1. What is bronchial asthma?
Bronchial asthma is a chronic respiratory disease characterised by chronic airway inflammation, which leads to sensitive airways. When exposed to certain triggers, these airways overreact and narrow. Individuals with bronchial asthma experience periodic “attacks” of coughing, wheezing, shortness of breath, and chest tightness.
Asthma is the leading chronic respiratory condition globally, impacting approximately 262 million individuals. In Malaysia, it is estimated to affect 8.9 to 13.0% of children and 6.3% of adults.
2. What are the symptoms of bronchial asthma in children?
Asthmatic children tend to cough frequently even when they are well. The cough or wheezing usually occurs at night or right after waking up from sleep, when they are playing or laughing, or when they are exposed to certain triggers (see below).
When children have an asthma attack (asthma exacerbation), their symptoms may become much worse, including severe coughing and wheezing, rapid breathing or difficulty breathing, chest retraction, trouble speaking, or they might even turn pale or blue.
3. What are the risk factors of childhood bronchial asthma?
Family history – both paternal and maternal histories of asthma are associated with an increased risk of asthma in offspring. A medical history of atopic dermatitis (eczema) and allergic rhinitis (hay fever).
A 2021 study highlighted a distinct gender disparity. Among children under 13, boys have a higher prevalence rate of 65%. However, in adulthood, the prevalence shifts, with women experiencing a higher rate of 65% compared to men.
However, another study in 2022 found that, Asthma prevalence and the relationship between level of knowledge and quality of life among asthmatic schoolchildren in Malaysia,” female children have a higher prevalence of asthma than male children. The study reported that 55.6% of the respondents were female, indicating a higher diagnosis rate among females than males.
The varied information online signifies that there is still much to be understood about Bronchial Asthma.
Other environmental risk factors include specific indoor allergen sensitisation (house dust mites, cat and dog allergens, cockroach allergens, etc.) in early life, which has been of interest regarding asthma development.
4. What is an allergic march?
Bronchial asthma is an atopic (allergic) condition. The allergic march is a pattern described clinically in individuals with atopic diseases. Its progression begins with atopic dermatitis (eczema) in infancy, develops into food allergy and allergic rhinitis (hay fever), and then leads to bronchial asthma later in childhood.
It has been reported that 12.6% of Malaysian children are affected by atopic dermatitis. Given Malaysia’s population of approximately 32.7 million, with about 24% under the age of 15, this percentage translates to roughly 990,000 children experiencing atopic dermatitis.
5. What is the common triggering factor for the asthma attacks?
Common triggers include respiratory infections, changes in weather, a cold environment, cold drinks and food, dust, smoke, animal dander, emotional changes (excessive crying or laughing), and exercise.
6. How is childhood asthma diagnosed?
Bronchial asthma is often difficult to diagnose in children, especially those younger than 6 years old. It can have symptoms similar to those of other illnesses, such as laryngomalacia, foreign body aspiration, and gastro-oesophageal reflux disease. Some asthmatic children do not develop symptoms of asthma, so it can be mistaken for other respiratory conditions (e.g., respiratory tract infection).
Paediatricians may diagnose bronchial asthma based on a detailed medical history (especially the pattern of coughing and wheezing, the presence of a risk factor for bronchial asthma), and a thorough physical examination. In addition, a peak flow meter is used to assist in the diagnosis of bronchial asthma in older children.
7. What is the treatment of bronchial asthma?
Developing a personal asthma action plan is important for managing asthmatic symptoms and preventing asthmatic attacks. An asthma action plan includes a guide on choosing asthmatic medication or inhalers, when and how to use the medication, what to do if symptoms get worse, and when to seek emergency care.
There are two types of asthma medications: preventer and reliever inhalers. A preventer inhaler is used daily to control asthma symptoms and prevent asthmatic attacks, while a reliever inhaler is used to alleviate asthma symptoms.
A doctor may prescribe additional medications during an asthmatic attack, including regular nebulisation, systemic corticosteroid, and antibiotics (if a bacterial infection is suspected).
8. How do you keep asthma under control?
Well-controlled asthma means no or infrequent symptoms during well-time (e.g., cough/wheeze during early morning, sleep, or exercise) and infrequent asthmatic attacks. The key factors in making this possible are good adherence to the asthma action plan, medication compliance, and avoidance of triggers.
9. Why is it important to keep asthma under control?
Well-controlled asthma conditions allow children to live active and normal lives with few troublesome symptoms. They can perform daily activities without difficulty and can help minimise school absenteeism due to symptoms. More importantly, they are less likely to have severe asthmatic attacks, which may be life-threatening.
10. What are the other diseases or comorbidities that could worsen asthma?
Asthma in children often coexists with several comorbidities, including allergic rhinitis, obesity, adenotonsillar hypertrophy, obstructive sleep apnoea (OSA), and gastro-oesophageal reflux disease (GORD). These conditions complicate asthma and affect the long-term health and quality of life of young patients. For example, obesity exacerbates asthma symptoms due to associated chronic inflammation, while OSA leads to disrupted sleep and cognitive difficulties, further intensifying asthma severity. Addressing and managing these comorbidities through medical interventions and lifestyle adjustments are essential for improving asthma control and overall health outcomes in affected children.
11. Can asthmatic children be physically active?
Asthmatic children need to be as physically active as other healthy children. Do not stop exercise; instead, use a reliever inhaler before exercise to reduce exercise-induced symptoms.
12. Asthma Remission in Adults: Insights into Long-Term Outcomes
While asthma is often perceived as a lifelong condition, a significant number of adults experience remission, meaning they no longer suffer from asthma attacks or symptoms. According to studies, remission rates among adults vary widely, with estimates ranging from as low as 2% to as high as 52%. Factors that increase the likelihood of remission include a younger age at diagnosis, milder initial symptoms, shorter duration of the condition, and better lung function overall.
Though asthma can persist into adulthood, these insights provide hope that, for many, symptoms may lessen or disappear entirely, improving quality of life. Further research could help clarify how these factors contribute to long-term asthma management, potentially guiding personalised treatment plans.
13. Personal advice to parents of asthmatic children, expectations and limitations of a child living with asthma
Bronchial asthma is a chronic inflammatory airway disease characterized by periodic asthmatic attacks. This condition may limit children’s daily lives, such as avoiding certain foods or drinks, limiting activity or exercise, and causing school absenteeism. Early diagnosis and prompt treatment are important. With good medication adherence and trigger avoidance, the symptoms will be well-controlled, allowing children to live normal lives like other healthy children. Many asthmatic children will eventually outgrow asthma by the time they become adolescents.
