by Neala S. Schwartzberg, PhD ~ ost children with asthma are diagnosed with

their condition at quite a young age. "Half of

all childhood asthma is diagnosed by age 3, and 80 to 90

percent by age 6," says Scott T. Weiss, MD, professor of

medicine, Harvard Medical School, and director of

Respiratory and Environmental Epidemiology, Channing

Laboratory. There is a common perception that asthma is a

childhood disease. This encourages many parents to be

hopeful that their child will outgrow the condition. No

one wants their child to have a chronic ailment, but is this

wishful thinking? Do children typically outgrow asthma?

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The answer is yes ... and no. "Of those with a milder form of asthma, about 40 to 50 percent go into remis- sion during their early teens," says Robert A. Barbee, MD, professor of medicine, University of Arizona Health Sciences Center. However, even when children with mild asthma outgrow the symptoms, they don't really outgrow asthma. The underlying condition doesn't go away; it goes underground.

"Active asthma becomes inactive," states Stanley Goldstein, MD, spokesperson for the American Academy of Allergy, Asthma and Immunology ( A A A ) . "If you follow these children with lung function tests, they still have mild abnormalities, even though they aren't having symptoms." This period of remission, or inactive asthma, can last for many years, or in some cases, indefinitely. This may cre- ate the impression that the person has ~'outgrown" the asthma.

A n a t o m y o f a n A s t h m a E p i s o d e

Asthma is caused by inflammation of the airways. Children (and adults) with persistent asthma have chronical- ly inflamed airways. People with asth- ma also have "twitchy" airways, which means the airways are prone to becoming constricted. These are the underlying conditions - - the problems that typically won't go away. When a child has an asthma episode, the air- ways become inflamed and the mus- cles that encircle the airways tighten, causing them to narrow. Then, in response to the inflammation, mucus is secreted in the airways which blocks them even more. This combination of events can leave little room within the airways for the air to pass through. This usually results in the classic symptoms of coughing and wheezing (the whistling noise created when air passes through a narrow space).

W h o Wil l L i k e l y O u t g r o w A s t h m a S y m p t o m s ?

Most children's asthma episodes develop as a result of a viral infection

or exposure to airborne allergens or irritants. Children who outgrow their symptoms generally have asthma episodes in response to viral infec- tions. "If you have allergies, and those allergens continue to be in your envi- ronment, you'll continue to have asthma," says Dr. Goldstein. "Your lungs never have a chance to recover." On the other hand, children who wheeze due to respiratory infections are more likely to outgrow their symptoms, since infections typically become less frequent as a child ages.

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In addition, males are more likely to go into remission than females. "Males have relatively smaller airways compared to their lungs when they are young," explains Dr. Weiss, "often making their breathing problems mechanical rather than due to inflam- mation." As they get older and their airways get larger, if it was the size of the ai'rways causing the problems, their episodes may become less frequent, less severe or may disappear altogether.

Research shows that there are cer- tain groups of children who are more likely to see their asthma improve; however, these are general statistics. "You can never really predict who is going to go into remission," Dr. Goldstein cautions. "Also, you always

have to be on guard because asthma could develop again."

T a k i n g A s t h m a S e r i o u s l y

In its Surveillance Summary for Asthma in the United States (1965-1995), the Centers for Disease Control estimated that more than 15 million Americans suffer from asthma. Five to 6 million of these are children. This disorder can require emergency medical care as well as hospitalizations. For children, it can result in time lost from school. Among children ages 5 to 17, the Asthma and Allergy Foundation of America reports that asthma accounts for more hospital- izations than any other childhood dis- ease and an annual loss of more than 10 million school days per year.

But asthma doesn't have to side- line children. Whether or not a child is going to "outgrow" the symptoms of asthma, there are things that can be done to control the condition, reducing the likelihood that episodes will occur.

W h a t P a r e n t s C a n D o

Despite a child's tendency to have asthma attacks, episodes rarely begin without a reason. "We have found that all children have an incredible burden of environmental exposures to allergens and irritants," says Dr. Weiss. Once parents learn what can cause an attack, they can help their youngster avoid those things that trigger his or her asthma.

Many children with asthma have respiratory allergies that can trigger an asthma episode. Common allergens are dust mites, cockroaches, mold, animal dander and various kinds of pollen. There are steps parents can take in the home environment to help their child avoid exposure to indoor allergens.

Dust mites are tiny insects that live in the home, seeking refuge in such places as carpets, mattresses, pillows, bedding and stuffed furniture. The problem isn't the mites themselves, but their decaying bodies and fecal waste products to which many people are allergic. These substances become air-

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borne and are then inhaled. In order to reduce a child's exposure to dust mites, parents can place mite-proof covers on mattresses and pillows, wash bedding weekly in hot water and remove carpets where possible, espe- cially in the child's bedroom. Cockroaches, too, present a problem for those who are allergic to them. Their decomposed bodies and waste products as well as their saliva are aller- gens that can trigger an asthma episode. Sticky roach traps from the hardware store are often the best way to get rid of these pests. It can also help to wash areas where the roaches were present, since residue from their saliva can act as an allergen long after the roaches have been exterminated. Indoor molds are most often found in bathrooms and kitchens where there is moisture or humid i~ Washing moldy areas and providing adequate ventila- tion can help reduce their presence. If there is a family pet and a child is allergic to animal dander, it is impor- tant to get rid of the pet. If this is not feasible, at a minimum keep the pet out of the child's bedroom.

There are some substances that don't cause an allergic reaction but irri- tate airways, predisposing a child to an asthma episode or triggering one. Tobacco smoke is an irritant that both inflames the airways and triggers asth- ma. If someone in the household smokes, it can increase the child's likeli- hood of having episodes. It can also

cause them to be more severe. Indoor "air pollution," such as

cleaning products with strong odors, perfumes, aerosol sprays, and wood smoke, can irritate the lungs. When these are present in the home, they can also trigger asthma. It is impor- tant that parents be aware of these irritants and limit their child's expo- sure to them as much as possible.

Finally, exercise can trigger asth- ma symptoms because it requires a child to breathe hard and fast. Does this mean children with asthma should not participate in sports or exercise? No, not at all. In fact, many doctors believe that exercise is actually helpful in promoting better breathing by strengthening the lungs. Kids with asthma should be able to exercise freely and participate in sports at any level. But the child's asthma must be well-controlled with the proper med- ications to allow him or her to exer- cise without asthma interfering. Taking medication just before exercise can be an important part of the treat- ment plan.

In addition to helping their child avoid things that trigger asthma, it is also important for parents to learn to recognize the early signs of an asthma episode. Steps can then be taken to treat the symptoms with the appropri- ate medication(s) before the episode gets out of control. It can also be help- ful to keep an asthma record or jour- nal, noting the situation surrounding

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each of the child's episodes. Where was the child? What was he or she doing? What was present in the environment that might have caused the episode? This will provide parents useful infor- mation to share with their health care provider, and to help their child avoid things in the future that could trigger an asthma episode.

T r e a t m e n t is I m p o r t a n t

It can be hard for parents to acknowl- edge that their child has a chronic ill- ness, and easy to dismiss or downplay the importance of symptoms. But chil- dren with asthma need treatment. Not only are asthma episodes uncomfort- able and frightening for a child, but asthma, left uncontrolled for an extended period, can cause permanent loss of lung function. When airways are chronically inflamed they can become scarred. This is known as air- way remodeling. Dr. Goldstein cau- tions, "This kind of scar formation can permanently narrow airways." The use of "controller" medications to control the underlying inflammation of asth- ma, as well as the avoidance of asthma triggers may benefit a child in two ways. First, it reduces the frequency and severity of asthma episodes. Second, it is believed that controlling inflammation over the long term sig- nificantly reduces the likelihood of air- way remodeling.

There is no way to know whether a child's asthma will become less severe or inactive as he or she gets older. The preventive measures outlined in this article, however, are steps parents can take to make asthma episodes a less fre- quent event in their child's life. Controlling asthma will also help keep their child's lungs healthy and func- tioning at their best as he or she grows and develops. This will provide the best opportunity for the child's asthma to become a thing of the past.

Neala Sehwartber~ Phi), writes frequently on health and medical topics. She is also the author of a parenting newsletter.