Asthma:
Asthma is a chronic lung disease characterized by inflammation and spasm of the airways. This causes breathing problems such as coughing, wheezing and shortness of breath. Asthma can be triggered by environmental factors, infections, allergies, exercise, temperature changes or other airway irritants.Asthma can result from environmental, chemical and infectious factors and may also be partially inherited.
The majority of children with asthma have allergies, such as allergies to mold, pollen, dust, dust mites, pet fur, feathers, rodents and cockroaches. Even exposure to low-grade allergens (allergens that do not cause significant allergic reactions) may increase the severity of the asthma. In addition, allergies may play a role in undiagnosed asthma cases.
Not all children with asthma, however, have allergies. They can have other asthma triggers.

Asthma Triggers:
Many things can cause asthma symptoms to start; these are called triggers. Every child's asthma triggers are different. Sometimes it can be difficult to figure out exactly what your child's asthma triggers are. Work with your child's doctor or nurse to identify your child's specific triggers. It is important to try to control your child's exposure to the triggers that make his or her asthma worse.
Irritants and allergies are the two main types of asthma triggers:

Irritants:
Irritants are substances that irritate the nose, throat, or airways. Common irritants include:

* Cigarette smoke
* Strong smells
* Colds or other respiratory illnesses
* Chemicals
* Air pollutants
* Weather conditions


Allergies:
Many children with asthma also have allergies, which can make asthma worse. With allergies, a child's immune system becomes sensitive to allergens, which can include:

* pollen
* pet dander
* dust mites
* mold and mildew
* cockroaches

These allergens can increase inflammation (swelling) in the airways and trigger asthma. With continued inflammation, the airways become even more sensitive to triggers.

Other triggers:

Exercise:
Exercise can trigger an asthma attack, often because of the inhaled cool and dry air. Long-term strenuous activities such as long distance running, are most likely to induce asthma. Swimming is the least likely.

Respiratory Infections and Sinusitis:
Infections can cause irritation of the airways, nose, throat, lungs, and sinuses, and worsens asthma.

Gastroesophageal Reflux:
GERD, characterized by persistent reflux of stomach acids, is also sometimes found in children with asthma. Symptoms may include heartburn, coughing, belching, or infants spitting up.

Sensitivity to Medications:
These medications may cause asthmatic attacks due to sensitivities or allergies:

* aspirin
* non-steroidal anti-inflammatory medications, such as ibuprofen, indomethacin, naproxen, Mefnamic acid (Ponstan)
* sulfites used as preservatives in food and beverage.

Emotional Anxiety and Nervous Stress:
Reactions from stress and anxiety are considered to be more of an effect than a cause. They can cause fatigue, which may affect the immune system and, in turn, increase either asthma symptoms or bring on an attack.

Symptoms:
Common asthma symptoms include:

* coughing (for some children coughing is the only symptom)
* shortness of breath
* tightness in the chest
* wheezing

Asthma symptoms indicate that an asthma episode is occurring. Action should be taken to treat these symptoms before they worsen.

Early warning signs of asthma:
Some early clues that asthma may be developing are:

* cough or breathing changes
* feeling tired
* difficulty sleeping
* less energy for exercise
* chin or throat itchiness
* lower peak flow numbers

Every person can have different symptoms, but do not ignore the early warning signs of asthma. Early warning signs are important to learn about and watch for so you know that an asthma episode may be developing.

Levels of asthma:
As determined by the National Institutes of Health (NIH), below is a guideline used by physicians to aid in determining the extent of asthma in your child. The guideline is classified as "steps," because each child may step up or step down to different levels at any time.
The steps are as follows:
Step 1 or mild intermittent asthma- Have symptoms less than two times a week with no problems in-between flare-ups and only has short flare-ups lasting up to a few hours or a few days. Nighttime symptoms occur less than two times a month.
Step 2 or mild persistent- Have symptoms more than two times a week, but no more than one time per day; activity levels can be affected by the flare-ups. Nighttime symptoms occur more than two times a month.
Step 3 or moderate persistent- Have symptoms every day, use rescue medication every day; activity levels may be affected by the flare-ups and have exacerbations greater than or equal to two times a week. Nighttime symptoms occur greater than one time a week.
Step 4 or severe persistent- Have symptoms constantly, have a decrease in their physical activity and have frequent flare-ups. Nighttime symptoms occur frequently.

Who is at risk for developing asthma?
It is important to know that anyone can have asthma. But it most commonly occurs in:

* children by the age of five
* children who have allergies
* children with a family history of asthma
* children who have exposure to secondhand tobacco smoke

How is asthma diagnosed?
Physicians use a combination of medical history, physical examination and laboratory tests to diagnose asthma, which may include:
spirometry - a spirometer assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of most common and simplest pulmonary function tests and may be necessary for some or all of the following reasons:

* to evaluate how well the lungs receive, hold and utilize air
* to monitor a treatment's effectiveness
* to determine how severe a lung disease is
* to keep track of a lung disease
* to establish whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
peak flow monitoring (PFM) - PFM is a device measuring the amount of air a person can blow out of the lungs. When asthma or other respiratory flare ups occur, the large airways in the lungs narrow slowly. This slows the speed of air leaving the lungs and can be measured by a PFM. Measuring this is essential to determining how well or how poorly the disease is being controlled.
allergy tests - tests to determine allergies.

Outgrowth of childhood asthma:
Every child is different in how they respond to asthma throughout their life. For some children, when they enter their teenage years, symptoms can subside. For others, symptoms can become more severe with time. About one-third of children with asthma will outgrow it, and about one-third of children with asthma will have fewer episodes as they get older.

A few tips for exercising with asthma:
* Have your child stretch before and after exercising, breathing only through the nose to warm and humidify the air before it enters the airways.
* Verify that your child takes all their necessary medication before exercising, as recommended by their physician.
* Have your child wear a scarf over their mouth and nose in cold weather, so air is warmer and easier to inhale.
* Have your child always carry a "reliever" or "reserve" medication, in case of an asthma attack.

The American Academy of Allergy, Asthma, and Immunology (AAAAI) recommends the following for children with asthma at school:

* Meet with the school nurse, teachers and other relevant school staff to tell them about your child's asthma and medical needs.
* Make sure your child’s school nurse has a copy of his Asthma Action Plan on file. This will explain what steps should be taken if your child has an asthma attack at school.
* Talk to school personnel about your child's asthma medications and how to help during an asthma attack.
* Ask school staff to treat your child normally when asthma is under control.
* Talk to the teacher or coach before your child starts a physical education class.
* Make sure indoor air quality, allergens and irritants in the school are monitored.
* Work to prevent asthma symptoms from starting that could bring your child's energy levels down.
* Make sure you tell your child they are not different from others.

Take care.