Sitting in the waiting room at Hamilton Community Health Network’s Burton clinic, I see an adorable little boy. He’s sitting about three feet from me, but I can hear him wheezing. I can also see the concern on his mom’s face as he continues to look at his book and tell her all about the animals. She laughs and smiles, but I know what’s going through her mind: “My son can’t breathe, and there’s nothing I can do to fix it.”
I’ve been there – many times. In fact, when my son was three years old, I was at his pediatrician’s office on a regular basis treating him for asthma that was triggered by colds. Granted, when a patient is three, doctors aren’t always willing to give him a label; but as I’ve also fought asthma my entire life, I know what it looks like and more to the point, what it sounds and feels like.
Just like this little boy, you could see my son’s chest rise and fall as he was just sitting. As a mom, it’s at those times that you feel the fear rise in your stomach and hope that the albuterol inhaler will open those breathing passages. After all, I knew a doctor who died on the floor of a hospital with his rescue inhaler in his hand. Once the airways are closed, they’re closed.
So, over the years, I’ve wondered about this disease. What made me get it, but not my sister? Why my son but not my daughter? Why this little boy at the clinic? Join me as we delve into the world of asthma with Dr. Meggan Shell of Hamilton Community Health Network, a pediatrician who practices at Hamilton’s Burton clinic.
“I see quite a few asthmatic patients, but together with their families, we’re managing it,” explained Shell. “Parents have to be involved when it comes to managing diseases, including asthma. But, with asthma, people often ignore the signs, so a lot of education goes along with the treatment.”
SS: Tell me a little about yourself, Dr. Shell.
Dr. Shell: I’m originally from Royal Oak, did my residency at Hurley in Pediatrics for three years, and now I’m here at Hamilton. I’m asthmatic and have a cat with asthma.
SS: You have a cat with asthma?
Dr. Shell: Oh, yes – cats can get asthma. I treat him with an inhaler just like I would a human.
SS: Do you think people know what asthma is? And about it’s severity?
Dr. Shell: Most have an idea of what it is, but many don’t understand the severity. That’s the largest difference between physicians and our patients and their families – they don’t think it’s serious and as a physician, we know it’s a very serious disease that needs treatment and management. Plus, asthma has a wide range of severity. It can be an occasional wheeze triggered by respiratory infection, or life-threatening with a patient needing a ventilator in ICU and even dying from it. When it gets that severe, it’s usually because people do not know the warning signs.
SS: So, what are the warning signs?
Dr. Shell: The basic signs are wheezing, cough, difficulty breathing, prolonged expiration (breathing out), increasingly labored breathing and inability to speak in full sentences without a breath.
“The largest difference between physicians and our patients and their families is that they don’t think it’s serious and as physicians, we know it’s a very serious disease that needs treatment and management.”
Meggan Shell, MD
SS: How do you know if your child has asthma?
Dr. Shell: In young kids, earliest signs are wheezing associated with respiratory infections. Consider other risk factors – parents with asthma, more than three wheezing episodes in a year, wheezing without a cold or respiratory infection, eczema and seasonal allergies. Those are the most common signs. If you suspect or are worried your child may have asthma, talk with a doctor about it.
SS: How does someone develop asthma? Are there contributing factors?
Dr. Shell: Your family history and genetics are the largest contributor or risk factors. Environment also impacts your chances of developing asthma – if you’re in a home with tobacco smoke and are prone to asthma, you’re going to develop it.
SS: Is there a way to prevent it?
Dr. Shell: There’s no way to prevent asthma, but you can prevent exacerbations by eliminating triggers, and taking medications correctly.
SS: What are asthma “triggers?”
Dr. Shell: Viral respiratory infections, smoke – any type of smoke – exercise, weather changes, air pollution, extremely hot or cold air, strong perfumes or scents, allergens such as dust, mold, pollen, pets, etc.
SS: What’s the best way to manage asthma?
Dr. Shell: Doctors will often use the “step” approach. The first step is to start treatment with “emergency” medication, such as albuterol, when symptoms occur and limit triggers and exposures to those triggers. Then, if the patient is having problems more than once a week, a doctor may prescribe a daily controller medication, such as Qvar.
SS: What’s the biggest challenge in managing asthma?
Dr. Shell: The biggest problem is lack of education and understanding. I see patients on a regular basis, and they understand how to take their medication when they’re talking with me. But when they’re home, they often forget which medication is for daily treatment and which is for an “emergency.”
Also, just to note, the best way to take asthma medication is with the metered dose inhalers used with a spacer (a device that makes administering aerosolized medication easier). Patients don’t know that we can use spacers with infants instead of nebulizers. Studies done on the nebulizer machine versus the spacer have found only ten percent of the medication actually gets into the patient’s lung when you use a nebulizer. So, if you need to use your rescue inhaler, use a spacer. You get more of the medication and you get it faster.
SS: Whose advice should parents seek if they suspect their child has asthma?
Dr. Shell: First, the child should be examined by their primary care doctor (PCP) or pediatrician. They will guide you through diagnosis, treatment, and if needed, refer you to a specialist, such as an allergist or a pulmonologist. Many patients can be treated by a pediatrician, family practice physician or primary care physician.
SS: What’s your best tip for managing asthma?
Dr. Shell: Don’t delay seeing your doctor, and open communication is a must. Take medication as directed, avoid triggers as much as possible and seek care at the first sign of exacerbation. Follow your asthma action plan. Even if you are managing it well, post your asthma action plan where you can find it, such as the inside of your medicine cabinet door. And always have your rescue inhaler with you.
That’s more than one tip, but all equally important. Managing asthma is a life-long commitment of the patient and his or her family. It’s important that asthmatics continue to stay active and healthy. Remember, treatment is available and you can live a full, active life with asthma.
- According to the Centers for Disease Control and Prevention (CDC), 1 in 13 people have asthma.
- Asthma is the leading chronic disease in children.
- 8.4% of children under 18 have asthma; 7.6% of adults
- Each day, ten Americans die from asthma. Many of these deaths are avoidable with proper treatment and care.
- African-Americans are three times more likely to be hospitalized with asthma and three times more likely to die from asthma.
- People who live below 100% of the poverty level are more likely to have asthma than those above the poverty level, according to the CDC.
Source: Asthma and allergy Foundation of America