Difficulty Breathing, Childhood Asthma/Wheezing the Basics- Dr. Virgil

It is easy as a pediatrician to share instructions with parents, to give them the medical information pertinent to taking care of their children with health conditions like Childhood Asthma. It comes second nature to those of us in practice long enough. We train for this; we go through rigorous hours as residents in the hospital. We sit for long stretches in the library pouring over text books and doing exam bank questions in preparation to give our patient families the absolute best clinical information. I know that I’ve done this effectively over the years.

However, I did not really know the feelings of fear, of anxiety, and terror parents experience when their child has difficulty breathing until I had to take care of my own child as he struggled with wheezing. An evening like any other I drove through Atlanta, GA traffic to pick my son up from daycare as I always did. As we drove home, I noticed he indeed was coughing a lot as his daycare director described earlier. However, my mind was preoccupied with fighting though the bumper to bumper traffic and running a list in my mind of dinner preparations. In the background my son continued to cough and cough. We finally arrived at our house after about 30 more minutes and pulled into the garage. I went to get him out of his car seat where he had been sitting more quietly than usual. I then finally noticed how rapidly his stomach was moving. I quickly ran into the living room and took his shirt off as we are trained to do, and noted that indeed he had retractions (hard movements of his chest from breathing) and continued to cough.

He’s wheezing I thought to myself, the words hit me like a ton of bricks. I was worried. I was scared for him

I had seen this many times before and knew what to do, but here it was happening to my own little one. I will admit, I panicked. For what felt like 5 minutes I just froze, held him close, and panicked. I know it was not actually that long in reality before my brain registered the respiratory distress and I began to act. We had a nebulizer machine in our home and albuterol liquid medication that goes in it. I ran to get those items all the while reassuring my little one he would be okay as he had picked up on my concern. I placed the face mask on him as the mist disseminated from the machine with the familiar hum going. In that moment I sent up a prayer of protection for my child. I called my husband and a friend who was also a pediatrician. The breathing treatment made a difference as I had seen so many times before in other children. We continued a few more treatments that night and went in to his doctor in the morning.

I’ll never forget that feeling though. Moments like these remind me that my patients and their families are not just data. They are not a collection of symptoms and signs with treatment plans. The experience of illness is emotional, it is palpable fear sometimes, it is profound worry. What helps us all is recognition of illness and having a plan. It provides some level of control in a situation that may seem out of our hands, even for someone with experience.

As we continue through what many of us in healthcare call respiratory season, cold and flu viruses increase the potential for kids who have reactive airway or asthma to have flares. A very important part of management of asthma or wheezing is knowing when to use medications, and how to use them correctly. I have found in my experience as a physician parents do not always understand the difference between a rescue medication (such as albuterol) vs a daily medication. Additionally, the technique of using an inhaler with spacer is not always done correctly. I encourage parents to talk with their child’s physician about wheezing/asthma several times a year and review techniques.

So please remember these simple recommendations to help improve life for your child with asthma or wheezing.

1. Find the triggers; talk with your child’s doctor about allergies, seasonal changes, foods that aggravate the wheezing. Sometimes eliminating or minimizing triggers can help cut down on asthma attacks/wheezing episodes.

2. Understand the signs, learn when things are escalating. It is extremely important to understand when you need to seek immediate or emergency care for your child who is wheezing or having an asthma attack. This should be discussed in detail with your child’s pediatrician.

3. Use medication correctly; follow instructions on how to use your child’s rescue medication (albuterol) and daily asthma medications. Ask questions about medication frequency and usage. I encourage families to put this information up in an area of the house where it can easily be seen. Carry medications with you if you are traveling away from home.

These three factors are commonly described in the American Academy of Pediatrics literature as key in educating parents about asthma and wheezing. The more parents understand the process, the better outcomes children will have managing disease and respiratory illness.