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November 19, 2019

Diagnosing and treating your child’s asthma: A "Q&A" with Scott Silverstein, DO


Scott Silverstein, DO

Scott Silverstein, DO

Nearly 9 million U.S. children have been diagnosed with asthma, according to the American Academy of Pediatrics. Asthma is a chronic lung disease characterized by episodes of inflammation and narrowing of small airways in response to asthma triggers.

With more than 170 patient care locations and approximately 1,500 employed physicians throughout central Pennsylvania and northern Maryland, WellSpan Health is here to help you and your family receive the care you need to stay healthy. Here, Scott Silverstein, DO, of WellSpan Pulmonary and Sleep Medicine, Ephrata, answers some of the common questions about diagnosing and treating pediatric asthma.

QUESTION. What is the difference between asthma and allergies?
ANSWER. Allergies are an immune system response to an environmental trigger (known as an allergen), such as pollen, dust, mold, pet dander or certain foods, to name a few. Signs of an allergic reaction include frequent or regularly recurring itchy eyes, nose, mouth or ears; sneezing; a runny nose; dry skin or hives; a productive cough; and wheezing or tightness in the chest. Asthma involves inflammation of the lungs that constricts the muscles around the airways, resulting in wheezing, coughing and shortness of breath. The bronchial tubes constrict, and air flow is reduced as the lungs expand. While allergens can provoke asthma attacks, other triggers can include upper and lower respiratory infections, smoke, cold or humid air, strong odors and strenuous exercise.

QUESTION. How is asthma diagnosed? 
ANSWER. Asthma can be hard to diagnose. Your child’s doctor or provider will consider the symptoms and their frequency as well as your child’s medical history. Your child might need tests to rule out other conditions and to identify the most likely cause of the symptoms.

Several conditions can have symptoms like those caused by asthma, including rhinitis, sinusitis, acid reflux or gastroesophageal reflux disease (GERD), vocal cord dysfunction and respiratory tract infections such as bronchiolitis and respiratory syncytial virus (RSV). To complicate the issue further, these conditions also commonly occur with asthma.

Tests that are commonly used in diagnosing asthma are:

Lung function tests (spirometry), which measures how air is exhaled and how quickly. Bronchoprovocation, which measures how the lungs react to certain provocations, such as exercise or exposure to cold air.

If the diagnosis of asthma is uncertain after lung function tests, your doctor might recommend an exhaled nitric oxide test.

High levels of exhaled nitric oxide can mean that airways are inflamed, which is one of the signs of asthma.

However, these asthma tests aren’t accurate for children younger than 5 years of age. Until that time, your doctor will rely on information you and your child provide about symptoms to determine appropriate treatment.

QUESTION. What are the treatments for pediatric asthma?
ANSWER. Avoiding triggers, using prescribed medications and monitoring daily asthma symptoms are among ways to control asthma in children of all ages. Most commonly, short- and long-acting bronchodilators for symptom relief and inhaled corticosteroids are critical for reducing inflammation in the airways. Singulair (Montelukast) is another medication, taken in tablet form, which has demonstrated benefits for asthma and allergies as well.

There also are several injectable biologics available that have been shown to dramatically reduce asthma symptoms in persons with certain types of asthma. Biologics are medicines that target a specific molecule made by the immune system.

QUESTION. Can children with asthma participate in sports?
ANSWER. Ten percent of Olympic athletes have exercise-induced asthma. With a proper treatment plan, any asthmatic should be able to participate in sports to the best of their ability without being hampered by asthma complaints.

QUESTION. What steps should a parent take to ensure that their child’s caregivers are equipped to handle an asthma attack?
ANSWER. It is critical for the child’s medical provider to create an asthma action plan that describes when and how asthma drugs should be used, what to do when asthma gets worse and when to seek emergency care. The plan should be shared with everyone responsible for the child’s care.

Visit WellSpan.org/Asthma or call (717) 738-4334 to learn more about our pediatric asthma program.

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