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Asthma is considered to be the most common chronic disease among children. It causes the most repeated visits to emergency rooms and the most missed days from school of all chronic problems.

Did you know:

n Approximately 7 percent of children suffer from wheezing at some point during childhood, which has been a consistent trend for many years.

n Certain areas have a higher number of children being affected by asthma, i.e., geographically (Luzerne County) or by neighborhood (closeness to highways).

Understanding the nature of asthma allows health care professionals to unlock sensible and effective approaches to controlling its severity, while providing more normal functioning of the lungs and an improvement in day-to-day living for those who truly suffer from its effects. Let us take a closer look at asthma:

Paroxysmal disorder

Paroxysmal means sudden and unpredictable. Asthma occurs at intervals that often are offset by relatively good health. While not always avoidable, health care professionals can help predict when a patient may experience an asthmatic interval and provide care that can "soften or shorten" the asthma effects.


Asthma is rarely permanent or unchanging. Correctly managed, it is not a permanent condition.

Resistance to airflow

Here we have to look at how the lungs deal with moving air so that they can extract oxygen and rid the body of carbon dioxide. While we do not typically think of air as a fluid, airflow always includes some friction with bronchial walls, which goes up rapidly if anything narrows the air passages. Anything that narrows part or all of an airway increases resistance. If something (narrowing, mucus, a foreign object, etc.) cuts the airway size in half, the difficulty in moving air throughout increases by a factor of sixteen. The smaller your air passages are to begin with (for example, a small child), then the more critical this resistance becomes.

Think about it: A person who is working hard to breathe can literally become too tired to breathe effectively and slip into lung failure. Also, because airways are naturally smaller during expiration (breathing out), air becomes "trapped" in the lungs and increases breathing difficulties.


There are cough receptors in our lungs that become more sensitive to cooling (winter air or rapid breathing during exercise), irritants in the air (particles like cigarette smoke, chemicals like ozone, viral infections, etc.), or to allergens (animal dander, pollen, etc.). Why are they more sensitive? That is not entirely clear, but a major component of this is inflammation, which appears to be more severe in asthmatics. A cough is often the first sign of an asthma attack. The cough is worsened by the secretions (mucus or phlegm), which further narrows the air passages.


When a river flows through a narrow gorge, the waters become turbulent and noisier. Similarly, airflow becomes turbulent in an abnormal air passage causing musical or low-pitched noises, especially during the breathing out phase of respiration. This is wheezing. In a severe attack, airflow may be so low that wheezing cannot be heard.

Sympathomimetic drugs

Sympathomimetic drugs, or bronchodilators, mimic the effects of adrenalin. All bronchodilators relax the muscle fibers in the bronchial walls, enlarge the airways, and decrease resistance, which decreases wheezing and makes breathing much easier.

What happens in the lung during an attack?

We tend to think of three stages. First and most immediate is the tightening of muscle fibers that spiral around small airways throughout the lung. A quick use of a bronchodilator may allow the sufferer to recover quickly. A second phase of an attack is marked by excessive production of mucus (6-12 hours into a typical attack). White blood cells are attracted and may migrate in, which increases the irritation. Multiple natural chemicals are released (histamine, leukotrienes, etc.), and they increase irritation and coughing. The third phase is edema (swelling) of the airway lining, which occurs approximately 12 to 24 hours into an attack. This stage results in a more severe narrowing of the airways, increased sensitivity to muscle spasm (bronchospasm), and a slower recovery, which requires longer and more intensive treatment.

How do physicians strategize treatment?

We think long term in regards to avoiding or eliminating environmental influences that can cause or worsen attacks. (We will address this specifically in a later article.) If an attack has occurred, we focus on the stage and duration of the attack, almost always aiming to decrease irritation and inflammation unless very minor. We always use medication designed to reduce airway narrowing and try to use treatments that are least likely to cause side effect reactions. Albuterol, a common bronchodilator used by asthmatics, is a mainstay of medical treatment and is provided either by inhaler, pump, or through a mist-creating machine called a nebulizer.

Albuterol is considered a quick fix that is effective for reducing symptoms but short term in its effect (lasting two to four hours per treatment). We call it a rescue medication - it does not control the cause of the attack and is rarely sufficient alone. We almost always will use a slower acting medication called a controller to reduce any inflammation and/or swelling. Controller medications include steroids, including but not limited to prednisolone, prednisone, Pulmicort, and Flovent. Other anti-inflammation medications include but are not limited to cromolyn and Singulair). An individual plan-of-action must be devised for each patient to help achieve optimal control and better quality of everyday life. Stay tuned for Part II of "Asthma in Childhood."

Alliance Medical Group Pediatrics is part of the Greater Hazleton Health Alliance. To learn more or to make an appointment, please call 570-501-6400.