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Tuesday, November 3, 2015

What is Childhood Onset Asthma?

The following was originally published on  March 18, 2015, on

What is Childhood Onset Asthma?

Childhood Onset Asthma (COA) is the term used to describe cases of asthma that are diagnosed before the age of 20. While asthma may be diagnosed at any age, most children are diagnosed by the age of five. This is mainly due to the nature of childhood asthma, which usually tends to be allergic.

Here are some more facts to consider.

Statistics. According to the Centers for Disease Control and Prevention, 7 million children under the age of 18 have asthma. That means that 9.3 percent of all children have it. Asthma is the most common chronic disease in childhood, and the most likely cause of days missed from school. It results in 14.2 million physician office visits and 1.8 million emergency room visits each year.

Allergic (Extrinsic) Asthma. Most children have asthma triggered by allergies. This means their bodies develop an exaggerated response to substances in the air called allergens that are innocuous (harmless) to most people. Examples of allergens are dust mites, cockroach urine, mold, pollen, and animal dander. While allergies can develop at any age, they are most likely to develop early in life, and this might explain why most cases of COA are diagnosed early. It usually doesn’t take long for susceptible children to be exposed to their allergens, particularly boys.

Boys. According to the American Lung Association, about 4 million boys and 3.2 million girls have it. This means boys are 16 percent more likely to have asthma than girls. Boys are also more likely to have an asthma attack, more likely to miss school days, more likely to visit an emergency room for asthma, and more likely to be admitted to the hospital for asthma. The reason for this remains a mystery, although one theory suggests that boys are simply more likely to participate in activities that expose them to their allergens, such as running around in pollen-filled forests, or hiding under dusty, moldy porches. This trend starts to reverse itself during teenage years, and in adulthood women are more likely to have it than men.

Non-Allergic (Intrinsic) Asthma. Some children have asthma triggered by something other than allergens. Examples include:
  • Chemicals in cigarette smoke
  • Air pollution
  • Viral infections (RSV)
  • Gastrointestinal contents (GERD)
  • Cold and dry air
  • Hot and humid air
  • Anxiety and depression
  • Exercise (especially in cold, dry air)
Severity. Allergic Asthma usually doesn’t cause airway remodeling or scarring that sometimes occurs with intrinsic asthma. For this reason, childhood asthmatics generally have less severe asthma that responds well to corticosteroids.

Asthma Treatment. This makes it easier to control with asthma controller medicines such as Advair, Symbicort, Dulera, Breo, Flovent, Asmanex, and Pulmicort. Since every asthmatic is unique, finding out which medicine works best is often a matter of trial and error. Most asthma experts recommend all asthmatics have an asthma rescue inhaler like Albuterol nearby at all times for those inevitable asthma flare ups.

Allergy Treatment. Allergy testing may help a physician diagnose allergies. Treatment usually involves efforts to avoid allergens, or medicines such as Claritin, Zyrtec, Benadryl, and Singulair. Preventing and controlling allergies is often the best way to prevent and control asthma.

Remission. Physicians used to tell asthmatics children that they would outgrow their asthma. Modern evidence suggests this is not true, that asthma never truly goes away. However, sometimes it does go into remission. One theory is that once children go through puberty their airways become larger and less sensitive. Another is that older children are less likely to expose themselves to their asthma triggers. For instance, older kids are less likely to crawl under dusty porches, or play in pollen-filled forests.

Conclusion. The good news is that, while there is no cure for asthma, it can be controlled by avoiding and controlling asthma triggers, and by taking asthma controller medicines on a daily basis, such as inhaled corticosteroids. By working with a physician and following a treatment plan, asthma may appear to go into remission.

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