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Making sick children better.

Dr John Chapman FRCPCH

Consultant Paediatrician (NHS & Private)

 General Paediatrics, Asthma and Allergy

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How to use your inhaler - cartoon

How to use your inhaler - video

A case study in asthma

Jack (not his real name) is a young lad who was keen on sports particularly football and running. He had asthma but it was under control. 

One winter, following a bad winter viral infection, Jacks asthma control started to deteriorate. He couldn't run without coughing and he found that football matches on cold winter mornings were particularly troublesome and, as football was a big part of his life, he was pretty miserable. 

Luckily for Jack, he had very proactive parents. They spoke to me and I saw him pretty swiftly before he lost his place in the team. It took only a couple of visits and some changes to his medication to get him back to his previous goal scoring best. 

Too many asthmatics leave their symptoms untreated. This can lead to worsening chest infections and hospital admissions. 

Later that year, I had the dubious pleasure of watching him beat one of my own children into second place in an inter-school running competition! 

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What is asthma?

This is a simple question with a complicated answer. I will try to cover the main points but still keep my explanation simple. 

Let's go on a journey into your lungs starting at your mouth. Behind the tongue, is the voice box. 

Beyond the voice box, is the trachea, which is a simple stiff tube. The trachea then splits into two smaller tubes (bronchi) and these tubes split into two and so on. The tubes get smaller and smaller as we get deeper and deeper into the substance if the lungs. Bronchi split to form bronchioles and these split until they end in an air sac called the alveolus which is like a little bubble. It is here that oxygen passes into the body and carbon dioxide comes out. 

Asthma is a disease of the large bronchioles. These bronchioles are lined with airway skin (epithelium) and surrounded on the outside by muscles. 

If you have asthma, your airway epithelium is swollen and sticky - a bit like you might see in active eczema - it is a similar disease after all. 

If you have asthma, your airway muscle is very twitchy and when it contract is squeezes the bronchioles. This, combined with the swollen epithelium causes narrowing of the tube which makes it difficult to breathe through.

The muscle twitchiness and airway swelling are made worse by viral infections (colds and flu) and by contact with allergens such as cat spit, grass pollen or house dust mite. 

And, like any muscle, the more you use your airway muscle the bigger and stronger it gets. Which means that untreated asthma can get worse and worse. 

Salbutamol, in the blue inhaler, relaxes the airway muscle very quickly and very effectively. This effect lasts for several hours and then the muscle returns to its previous twitchy state. Salbutamol does nothing for the airway swelling. 

Inhaled steroids (and steroid tablets such as prednisolone) act on the airway swelling AND the muscle twitch but only slowly. They can take a couple of months to start working but they will eventually remove the swelling AND stop the twitch long term. If you take these for a couple of years then your lungs will be identical to those of a non-asthmatic. Even the pumped up muscle will go back to a normal size. 

This why you should take your inhaled steroids every single day even when you are well. 

There are many other very good asthma medicines.

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