child is taking. Also have the name and phone number of your pharmacy ready in case the doctor needs to call in a prescription, Ellis said.

* Learn (and teach your child) abdominal breathing, in which you expand the chest cavity by pushing down the diaphragm. This can help reduce the severity of an attack by increasing lung capacity. Push the diaphragm down, filling the bottom of the lungs first, and take twice as long to exhale as to inhale, blowing out slowly through pursed lips. Get the child to blow soap bubbles, concentrating on blowing the largest bubble possible. This will help the child learn to exhale slowly.

For information on asthma or FACES, call (714) 835-5864 (835-LUNG).

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