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Abstract Dr. Nahida Mulla discusses the various forms of asthma and its symptoms and provides keynotes of the most often indicated remedies.
INTRODUCTION: Asthma is a disorder caused by inflammation in the airways (called bronchi) that lead to the lungs. This inflammation causes airways to tighten and narrow, which blocks air from flowing freely into the lungs, making it hard to breathe. Symptoms include wheezing, breathlessness, chest tightness, and cough, particularly at night or after exercise/activity. The inflammation may be completely or partially reversed with or without medicines. Inflammation of the airways is linked to bronchial hyper responsiveness, which means that the airways leading to the lungs can narrow when they are exposed to anything to which they are sensitive, making it hard to breathe. All children with asthma have airways that are overly sensitive, or hyper reactive to certain asthma triggers. Things that trigger asthma differ from person to person. Some common triggers are exercise, allergies, viral infections, and smoke. When a person with asthma is exposed to a trigger, their sensitive airways become inflamed, swell up, and fill with mucus. In addition, the muscles lining the swollen airways tighten and constrict, making them even more narrowed and blocked (obstructed). An asthma flare is caused by 3 important changes in the airways that make breathing more difficult:
Inflammation of the airways Excess mucus that results in congestion and mucus “plugs” that get caught in the narrowed airways Bronchoconstriction (bands of muscle lining the airways tighten up)
Anyone can have asthma, including infants and adolescents. The tendency to develop asthma is often inherited; in other words, asthma can run in families. Many children with asthma can breathe normally for weeks or months between flares. When flares do occur, they often seem to happen without warning. Actually, a flare usually develops over time, involving a complicated process of increasing airway obstruction. Symptoms of Asthma
Wheezing: Wheezing is when the air flowing into the lungs makes a high-pitched whistling sound. Mild wheezing occurs only at the end of a breath when the child is
moderate. In asthma related to exercise (exercise-induced asthma) or asthma that occurs at night (nocturnal asthma). Usually. Also. especially in exercise-induced or nocturnal asthma. The feeding may be with interruption. Symptoms can be different depending on whether the asthma episode is mild. Children with even more severe asthma can also have wheezing while they breathe in (inspiration or inhalation). and they are usually restless. wheezing can be associated with other lung disorders. Coughing: Cough may be the only symptom of asthma. Other symptoms: Infants or young children may have a history of coughs or lung infections (bronchitis) or pneumonia. Infants have a softer shorter cry. They can talk in sentences and lie down. Infants are not interested in feeding and are restless and out of breath. wheezing may be present only after exercise or during the night. There is feeding with interruption and the child may not be able to finish the usual quantity of food/milk. the child is sleepy and confused. adolescents may not have these symptoms until they actually stop breathing. Infants may try to start feeding but cannot sustain it due to breathlessness. Chest tightness: The child may feel like the chest is tight or won’t expand when breathing in. Most children with chronic or recurrent bronchitis have asthma. such as walking. so wheezing is not necessary for the diagnosis of asthma. or severe. therefore. Also. they sit upright. Children with asthma may get coughs every time they get a cold. such as 1 am to 4 am. Symptoms indicating that breathing will stop: In addition to the symptoms already described. or there may be pain in the chest with or without other symptoms of asthma. Symptoms during a moderately severe episode: Children are out of breath while talking. However. wheezing may be absent because almost no air is passing through the airways. during a most extreme asthma attack. the child doesn’t cough anything up. Symptoms during a mild episode: Children may be out of breath after a physical activity. such as cystic fibrosis. coughing may occur with wheezing. and they may be restless. they talk in words (not sentences). Symptoms during a severe episode: Children are out of breath while resting. especially in cases of exercise-induced or nocturnal asthma. Asthma can occur without wheezing. and feeding is difficult. Cough due to nocturnal asthma (night time asthma) usually occurs during early hours of the morning. More severe wheezing is heard during the whole exhaled breath. However. .breathing out (expiration or exhalation). the infant takes longer to finish feeding. The infant may not be interested in feeding. so there is no phlegm or mucus.
These classifications do not always work well in children because lung function is difficult to measure in younger children. each with different characteristics and requiring different treatment approaches. Children rarely have symptoms between episodes (maybe just one or two flare-ups . no matter how unrelated they might seem. Other diseases and conditions are ruled out. coughing. To establish a diagnosis of asthma. performs a physical exam. A child’s symptoms can be categorized into one of four main categories of asthma. and this kind of asthma does not fit into any category. and lung function. The criteria for a diagnosis of asthma are: Airflow into the lungs is reduced periodically (due to narrowed airways). and how long do they last? Triggers: Has the child been exposed to irritants and allergens? Has the child experienced any recent life changes or stressful events. The symptoms of reduced airflow are at least partially reversible. Be sure to provide the doctor with as many details as possible. and in more than half. Categories of asthma The severity of asthma is classified based on how often the symptoms occur and how bad they are. some kids cough at night but seem fine during the day. while others seem to get frequent chest colds that don’t go away. children often have asthma that is triggered by infections. or shortness of breath that occur no more than twice a week are called mild intermittent asthma. In particular. asthma develops before the age of 3 years. Mild intermittent asthma: Brief episodes of wheezing. In most children. and possibly orders laboratory tests (see Tests Used to Diagnose Asthma). keep track of and report the following: Symptoms: How severe are the attacks? When and where do they occur? How often do they occur? How long do they last. which can then be compared to the characteristics of different categories of asthma (see below). and how do they go away? Allergies: Does the child or anyone else in the family have any history of allergies? Illnesses: How often does the child get a cold. For example. the characteristics of episodes. and do any other things seem to lead to a flare? This information helps the doctor understand a child’s pattern of symptoms. a doctor rules out every other possible cause of a child’s symptoms. Also. how severe are the colds. asthma develops before the age of 5 years. including symptoms that happen at night. The doctor asks questions about the family’s asthma and allergy history. Diagnosing Asthma Diagnosing asthma can be difficult and time-consuming because different children with asthma can have very different patterns of symptoms.
or parasites might be responsible. Symptoms usually occur at least twice a month at night and may affect normal physical activity. or shortness of breath are frequent and may require emergency treatment and even hospitalization. These triggers may change as a child ages. Many children with severe persistent asthma have frequent symptoms at night and can handle only limited physical activity. Weather changes: Asthma attacks can be related to changes in the weather or the quality of the air. Emotional factors: Some children can have asthma attacks that are caused or made worse by emotional upsets. or shortness of breath that occur more than twice a week but less than once a day are called mild persistent asthma. Viral infections can increase the likelihood of an asthma attack. it can cause an asthmatic response. cold air. Allergens (see below for more information): An allergen is anything in a child’s environment that causes an allergic reaction. airways are inflamed. pollens. trees). coughing. pet dander. Episodes of wheezing. or triggers. perfumes. but it may have to do with heat and water loss and temperature changes as a child heats up during exercise and cools down after exercise. which can be caused by allergies. In some patients. molds. or dust mites. Mild persistent asthma: Episodes of wheezing. Exactly how exercise triggers asthma is unclear. Weather factors such as humidity and temperature can affect how many allergens and irritants are being carried in the air and inhaled by your child. These symptoms affect normal physical activity. coughing. A child’s reaction to a trigger may also change with treatment. hair sprays. other infections with fungi. Severe persistent asthma: Children with severe persistent asthma have symptoms continuously. Allergens can also be seasonal outdoor allergens (eg. Tobacco smoke. even between flares. Episodes of wheezing. roach allergens. and air pollutants are irritants that can cause inflammation in the lungs and result in asthma symptoms. Causes of Asthma Asthma in children usually has many causes. per month involving mild symptoms at night). Inflammation of the upper airways (including the nasal passages and the sinuses): Inflammation in the upper airways. Allergens can be foods. Gastro esophageal reflux (GER): GER is more commonly known as heartburn. Nighttime symptoms occur more than once a week. bacteria. Exercise (see below for more information): Exercise can trigger asthma. paint odors. Irritants: When an irritating substance is inhaled. mold spores. Mild asthma should never be ignored because. grass. coughing. Moderate persistent asthma: Symptoms occurring every day and requiring medication every day are called moderate persistent asthma. sinus . chemicals. fungi. or shortness of breath occur more than twice a week and may last for several days. Common triggers of asthma include the following: Respiratory infections: These are usually viral infections. GER is related to asthma because the presence of small amounts of stomach acid outside of the stomach (in the esophagus) can irritate the airways.
For some children. or biking. or body position during sleep. If exercise is a child’s only asthma trigger. runny nose. and teachers must be informed of the . over 10% of Olympic athletes have exercise-induced asthma they’ve learned to control. An allergist can usually identify any allergies a child may have. Children inherit the tendency to have allergies from their parents. Parents (or older children) must carry the proper “rescue” medication (such as inhalers) to all games and activities. coaches. Not every type or intensity of exercise causes symptoms in children with exercise-induced asthma. must be treated before asthmatic symptoms can be completely controlled. infections. People with allergies make too much “allergic antibody. When avoidance isn’t possible. Histamine occurs in the body naturally. In a child with asthma. exercise is the only thing that triggers asthma. an allergist can prescribe immunotherapy. Once identified. the best treatment is to avoid exposure to allergens whenever possible. histamine can also trigger asthma symptoms and flares. Even if allergies are not your child’s primary triggers for asthma (asthma may be triggered by colds. or lung (respiratory) infections. In fact. and the child’s school nurse. but it is released inappropriately and at too high an amount in people with allergies. The IgE antibody recognizes small quantities of allergens and causes allergic reactions to these usually harmless particles. Nocturnal asthma: Nighttime asthma is probably caused by multiple factors. or exercise for example). asthma flares can still occur. the allergy isn’t always the primary cause of asthma. exposure to allergens during and before sleep. allergies can still make symptoms worse. With the right medicine. for other children. Allergy-related asthma Although an estimated 75-85% of people with asthma have some type of allergy. scout leaders. Some factors may be related to how breathing changes during sleep. Allergic reactions occur when IgE antibody triggers certain cells (called mast cells) to release a substance called histamine. the doctor may prescribe a medication that the child takes before exercising to prevent airways from tightening up. such as running. In some cases. most children with exercise-induced asthma can play sports like any other child. exercise as well as other factors triggers symptoms. Of course.” which is called immunoglobulin E (IgE). Nasal steroids can be prescribed to block allergic inflammation in the nose. the flu. and watery eyes associated with some allergies. Exercise-induced asthma Children who have exercise-induced asthma develop asthma symptoms after vigorous activity. which is a series of allergy shots that gradually make the body unresponsive to specific allergens. swimming. Young children with exercise-induced asthma may have subtle symptoms such as coughing or undue breathlessness after physical activity during play. antihistamine medications may be prescribed to block the release of histamine in the body and stop allergy symptoms. The released histamine is what causes the sneezing.
A person needing this remedy is typically very irritable and impatient.m. and sitting up and burping offers some relief. and not . The person seems hypersensitive and may be extremely irritable and agitated. The person may be very cold (especially hands and feet). Ipecacuanha: Coughing spasms that lead to retching or vomiting strongly indicate this remedy. Arsenicum album: A person needing this remedy can feel exhausted. Both physical effort and mental exertion can make things worse. Pulsatilla: Wheezing that starts when a person gets too warm (especially in a stuffy room). Warmth often brings improvement. Overindulgence in stimulants. hard. Dry wheezing may progress to a cough that brings up frothy whitish fluid. HOMOEOPATHIC THERAPEUTICS: 1. and episodes tend to be worse in the very early morning. with a sawing sound. 3. and warmth and sleep often bring relief. and may begin. (Children may even shriek and hit. because it feels so weak. Spongia tosta: A hard or “barking” cough during an asthma attack is a strong indication for this remedy. but the person has difficulty coughing much out. wanting a lot of attention and comforting. with burning pains in the chest and heat in the head. Natrum sulphuricum: This remedy is sometimes indicated when asthma attacks are brought on by exposure to mold and dampness. and worse from talking. with pressure in the stomach. General chilliness is usually seen. Coughing brings up yellow-colored mucus. 6.) 4. The person may sweat a lot and feel clammy or nauseous. Breathing can be labored. 7. and may continue into the night.) 8. The person can be thirsty.child’s asthma. with gagging and choking. between midnight and two a. Breathing problems tend to be worse while lying down. Gas and digestive upset are also likely. (Pulsatilla is often useful in children’s illnesses. A person who needs this remedy is likely to be changeable and emotional. or strong spicy food can bring on or aggravate an episode. or after eating rich food. Problems are often worse in the morning. 5. better when sitting up. Make sure the child will be able to take the medication at school as needed. taking frequent tiny sips. Mucus collects in breathing tubes. Chamomilla: Asthma with a dry. or after becoming overexcited and angry.. Carbo vegetabilis: This remedy may be indicated when a person feels weak or faint with a hollow sensation in the chest.m. with a general feeling of chilliness. 2. irritating cough that starts after being exposed to moving air. be worse from motion. or be the most intense. The cough is often worse around nine p. eating. constricted feeling in the chest during asthma attacks. and is relieved by cool fresh air. Coughing jags can lead to gagging. or lying down are other indications for this remedy. Wheezing can come on suddenly with a feeling of suffocation and heaviness in the chest. Feeling worse in the evening. though they often calm down if someone carries them. wanting to sit beside a fan or open window. alcohol. yet be very restless and anxious. Wheezing and breathing difficulties are aggravated by exertion. Tightness in the chest tends to be worse in the evening and at night. may be helped with this remedy. The person may hold the chest while coughing. Nux vomica: Indications for this remedy include a tense. and sometimes worse from warmth. can indicate this remedy. sweets. yet feels a need for moving air.
Cuprum met: Cough has a gurgling sound and he is better by drinking cold water. wants windows open. Drenching sweat during sleep. Expectoration scanty and must be swallowed. sits up and turns blue. The person may feel best when sitting up and tilting the head back. The keynote for using this option is the presence of fine rattling or crackling sounds in the chest. Kali bic might help patients who experience attacks at about 3 or 4 a. worse lying on side lain upon. Voice re-echoes. as well. Indicated after arsenic when this is insufficient.m. Aralia Racemosa: (American Spikenard) This is a remedy for asthmatic conditions. Cannot expire. The chest also seems full of phlegm that the patient cannot cough up.t). 18. Acts best in stout and corpulent patients. Suffocative attacks worse 3 a. nose dry and obstructed. The patient feels compelled to sit up to breathe. a remedy used by conventional medicine for asthma. has great difficulty breathing. Complaints relapse . Sniffles of infants. Diarrhea.. with cough aggravated on lying down. Own voice roars in ears and distresses. The patient must sit up at about 3 a. Especially when associated with bronchitis. 16. Intensely sympathetic child. better by sitting up. Antimonium tartaricum (Ant. The problems often start while the person is asleep (typically before midnight). Much pus-like mucus. Aching in rectum extending upwards. 11. Feels as if heart would stop. Cough with pain in hip.much mucus is produced. Antimonium tartaricum is especially suited to young children and the elderly. Warm drinks may be helpful. Pulse more rapid in morning than in the evening. better by rapid walking. 15. 13.Millars asthma. prolapse of rectum. and feels suffocated. Difficult respiration. felt in the pit of stomach and preceded with prickling all over. Spasmodic asthma alternating with spasmodic vomiting. and the patient sits up and holds the chest with the hands while coughing. 17. 9. Spongia is often used in croup. The patient coughs up stringy yellow mucus. Cough with DYSPNOEA in bronchitis and phthisis. better by drinking cold water. Sambucus nigra: Paroxysmal suffocative cough coming on about midnight with crying and dyspnoea. Blatta orientalis: A remedy for asthma. Wheezing and breathing difficulties are aggravated by exertion. Dyspnoea in the middle of night. Angina with asthmatic symptoms and cramps.. and bending forward while sitting brings some relief. ·Natrum Mur treats general symptoms including a worsening of asthma when exposed to mold and dampness. or when leaning forward.m. 12. Sulphur: Oppression and burning sensation in chest. with a feeling as if there were no air in the chest. 14.m. 10. The patient usually also has loose bowels after each attack. Cannot lie down at night.m.. Causticum: Cough with rawness of chest. Spasm and constriction of chest. attacks occur at about 4 to 5 a. Sensation of weight or pressure in chest. can also be used as a homoeopathic treatment for certain symptoms. Child awakes nearly suffocating. Lobelia inflata: Asthma attacks with weakness. Extreme sensitiveness to draughts.
. Drawing pain from left of back into chest. Asthma with cough. cannot expand the chest. Croton tig: Coughs as soon as he touches the pillow and must get up. Stercula: Asthma. It gives power to endure prolonged physical exertion with taking food and without feeling fatigued. 20. It promotes appetite and digestion. Sensitive to deep breathing.19.
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