I was out riding my bike with my buddies the other day and had an experience that reminded me of something I talk to parents about all the time…that is the concept of bronchial sensitivity. We all understand that different humans are born with different, genetic sensitivities to irritants. Let’s take light sensitivity for example; some of us with very dark skin can tolerate an enormous amount of sun exposure without burning and others of us sustain suffer first and second degree solar burns from minimal sun exposure. How can this be? I go to the beach with my black friends and they can be out on the beach all day without any problem and me, sitting right next to them, I get sick with severe sun poisoning. The answer is mostly in the genes and today we are going to explore how this relates your children.
The irritants we are going to talk about today are bronchial irritants…you know, things, other than viruses, that when inhaled, cause an irritant effect in the lungs of children. The irritant triggers a number of things to happen in the airways of the child such as swelling and inflammation of the bronchial membranes, increased mucous production, and even bronchospasm or muscular tightening of the airways. All these reflexes are presumably there to protect the child’s lungs. When children are pulled from a burning home having been exposed to noxious house fire smoke, these are exactly the symptoms they have: airway swelling, increased mucous production, and bronchial constriction. Now here is the key concept that I want you to learn today. Not all children are born with the same bronchial sensitivity, some having great susceptibility to irritants and other children, not so much; just like my sunburn analogy.
I know it seems crazy and very unlikely, but some children have the smoke inhalation response when they go out on a cold day and exercise. Some trigger these reflexes if they get near a cat or go into a barn. Some begin to wheeze and cough if they inhale some chemical like perfume, get a viral infection, or inhale a minute amount of a cleaning product that contains chlorine or a volatile solvent. But, most children aren’t bothered at all around these things. How can children be so different you ask? The answer is mostly in their genes.
Now here is the another concept I want you to master. Now that you understand the concept of bronchial sensitivity, you need to know that bronchial irritants are additive. I see it everyday in children when they are sick. The most common situation I encounter is a child with allergy who gets a cold during pollen season. A little grass allergy PLUS another irritant like a cold= big trouble, you know airway swelling and inflammation, more bronchial mucous, and bronchospasm. Or the situation that happened to me the other day while biking; I had a little spring allergy that I get every year at this time + breathing a lot of cold air while biking on a cold day for 2 hours+ I inhaled some particulates from the exhaust of a diesel car at a stop light. Bam, for me these things added up to 20 minutes of non-stop coughing, lots of bronchial mucous and a little wheezing. So here is the Doc Smo pearl of the day; when it comes to bronchial irritants, sometimes 1+1=3. Maybe this is why so many grandmas believe that children shouldn’t play in the cold when they already have a cough. Grandma understood bronchial sensitivity without med school; she just observed children with great care. Amazing. So if your child wheezes, gets croup easily, has bronchitis more than twice a year, or has ever had pneumonia, try be especially mindful of exposing them to bronchial irritants, especially if they already have a cough. Cigarette smoke, cold air, pollens and dust, perfumes, smoke. or chemical fumes from cleaners, solvents, or paint can really tip them over the edge.
Thanks again for joining me today. If you enjoy learning pediatrics the pedcast way, take a moment and subscribe to the feed at www.docsmo.com. That way, you will get an email notice of each weeks post. I hope you will join me every week. This is Doc Smo, hoping if your child already has a Hack, you will take care not to let them have a bronchial Attack. Until next time.
Bronchial sensitivity and bronchial reactivity in children with cough variant asthma.
Bronchial responsiveness: sensitivity, reactivity, maximal …
Egyptian Journal of Chest Diseases and Tuberculosis
Reactive airways dysfunction syndrome and irritant-induced asthma