Debi Kendrick delivered her son to school to take his state tests then reluctantly returned to her car and headed for work. Her family had spent the previous night in the emergency room because Zak’s airways were restricted, and his air intake had dropped to dangerously low levels. After too much medication, Zak shook, tired and jittery, his lips blue. The next morning he’d been better, but was still coughing and experiencing shortness of breath. Debi asked the school administration if she could wait in the nurse’s office in case Zak’s asthma became worse. Administration said she could not stay, so she drove to her office, praying her son would be alright.
As she settled into her cubicle, Debi noticed the blinking message light on her office phone. She hit the button and Zak’s physician’s voice boomed. He demanded Zak be brought to his office immediately for monitoring. “What do you want?” he asked. “A dead child or a child who passes his state tests?” Debi’s stomach churned. Had she made the wrong decision? Then the school nurse called, worried that she could not be close enough to Zak during the tests to help him in case he had an attack. The state had strict guidelines regarding testing, and only certified monitors were allowed in the testing room. Debi leaned back in her chair and listened to the assistant principal’s message. He said that Zak’s coughing had been a major distraction to other students, and the school did not have the staff to move him into a room alone. Debi knew then that she should have stayed. She should have insisted on it.
Zak’s voice came over the phone’s speaker last. “Mom, it’s me. I know I can take this test fast. Then you can pick me up and we can go to the doctor’s office.” His calm voice sounded mature beyond his eleven years because Zak had endured many emergencies. Like nine million U.S. children, Zak suffers from asthma. Diagnosed before his first birthday, he has experienced one battle after another in his struggle to breathe easy and be a normal kid.
Symptoms and Diagnosis of Asthma
Dr. William Neaville, Pediatric Allergy and Asthma Specialist at Children’s Medical Center Dallas, describes asthma as a chronic disease with no known cure. Asthma is also known as reactive airway disease, a condition affecting the respiratory system. Sufferers experience inflamed airways. Because of the inflammation, airways are more sensitive than normal, causing a greater potential for irritation. Obstruction of airflow occurs when muscles around airways tighten, and often mucus production increases. These problems combine to restrict airflow to the lungs, resulting in the body not receiving enough air to function properly. During an asthma attack, a person experiences suffocation. Asthma claims five thousand lives annually.
What causes asthma? Approximately 40% of children with asthmatic parents will develop the condition. “Other factors, such as delayed lung development, may also be involved,” according to Dr. Neaville. “Some infants may be diagnosed as asthmatic if they experience recurrent wheezing, even if the wheezing is due to a viral infection.” Asthma can be mild or severe and is usually affected by environmental triggers such as pet dander, smoke, seasonal allergies, stress, exercise or air pollution.
“Asthma symptoms include wheezing, coughing, tightness in the chest, and shortness of breath,” Dr. Neaville explained. “The average age for diagnosis is two years, and some children may grow out of it.” Asthmatics may also develop a skin condition known as eczema.
Treatments of Asthma
For children with asthma, the best prevention for attacks is trigger avoidance. The most common treatment is steroids. Many young children take asthma medication through a nebulizer. This piece of equipment forces air over liquid medication to create a mist, which patients inhale through a mask. Older children may also use a metered dose inhaler, or MDI.
“The types of medications don’t change from patient to patient,” according to Dr. Neaville. “What does change is dosage and delivery method. Controller medications are given, usually two times per day, to prevent symptoms. Rescue medications are provided to counteract asthma attacks.”
Two classes of medications are currently used to treat asthma. Anti-inflammatory medications include corticosteroids and cromolyn sodium. Leukotriene modifiers are a new type of anti-inflammatory medication. They differ from other anti-inflammatory medications in that they block leukotrienes, chemicals that cause inflammation.
Bronchodilators are the second class of asthma medications. By relaxing the bronchial muscles, bronchodilators dilate airways, allowing unobstructed airflow. Some bronchodilators are beta adrenergic antagonists, methylxanthines, and anticholinergics.
Zak’s symptoms subsided significantly after he had his tonsils and adenoids removed at the age of five. Until that time, recurring colds and strep throat aggravated his asthma. According to Debi, “The colds and strep throat tapered off when he developed some immunities, but having his tonsils and adenoids removed helped his breathing immensely.”
While the old remedy of holding a chihuahua to transfer asthma to the dog isn’t likely to be effective, asthmatics have reported success with other natural treatments. These include chiropractic care, nutritional supplements, herbal and homeopathic remedies, and use of essential oils. Some supplements, herbs, and essential oils act as bronchodilators. They may also reduce inflammation, mucus, and seasonal allergies.
Barriers and Hurdles
Parents and caregivers of asthmatic children should enroll in classes to learn about asthma and how to administer medications properly. Pediatricians or hospitals can advise where asthma education is offered. “The best things are for parents to know as much as they can, avoid triggers, and use medications correctly,” says Dr. Neaville, whose practice offers asthma education classes.
Some parents are not with their children twenty-four hours a day. Debi Kendrick remembered Zak’s daycare center. “Nebulizers lined the kitchen counter. The daycare workers were wonderful about giving Zak his required two times per day treatments.” At Zak’s elementary school, the PTA purchased three nebulizers for the school nurse. While children cannot carry MDI’s on their persons in public school, they can go to the nurse for medication as needed, if parents provide appropriate documentation and supplies.
Debi first started administering nebulizer treatments to Zak when he was a toddler. She would hold him down, feeling anxious and nervous. Her husband, Aaron, who was diagnosed with asthma at age sixteen, explained that holding Zak down and being anxious would only cause more stress for Zak and intensify his asthma attacks. Gradually, Debi learned administer treatments calmly and methodically. This helped Zak and her deal with treatments and attacks much better.
“I will never feel what Zak and Aaron feel because I don’t have asthma,” Debi said. “But something about watching my child unable to breathe makes it hard for me to breathe too.”
Educational, physical, and psychological issues are not the only challenge for a family with an asthmatic child. Because of Zak’s asthma diagnosis, the Kendricks have been turned down by insurance agencies and upgraded, which means they were assigned a higher deductible than normal. Currently, they can only attain catastrophic coverage for Zak. This means a high deductible for emergency treatment, a deductible for prescriptions, and a ceiling that is usually exceeded by June of every year. “If Zak has to be hospitalized for asthma, it’s not covered by insurance,” Debi explained. “His medications cost about $150 per month.”
Living With Asthma
Children with asthma do not have to live sheltered lives. Zak has played soccer, baseball, basketball, and golf. He also roller blades, skateboards, and “pretty much loves every sport,” according to his mother. In the summer he attends College for Kids at a local community college, and he sings in his school’s honor choir.
Zak isn’t shy about telling people he has asthma. His friends know what to do if he stops mid-court and says he needs his inhaler. They run to his backpack, bring him his inhaler, then hold up one finger at a time after Zak takes a puff. When they get to ten, Zak releases his breath and begins to relax, taking in more and more air until he’s back to normal.
Not all asthmatic children can endure outdoor sports because exercise and allergies may trigger an attack, even if they are on a daily double dose of controller medication. The Consortium of Children’s Asthma Camps hosts summer camps to allow high-risk children a chance to enjoy a camp in a safe environment. Specialists on staff assist with medications and emergencies.
Neaville advises parents to let children be themselves, and that’s exactly what the Kendricks have done. Zak has learned to deal with his asthma as a part of everyday life. “At first I worried he wouldn’t be able to do all the things boys do,” Debi said. “But he’s accomplished everything he’s attempted pretty well, I think. Of course, I wish he didn’t have asthma. It would make all our lives much easier. But the older he gets, I see him handle it more himself, and with confidence.”
Nine million children in the United States suffer from asthma. For children under the age of fifteen, it is the third leading cause of hospitalization, and it accounts for more than ten million missed school days each year. Through education and treatment, asthmatic children are living, breathing examples of courage and confidence.