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SOME FACTS ABOUT CHILDHOOD ASTHMA
It is interesting that almost half the inhabitants of the island of Tristan da Cunha have asthma and yet there are no extra provoking agents. The commonest allergen to be found there is the house-dust mite, just like in this country. It seems to be the inbreeding on Tristan da Cunha that is vital, as of the five original female inhabitants three had asthma, indicating that most of the asthma is handed down from generation to generation.
There is also no doubt that if you move children from a rural to an urban way of life then asthma increases dramatically. The most likely reasons are the increased pollution and faster, more stressful lifestyle in the towns and cities. However, it may be that it is something even more basic in that movement of people from the country to town is often associated with a decrease in the extent to which children are breast-fed. In the first six months of life the child’s chief nourishment is from milk. If the mother’s milk is replaced by cows’ milk the exposure of the infant to foreign and potentially allergenic material will be increased. It has been shown that avoidance of cows’ milk does reduce the chance of developing eczema which seems to have the same genetic and allergic basis as asthma. In Papua New Guinea asthma is virtually unknown and all children there are breastfed. Whether this is in fact the sole reason for the freedom from breathing problems cannot be proved.
Apart from the question of breast-feeding there is a hypothesis that social differences are important. It was at one time suggested that children from upper social classes were more prone to asthma. This was put forward when school doctors’ records in the Isle of Wight were analyzed. Unfortunately a similar study amongst children in Aberdeen showed an excess of asthma in the children of semi-skilled and unskilled manual workers.
When you look at all the evidence, it appears certain that the dual influences of external and inherited forces are closely interlinked. Climatic and socio-economic circumstances cannot alone induce asthma to those not inherently predisposed. Equally, given an inherited tendency to asthma, the environment, whether this be in terms of exposure to allergens, adverse weather conditions, industrial pollution or domestic circumstances, can play a major role in actually triggering an attack.
Thus, whether viewed in the individual child or in whole communities, there is no escape from the conclusion that asthma is truly a multi-factorial disorder and cannot be put down to a single cause. It is the summation of the effects of inheritance and environment that determines whether asthma will or will not be experienced. The addition of one further trigger factor, however minor it may be on its own, can be sufficient to bring the underlying tendency to asthma out into the open. If your child is fortunate not to combine enough of the trigger factors together at any one time, then the wheezing problem may never surface. Conversely what might itself be only a minor adjustment in environment or medical management may be all that is needed to convert a troublesome persistent asthma to a mild and occasional wheeze.
This complex situation explains why it is proving so difficult to find a single cure for asthma. Some day, no doubt, a remedy will be found but that time seems some way off. It is important to remember that while this cure does not yet exist; present-day treatment is very effective at both preventing the attacks developing and relieving any wheeze that may arise.
Why is it, then, that a number of children die from asthma every year if the treatment is so efficient? I am quite certain there are two main reasons: first, the therapy is not given in a logical fashion but in a rather haphazard irregular way. This may be the doctor’s fault in not fully explaining the situation or it may be the parents’ fault for not ensuring their child takes the recommended dosage. The second reason is that it has only recently been realized that while rapid narrowing of the airways by muscle spasm has always been assumed to be the main process in asthma, actual swelling of the airway linings is just as important and can come on much more insidiously. This is much slower to resolve and can lead to exhaustion. It is vital therefore if your child’s peak flow is consistently below normal for you to see your doctor for assessment. The only really effective treatment for swelling of the linings is cortisone, either via an inhaler or in tablet form. If cortisone is used correctly in short sharp courses it is perfectly safe.
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