In a previous newsletter we have discussed the special features of asthma in the elderly. In this newsletter let us understand the peculiarities of asthma in children.

But before doing that, let me narrate to you my recent experience with a young asthmatic. This young boy, all of seven years, was brought to me for the first time. I was asking the parents about his symptoms. When our conversation had gone on for two minutes, this boy raised his right hand, much in the way you do it in school when you want to say something. And he said ” koi meri baat bhi sunega kyaa” ( will someone listen to me ? ). So I asked him to tell me his problem. He said ” mere andar se awazein aati hai ” I said “kaisi awazein ?” he said ” aisa lagta hai ki FM Radio kharaab ho gaya hai ”

A very vivid, apt and original description of wheeze !! That’s how original a child’s mind is.

So how is asthma in children different from the usual asthma ?

Let’s again see it from two perspectives : the patient’s and the doctor’s.

The Patient’s perspective:

• Denial : The label of “Asthma” is hard for the parents to accept. Part of the reason is that the parent’s notion of asthma is that of a acute or severe breathlessness. Asthmatic children have a lot of cough. Cough that is more in the morning or late at night, cough that is brought on by running or laughing or on exposure to strong smells is highly suggestive of asthma. Colds that become chesty or a cough that appears after a viral respiratory infection and don’t go away quickly are features of asthma.

Thus we see that the symptoms of asthma are different in children. The main symptom of asthma in children is cough while in adults it is breathlessness.

• Children cannot assess or explain their symptoms clearly. Therefore even if the child is finding breathing difficult he usually does not complain much.
• The mother of the asthmatic is usually very worried about the side effects of medications.
• About 50% of asthmatic kids outgrow their asthma. Adults outgrow asthma very rarely.

The Doctor’s perspective:

• Doing a lung function test (spirometry) or allergy testing by the skin prick method in a small child is not easy. Therefore the diagnosis of asthma in children is based on history taking and examination only.
• The fact that the child improves with asthma medication is taken as a sign that this is asthma – a practical method of diagnosis though scientifically not the best way.
• Teaching and ensuring that small children take the inhalers properly,so that the medicine goes all the way into the deepest air tubes, is not very easy for the doctor. He must work harder and with more patience with children.
• Rebellious teenagers with asthma pose special challenges.