“We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right – one after the other, no slipups, no goofs, everyone pitching in.” ― Atul Gawande, surgeon and journalist
Since I have talked of colds and allergies I guess it is natural to feel compelled to discuss the challenges a paediatrician faces with managing asthma. My moment of truth came when a close friend of mine broke down as I was nebulizing her nephew. I knew that she had outgrown wheezing episodes as a child and I expected her to be reassuring by virtue of her experience. When I asked her to explain herself she said, “The fear you feel when it becomes increasingly difficult to breathe, it’s horrible…I know what the child must be going through, can’t help feeling bad for him.” That’s when I guessed that it’s this panic that actuates so much of absurd behaviour and decision making. So let me share some facts to allay some of it.
First of all being asthmatic means you have airways that are hypersensitive and prone to becoming narrowed because the surrounding tissues get bloated as a part of the rabble rousing response of the immune system when it encounters some triggers. Asthma attacks come and go, with wide variation in the symptoms at different times. Many people with asthma have problems only occasionally but others struggle with it every day. There is no cure, the focus should be on control, and it can be achieved. What we aim for when we say control, is generally
- An ability to live an active, normal life (which means performing daily activities, play, and participation in sports without difficulty)
- Prevention of chronic and troublesome symptoms
- Zero school absenteeism because of asthma related symptoms
- Avoidance of symptoms during the night
- Stopping the need for urgent visits to the doctor, emergency department, or hospital
- Prescription and adjustment of medications to control asthma with little or no side effects
Secondly, not all wheezing is asthma. About half of infants and toddlers with repeated episodes of wheezing with shortness of breath or cough (even though these illnesses usually respond to asthma medications) will not have asthma by the age of six. Because of this, many paediatricians use terms like “reactive airways disease” or “bronchiolitis” when describing such children instead of labelling them as asthmatic.