by Dr Suhail A Naik
Childhood asthma is rising and often goes unnoticed. Early diagnosis, inhaler-based treatment, trigger control, and adherence are essential to prevent complications and ensure normal growth
Childhood asthma remains one of the most common chronic respiratory conditions encountered in paediatric practice today, and its rising prevalence is a matter of growing concern. In my clinical experience, I am seeing an increasing number of children presenting with symptoms that were either previously overlooked or misattributed.
Asthma, fundamentally, is a long-term inflammatory disorder of the airways, characterised by recurrent episodes of cough, wheezing, breathlessness, and chest tightness. Infections, allergens, exercise, or environmental pollutants often trigger these episodes. Despite being highly treatable, a significant number of cases remain either undiagnosed or inadequately managed, leading to avoidable complications, school absenteeism, and considerable distress for families.
A striking observation in recent years has been the surge in childhood allergies alongside asthma. Globally, nearly 20–30 per cent of children are affected by allergic disorders, while asthma alone affects around 10–15 per cent. These conditions are not isolated entities but manifestations of a common underlying dysfunction, an altered immunological axis where the body begins to recognize otherwise harmless environmental elements as threats. Depending on the system involved, this manifests differently: skin involvement presents as eczema or urticaria, nasal involvement as allergic rhinitis, and lung involvement as asthma. Although the names differ, the biological error remains the same.
In earlier times, persistent cough lasting more than two weeks often raised suspicion of tuberculosis. Today, the clinical landscape has shifted, and such presentations are more commonly linked to allergic asthma unless proven otherwise. This shift underscores the importance of updated clinical awareness among both healthcare providers and caregivers.
Allergies in children can affect multiple systems. Some children present with skin manifestations such as rashes, itching, or eczema. Others may develop gastrointestinal symptoms due to food allergies, including vomiting, loose stools, and poor weight gain.
Respiratory allergies are particularly distressing, with symptoms like nasal blockage, sneezing, and itching in allergic rhinitis, or coughing and wheezing in asthma. Children may be allergic to common food items such as milk, eggs, peanuts, and wheat, as well as airborne allergens like dust mites, pollens, and moulds. While food allergens can be avoided to some extent, environmental allergens are unavoidable, making it imperative to strengthen the child’s biological response rather than impose excessive dietary restrictions.
The aetiology of asthma and allergies is multifactorial. A genetic predisposition plays a central role, often evident through a family history of allergic conditions. However, environmental triggers are equally significant. Air pollution, indoor smoke exposure, recurrent viral infections, agricultural activities, pesticides, herbicides, pollens, and dust mites all contribute to triggering the disease in susceptible individuals. Essentially, it is the interaction between genetic vulnerability and environmental exposure that drives disease manifestation.
Diagnosis in paediatric asthma is largely clinical, supported by targeted investigations when necessary. A detailed history remains the cornerstone, recurrent cough, especially at night, wheezing, and symptom relief with bronchodilators are key indicators. I strongly encourage parents to maintain a respiratory diary, documenting episodes, triggers, medications used, and response patterns. Clinical examination may reveal signs such as polyphonic wheeze or, in severe cases, a silent chest, although it can often be normal.
Objective assessment tools significantly enhance diagnostic accuracy. Spirometry is useful in children above six years, while oscillometry is particularly valuable for younger children. The introduction of impulse oscillometry has allowed for a more precise and child-friendly evaluation of lung function. Additional investigations such as skin prick testing help identify specific allergens and can liberate children from unnecessary food restrictions. Serum IgE levels may indicate an allergic predisposition and help identify candidates for advanced therapies like Omalizumab. In select cases, tests such as chest X-rays, eosinophil counts, or fungal antigen assays are used to rule out alternative diagnoses or complications.
When it comes to management, it is crucial to understand that while allergies cannot be cured, they can be effectively controlled. The primary goal is to improve quality of life, ensure normal growth and development, enhance school performance, and minimize both short- and long-term complications. Inhaled therapy remains the cornerstone of asthma management. In fact, across all stages of treatment, inhalers form the backbone, what changes is the dosage, not the modality. These medications deliver drugs directly to the lungs, ensuring maximum efficacy with minimal systemic side effects.
There is a widespread misconception among parents regarding the safety of inhalers. This fear is unfounded. Inhalers are among the safest and most effective treatments available in modern medicine. Avoiding their use often results in poor disease control and increases the risk of severe complications.
Untreated or poorly managed asthma can lead to serious consequences. In the short term, children may experience severe, life-threatening asthma attacks requiring intensive care or ventilatory support. They are also more prone to recurrent infections, including bacterial pneumonia. Viral infections often trigger asthma exacerbations, and asthma itself predisposes children to secondary infections—a clinical interplay that can be particularly dangerous. These children frequently miss school, suffer from poor sleep, and have a diminished quality of life.
The long-term implications are even more concerning. Persistent, uncontrolled airway inflammation can impair lung growth and development, leading to reduced lung function in adulthood. Children may develop exercise intolerance and become unable to participate in physical activities, which further affects their overall development.
While asthma may not always be preventable, it is certainly controllable with the right approach. Early diagnosis, appropriate therapy, and regular follow-up are essential. Effective management hinges on five key principles: the right diagnosis, the right drug, the right dose, the right duration, and the right technique, combined with strict adherence. Avoidance of known triggers, annual influenza vaccination, and a healthy lifestyle are equally important. Good nutrition, preferably based on natural, home-prepared foods, along with at least one hour of daily physical activity, should be integral to a child’s routine.
It is important for parents to recognise warning signs early. Recurrent cough, wheezing, frequent hospital visits, repeated nebulisations, or excessive reliance on cough syrups should not be ignored. These are indicators that the underlying issue is not being adequately addressed. Timely intervention can prevent long-term lung damage and significantly improve outcomes.
Asthma, when managed correctly and consistently, does not have to limit a child’s potential. Children with well-controlled asthma can excel in academics, sports, and even competitive athletics at the highest levels. However, if neglected, the disease can silently progress, transitioning from an obstructive pattern in childhood to a restrictive pattern in adulthood, with irreversible lung damage.
The message is clear: asthma is manageable, but only if it is recognised early and treated with scientific precision and consistency.
(The author is a senior a Senior Consultant and Assistant Professor Department of Paediatrics Government Medical College Srinagar.)
