Asthma Update 2016 (Pedcast)

Topic introduction


Ever wonder what asthma is and why so many children have it?  Understanding and treatment of this chronic condition in children has really come a long way in the past few decades and I thought I would bring you some of the latest information I have recently learned about the common condition called asthma.  I hope after listening to today’s discussion, you will be able to recognize the common symptoms of asthma and have some understanding of what is going on in an asthmatic child’s lungs so stay tuned to this important edition of Portable Practical Pediatrics!

Musical Intro

For those of you who are new to Portable Practical Pediatrics, I am your host, Dr. Paul Smolen, a board certified pediatrician who has practiced in Charlotte NC for the past 34 years. I think 34 years of middle of the night care for asthmatic children qualifies me as something of an expert so with that said, let’s get into today’s topic.

What is Asthma?

Let’s start with the question, what is asthma?  Many parents are surprised when I tell them that everyone, whether they are asthmatic or not, are capable of having the physiologic responses that asthmatics do during an asthma attack. You heard me right; anyone can have a bronchiole attack just like asthmatics do, even children and adults who don’t have asthma. Bronchospasm or tightening of one’s bronchioles is actually a protective reflex that everyone’s lungs are capable of in response to irritants. Wheezing, the high pitched sound coming from the lungs during an asthma attack, is the hallmark of bronchospasm. It is a protective reflex to keep smoke and toxic chemicals from injuring our lungs. Bronchospasm protects a child’s lungs. We all have this reflex that some describe as a loaded gun response, waiting for something to pull the trigger to start.  For non-asthmatic children, that “Something” is usually a serious case of smoke inhalation, inhaling strong heat like in a fire, or exposure to toxic chemicals.  It takes a lot to pull a non-asthmatic’s trigger. But not in asthmatic children; for them the trigger is usually pulled by just a cold virus or rolling in the grass on a nice spring day or running up and down a soccer field on a cool fall morning. In these children, the reflex has gone haywire, and the trigger is pulled for almost no reason. So you can see, asthma is a condition of heightened bronchial responsiveness, that I like to call twitchy bronchioles.  Low threshold of irritation combined with recurrent episodes that are reversible with medicine… you got a diagnosis of asthma.

Why is Asthma Becoming More Common in Children?

But why is this disease becoming more common? Fewer children in America are growing up around cigarette smoke, the air is cleaner than it was when I was a child, more kids have air conditioning and central heat, and power plants are putting out far less particulates than in previous generations, so why is the incidence of asthma climbing. The short answer is, no one knows but here are some of the theories:

  1. The Hygiene hypothesis-Lack of microbial life in a child’s gut is the root cause of allergy. This lack of germs stems from repeated courses of antibiotics, a lack of playing in dirt, not growing up around animals microbes, dishwashers that essentially sterilize what we eat, pristine clean food that may have been even irradiated, antibacterial soaps and gels, and a lack of cultured bacteria rich foods are among some of the reasons that seem to support this theory.
  2. Acetaminophen- there is evidence that children who take this drug seems to be more prone to allergies and asthma. Yes, Tylenol. We have talked about this before in previous podcasts. How this happens, I am unsure but research does seem to make a link that may be causal or just associated with something else these children do.
  3. Obesity and processed food, especially highly processed food found at fast food restaurants cause inflammation to ramp up in a child’s body and may be part of starting the inflammation in a child’s bronchioles. Very theoretical but there is some evidence that supports this theory.
  4. Vitamin D deficiency-Here is another popular theory. Childhood has come indoors and we all know that it is outdoors, under the influence of ultraviolet light, that a child’s body makes vitamin D. It’s absence somehow turns on inflammation again, the root cause of asthma and allergies.
  5. And finally, early severe viral infections with RSV and genetic factors clearly have a strong influence on whether a child develops asthma and allergies. Asthma. And maybe some of these genetic factors are gene expression changes from things that our ancestors experienced; the so-called epigenetics.


So now that you know what asthma is and some of the theories about why its incidence is increasing, let’s look at what recent recent research tells us about asthma?

  1. Attacks are most commonly triggered by everyday viral illness, most commonly rhinovirus, the ordinary cold virus.
  2. After a viral illness, a child’s bronchioles are hyper responsive for  7-12 weeks. That’s longer than we previously thought.  Unfortunately, most young children will get another viral illness before the 7-12 weeks go by so you can see how young infants have wheezing episodes almost continuously for the first years of life.
  3. While death from asthma is relatively rare, 1/3 of children who die from asthma only had mild disease before their severe attack. Their pediatrician didn’t feel that they had severe asthma beforethey had a fatal asthma attack.  I find this revelation particularly frightening.
  4. Severe attacks usually require the inflammation stopping effect oral systemic steroids but research has found that often one dose of a steroid called decadron, also known as dexamethasone, can abort an attack as well as the traditional five days of oral prednisolone.
  5. Increasing the preventative dose of inhaled steroid controller to 4X the preventative dose can often abort an asthma attack and obviate the need for oral steroids.
  6. And finally, research tells us that if a child is not doing well with their asthma, the most common reason for their poor control is that the child and their family’s are not complying with giving the the child their medications. It’s not that the medications don’t work; they are often not being taken for various reasons. Managing a chronic condition like asthma is difficult for families and frank denial of the existence of the illness can be very strong, especially in teens.


Preventing Asthma

I think in the next decade we are going to start really understanding what triggers asthma and we are going to learn how to prevent many children from ever developing it. Basic science research is closing in on the answers at a rapid rate. A child’s lungs, especially as they are growing, are very amazing and delicate structures. Preventing and controlling asthma needs to be a very high priority for both doctors, parents, and really all of society since it is the most common chronic illness that children experience.


Well, always, thanks for joining me for today’s pedcast. If you enjoy hearing about what is new in pediatrics with podcasts, take a moment to subscribe to Portable Practical Pediatrics on iTunes or at my website, Got a comment, share your thoughts and experiences with my listeners. Together, we can make children healthier. I know we can. This is Dr. Paul Smolen, noting that is doesn’t seem fair, that every child isn’t able to get a breath of fresh air.  Let’s change that. Until next time.



Smo Notes:


  1. Asthma Facts

  1. Why is the incidence of allergy and asthma increasing?