Brahmi

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TREATMENT OF MILD ATTACKS IN ASTHMATIC CHILDREN
In past years many children had oxygen cylinders in their bedroom, but this had little therapeutic value unless the attack was severe enough to be life threatening. Too much oxygen can actually depress the respiration further.
The anxiety which accompanies difficulty in breathing is also relieved by the presence of a loved one. No asthmatic needs telling that breathing is easier when sitting up, and most children will have their preferred position. This may be propped up in bed with several pillows, or when wheezing it may be easier to breathe if the legs are hanging downwards, so sitting in a chair – providing the child can keep warm – is usually more comfortable. The idea that one must be in bed if ill is a difficult notion to dispel in many parents, but there is no doubt asthma is better managed in an armchair downstairs.
Sleep is always a problem, and I have found at home that the first night of an attack is usually spent downstairs in front of the video recorder. It is much better now that we have all-night television but in the old days when there was no night entertainment the morning often seemed a long time coming. It is important that children with asthma should not be woken for any reason once they have fallen asleep. The audible wheeze always sounds much worse when asleep, but if the breathing deteriorates further it will always make the child wake up anyway. The benefits of going to sleep are very great, as not only does it produce relaxation but also reduces the body’s energy requirements. For this reason I sometimes prescribe a gentle sedative to help induce sleep.
These steps will settle nearly all mild attacks of asthma without recourse to further measures. However, there are a few children where the response to bronchodilator inhalers is less than would be expected. To understand the reason for this we must look again at why the wheeze occurs. Spasm or contraction of the muscles in the walls of the airways is undoubtedly the initial problem but there is also the swelling of the lining of the breathing tubes to take into account. Some children undoubtedly develop much more swelling than others and this can prolong the breathing difficulty Bronchodilator inhalers will relieve the muscle spasm but will not ease the swollen linings.
Debbie was a classic example of this, as although her initial wheeze improved with her bronchodilator inhaler she was left with a persistent cough and some shortness of breath. This was not relieved by increasing either the frequency of the dose or the number of puffs she took. The most effective treatment is to use a cortisone inhaler in which a measured dose of steroid is taken directly into the lungs. Please do not be doubtful about the use of cortisone as insufficient is absorbed into the rest of the body to cause any unwanted effects.
Debbie’s parents asked what exactly steroids are? ‘Steroid’ is a name given to a group of chemical compounds, many of which occur naturally in the body. There is a wide variety with different effects. For example, there are the muscle-building steroids used by some athletes illegally to improve their performance. There are also steroids in contraceptive pills and steroid creams for the treatment of sore, inflamed skin. Cortisone is used in asthma as it is a very powerful anti-inflammatory agent so will relieve the swelling in the affected airways. The preparation I recommend is Becotide and this is available in all the same devices as Ventolin and Bricanyl – a pressurized inhaler, a diskhaler or a rotahaler. Debbie was used to the simple pressurized inhaler, so I prescribed Becotide in a similar form. The dose was two puffs four times daily which we were able to stop after four days when her peak flow had returned to normal. It is important to note that the swelling of the airway lining does not settle anywhere near as dramatically as the spasm, so it may take some time for the child to return fully to normal.
On one occasion when Debbie used a steroid inhaler she noticed her voice became a little husky, and she developed a mild throat infection. This can sometimes happen, but neither effect is serious and both can be prevented or reduced if the mouth is rinsed out after using the inhaler. Should it continue to be a problem then using a spacer device like a volumatic (a chamber into which the inhaler is puffed) will also cut down the problem, by reducing the amount of the drug which lands in the mouth and throat.
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