Dr. Nathan Forbush understands asthma. His elementary-aged daughter hassles with it, and he just discovered in recent years that he’s an asthmatic himself.
But if handled correctly, says the Tanner Clinic pediatrician, the disease can be kept in check. When the disease is not under control — for instance in children who can’t participate in certain activities — the reason is an inadequate asthma treatment plan. “Our whole goal of asthma management,” he says, “is to get children to where they can live a totally normal lifestyle.”
As examples, he points to athletes who’ve become champions despite having asthma — Olympic track and field star Jackie Joyner Kersee, Super Bowl champ Jerome Bettis, Sacramento Kings point guard Isaiah Thomas and gold-medaled swimmer Mark Spitz.
Dr. Forbush defines asthma as “a hyper-reactive airways disease where the bronchioles constrict.” The bronchioles are the small passageways that allow air to pass from the nose or mouth into the lungs. The symptoms are wheezing, chest tightness and sometimes difficulty breathing.
Common cold an asthma trigger
Dr. Forbush has found that young asthma patients generally fall into one of three evenly split categories:
▸ Children who have a few wheezing events and then never show additional symptoms.
▸ Children who contend with asthma through their young years, but when they reach an older age, say 5 or 9 or 12, it seems to wane.
▸ Children whose asthma continues into their adult years.
While the cause of asthma remains unclear, physicians like Dr. Forbush believe there’s a genetic predisposition. The triggers, however, are likely to be environmental.
The most common trigger in children, said Dr. Forbush, is a viral cold. “They catch a cold that triggers their asthma,” he says. For adults, those triggers can include pollens or other allergens.
Asthma patients can be tiny
Dr. Forbush has asthma patients as young as 3 months, but the illness is most often detected at age 1 or 2.
The tiniest patients are diagnosed through observation. “The first time I hear a child wheeze, I call that wheezing,” Dr. Forbush said. “The second time I hear the child wheeze, I may diagnose that as asthma.”
Older children are tested with a spirometry — a pulmonary function test. The results are based, not on volume of air, but how long it takes to get that breath out.
Asthma symptoms can be managed through medications delivered via an inhaler or nebulizer. There’s a chewable tablet as well. To calm asthma symptoms in infants, Dr. Forbush recommends an inhaler or nebulizer with tubing and a mask. “The air is pumped through the tubing and it causes the nebulizer medication to be a fine mist, which is sprayed into the mask and is just breathed in,” he said.
Asthma management plans
Dr. Forbush sees his asthma patients on a regular basis to ensure the disease is in check. At those times when patient and parent don’t have
adequate control over the asthma — such when patients use their rescue inhaler multiples times a week — the youngster’s regimen will be “tweaked,” said the doctor. He may prescribe an inhaled corticosteroid, such as Advair. The corticosteroid, he said, helps suppress inflammation “so that when a trigger does come, their airways don’t constrict down.”
Parents are often untroubled by the diagnosis of asthma, said Dr.Forbush. “A lot of parents are just looking for answers to why these things are happening to their child.”
However, he adds, it can become “overwhelming” as the parents are educated on how to manage their child’s illness, a task that takes a lot of supervision. “At a certain age when children are uounger, they shouldn’t manage it on their own,” he said. “They should have a parent nearby so they are taking their medication appropriately.”
His 9-year-old daughter with asthma, he adds, “still requires lots of supervision so she takes things correctly.”
As children get older, learning to manage it on their own becomes more important.
JUST AN AFTERTHOUGHT — Utah’s high smog levels knock the wind out of asthmatics, said Dr. Forbush. The pollution tends to trigger, and aggravate, asthma symptoms and attacks. “Any pollutants in the air cause our airways to clamp down,” he explains, “because the body does a good job of protecting garbage from getting in.” When airways are already inflamed and restricted, the results can be serious.