Master A, aged 3year 4 month presented to Aster CMI with complaints of fever, cough, cold and mild breathing difficulty since 4 days. He has had similar complaints in the past 6 months with symptoms recurring every month. Mother also complains that the symptoms started only after the child started school and was perfectly fine when at home. On further query, there was no significant past history of Atopic dermatitis/Allergic rhinitis. A child is absolutely fine between 2 episodes of? viral induced wheeze, with no inter-interval symptoms. There is neither significant family history of asthma /Allergic rhinitis nor significant environmental history (Smoking in the house, Carpets, Fluffy toys, Pets, Construction in or around the house). Mother reiterates that she is worried as her friends and relatives feel that, this is asthma and her child would require prolonged treatment which can be addictive as well as significantly harms the child due to its side effects. She is also worried about her Son’s immunity being week.
Here we have a 3year 4month old toddler, who has just started school during monsoon season, presenting with above mentioned complaints. The questions asked by the mother are not only appropriate but also very practical. So let’s start answering her questions one by one.
Is this Asthma?
A. a heterogeneous disease – a syndrome - characterized by chronic airway inflammation. It manifests by the following respiratory symptoms: wheeze (a whistle on the chest), shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory air flow limitation. This child, who started with symptoms only when he started school, without any pre-existing problems has symptoms only once a month associated with fever with no inter – interval symptoms (i.e. no night-time, daytime and exercise induced cough). There is also neither significant personal, family of asthma/allergic rhinitis nor environmental exposure. So is this asthma? No. we call them as “under 5 wheezers”, and as this child is wheezing with every viral infection, we call them “viral induced wheeze”.
How is this viral induced wheeze different from Asthma?
A. Asthma is a condition in which, the child either coughs or wheezes in the night-time, daytime or during exercise (Laughing, crying, playing) almost 4 days a week with recurrent episodes of increased wheeze during viral infections and exposure to triggers. This boy had no such symptoms and only wheeze with? Viral infections, so called viral induced wheezer.
How long does this last for?
A. Viral induced wheezing is quite common at the start of the academic career i.e. when child first steps into preschool (protected to unprotected environment for infections) and sometimes occurring almost every 15 days, but as the child becomes more immune to infections with breathing pipe increasing in size, the frequency and severity of it reduces and becomes infrequent to non-existent by 6 years of age.
What is the treatment? And for how long?
A. As your child has had frequent viral induced wheeze almost every month, we give a trail of inhaled corticosteroid with as and when required short acting beta agonist for a period of 3 months. This is given to prevent damage to the breathing pipe so as to restore the normal architecture of the breathing pipe without allowing further damage. If your child had, say one episode every 2 to 3 month, we would treat with as and when required short acting beta agonist only.
I have heard that this is steroid and harmful for my child as well as addictive, is that right?
A. Yes, its inhaled steroid is what we use in controlling inflammation. But to the contrary belief, inhaled corticosteroid are extremely safe. Firstly as it is given through inhalation route, the dose delivered to your child’s lung is only 10-15% of the actual dose, and secondly, systemic absorption is almost negligible and thirdly the dose that we use is called as low dose which is not associated with any side-effect.
And to answer to your other question of being addictive? This isn’t drugs to get addicted too. It’s similar to elders in the house using medications for diabetes or hypertension, i.e., used to prevent symptoms and complications of them!!
And last, do you think my son’s immunity is weak? Should I do something about it?
A. Your son’s immunity is absolutely fine. He is mounting a very good response to a viral infection. It’s just that the inflammation is so significantly high in your child’s breathing pipe that it’s causing it to narrow and cause wheeze. On the contrary, your son’s immunity is absolutely fine and doesn’t require any specific supplement.