Pollution: The Main Cause of Childhood Asthma

Childhood asthma is quite different from adult asthma in a number of ways. Children, if treated well, may get rid of asthma later in life. Vaccination is a very important part of disease management. As we know, asthma is a condition in which the patient has over–reactive (hyper-responsive) airways, which repeatedly go into congestion and obstruction. The patient develops cough, difficulty in breathing and it may result in decreased activity. The situation reverses in a few days either on its own or with medication. There is an alarming increase in the prevalence of asthma in the major cities of India. One of the frequently asked questions is why asthma is becoming so common? An exact answer is not available. However, a number of reasons can be listed for the rising incidences. Outdoor pollution is a major factor but it is only one of the causes. Exposure to indoor allergens in early life, changing diet, pets, reduced exposure to infections and passive smoking by the child, all contribute to the increasing number of children suffering from such chronic diseases. Indoor pollution is also a major factor. After all, the child spends more than 16-18 hours at home every day. There is a clear scientific evidence to prove that indoor pollutants, irritants and allergens cause asthmatic attack. All efforts should be made to avoid them. While pollution is a causative factor, it must be remembered that asthma is very common even in developed countries where pollution is not high (e.g: Australia). Thus, other factors should also be considered, such as inherent hyperactivity to various triggers. Risk factors for developing asthma are as follows: Family history of atopy / allergies or asthma Trigger factors such as mites, pollens, animal dander resulting from pets, dust Passive smoking Maternal smoking Irritants such as perfumes, room fresheners, incense sticks Construction activity, which is common in Delhi/NCR area Obesity Atmospheric pollution Stress — both physical and mental Premature and low birth weight babies Recurrent viral infections in early childhood Over usage of antibiotics Risk factors for persistence of symptoms are as follows: Age lesser than one year or above three years at presentation Family history of asthma Coexisting allergies Severe or frequent exacerbations Abnormal lung functions tests In monsoons, with increased humidity and moisture level in atmosphere, the situation worsens. Viral infections are more common and transmitted easily in the day-care boarding and schools. Foods, generally, do not cause asthma in children. They can sometimes be the cause of exacerbation in a child who already has asthma. But before we incriminate a particular food item as the cause, we should prove that a particular food item causes the exacerbation every time the child eats it. Problems, which we have encountered may be varied, for example, parents refusing to accept the diagnosis or the treatment options, doctors who may either under-diagnose the condition due to lack of experience or try to underplay and simply hide the facts from parents, etc. The emphasis now is on administering the drugs by inhalation to small children and even infants. Thus, now children are advised metered dose inhalers (MDI’s), dry powder inhalers and nebuliser therapy. Use of spacer devices is encouraged. The side effects are minimised by these methods while the beneficial effects are enhanced. While medicines form an important part of management of childhood asthma, the guidelines emphasise that environmental control should be an integral part of management in each and every case. Thus, patients are accordingly counselled. IN MONSOONS, WITH INCREASED HUMIDITY AND MOISTURE LEVEL IN ATMOSPHERE, SITUATION WORSENS. VIRAL INFECTIONS ARE MORE COMMON AND TRANSMITTED EASILY IN THE DAY-CARE BOARDING AND SCHOOLS.