Cold season is hanging on, and as parents of children with asthma know, winter colds are often accompanied by wheezing.
Many children will wheeze once in their lifetimes, and as I tell parents, "everyone gets one free wheezing episode." But if a child wheezes on several occasions and responds to bronchodilators, the youngster probably has asthma. If you throw in a family history of wheezing, as well as wheezing that begins every time a child gets a cold, it's time to discuss the possibility of asthma with your pediatrician.
The good news is, there are a lot of great medications available to treat asthma. That being said, I think it's important to teach parents about the pathophysiology of asthma, and then talk about treatment. I tell my patients and parents that understanding wheezing is somewhat analogous to the work of a medical intern: You have to observe what's happening until you finally "learn it and know it" and can begin to understand treatment.
With each wheezing episode, it should become easier for parents to know what they're dealing with, and when and how to start treatment. Parents may not need a doctor to be involved once they're comfortable with the medications.
In fairly simplistic terms, there are two components to asthma: airway narrowing (brochospasm) and airway inflammation. In most cases, it's important to be treating both symptoms. The most common trigger for asthma in children is a viral upper respiratory infection. The virus causes airway inflammation and irritation in all of us. That's one reason we all cough with a cold. For an asthmatic child, it also causes bronchospasm and resultant wheezing.
By the time you audibly hear your child wheezing, they're what we pediatricians refer to as "being tight." The goal, therefore, is to treat the asthmatic episode early and aggressively; you never want to hear audible wheezing.
An asthmatic cough is often short, frequent, non-productive and occurs throughout the day and often all night long. I love to walk into a room and hear a child with a productive, "phlegmy" cough. That dry little cough that occurs incessantly is often the hallmark of a child who's wheezing.
In severe cases of wheezing and bronchospasm, children will also show signs of respiratory distress, where their chest may show retractions (pulling in between ribs) or they're using their abdominal muscles to help them breath. These children look uncomfortable and are usually not running around the exam room.
Other children may not display any respiratory distress, but when you listen to their chests with a stethoscope, you hear a high-pitched noise on expiration and sometimes on inspiration, as well. You just have to get used to listening. By practicing with a stethoscope, parents get better at understanding asthma.
When a child is actively wheezing, it's time to start medications to relieve their symptoms pronto.
(Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show. Submit questions at http://www.kidsdr.com.)