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The narrowing of the bronchi in a child can be detected early enough by measuring the rate of air flow or the peak-flow of the breath with the help of small, portable devices called peak flow meters. These can detect changes in the bronchi before any apparent symptoms of breathlessness, or the detection of wheeze through the stethoscope. The test is itself quite simple, the instrument not very expensive and the child can perform the test independently.

Peak Expiratory Flow Monitor or Meter measures the force of expiratory breath. The child after a full inspiration, exhales forcefully into the tube of the monitor which has an indicator and a scale attached to it. The force of expiration is indicated by the push of the indicator along a scale and is read as Peak Expiratory Flow Rate (PEFR). Usually with the onset of asthma there is a narrowing of the airways and the force of expiration decreases.

Although many asthmatics have normal lung volume, their obstructed bronchial tubes prevent air from being exhaled at the normal speed. If the first set of breathing tests show abnormal results, the child is asked to inhale a bronchodilator drug and repeat the test. Testing the amount of air that can be forcefully exhaled in one second (FEV1, forced expiratory volume in one second) is the most important test in asthma. If the second set of tests shows more than a 15 to 20 per cent improvement in the FEV the diagnosis of asthma is almost certain.

A peak flow meter can be compared to a thermometer. Sometimes a child may feel hot or feverish but the thermometer may show normal body temperature. Similarly a child may sometimes complain of a tightness or heaviness in the chest, but may still have normal lung function. The peak flow meter helps in determining whether the tightness of the chest is really an airway obstruction. It is light and simple and can be used at home, office or in a doctor’s clinic.

Measuring and Interpreting PEFR

1. Move the indicator to the base or the bottom of the numbered scale.

2. Stand up.

3. Take a deep breath.

4. Place the monitor in the mouth and grip the mouth piece with the lips.

5. Blow out as hard and as fast as possible. The indicator will move up.

6. Write down the achieved measurement or value.

7. Record the highest of the three measurements achieved.

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Nearly half of all children in Australia and New Zealand experience symptoms suggestive of asthma before the age of seven. Asthma is the most frequent cause of admittance to pediatric hospitals and one of the most common causes of long-term health problems in children.

Recent surveys and reviews have shown that the incidence of asthma among children in Australia is continuing to rise. At this stage, it is impossible to determine whether the growing prevalence of asthma among children is the result of greater community awareness of symptoms, better medical diagnoses or, simply, larger numbers of children being afflicted with the disease. What is apparent is that at least 20 percent of all children in both countries will experience an asthma attack at some point in their young lives.

As is the case with adult asthma, some children only experience mild or infrequent symptoms, while others suffer from chronic or severe asthma. It is not uncommon for some children to have a severe attack as infrequently as once a year and be perfectly well the rest of the time.

For some unknown reason, more boys than girls suffer from asthma. Boys also appear to have more severe symptoms. By adolescence this disparity between the sexes no longer exists.

Asthma can be difficult to diagnose in the first three years of life because it can be confused with so many other illnesses. It is particularly difficult to make a diagnosis in infants, as symptoms can be similar to bronchitis or croup. However, if episodic wheezing continues after the age of five, you can be fairly certain the child is presenting asthma symptoms.

An asthma management plan that is suitable for adults must be modified for children. Even if your child is a mild or infrequent asthmatic, a management plan should be discussed with your doctor. In the past it was believed that only severe asthmatics were at risk of death. This is not correct, particularly regarding the young age group. WITH CHILDREN, MILD ASTHMATICS ARE ALSO AT RISK OF DEATH.

There has been a tendency among doctors to direct attention to severe asthmatics at the risk of undertreating mild sufferers. The current medical approach is that all asthmatic children must be regularly assessed and given a management plan. The parents of asthmatic children and their chosen doctors must assume joint responsibility in ensuring that the child is receiving the best possible care.

Asthma is particularly distressing for very young children who are not old enough to understand what is happening to them. Having an asthmatic child is also very upsetting for parents and other family members. Parents are much better equipped to cope physically and emotionally with asthmatic children if they have a thorough understanding of the disease and have been instructed in how to deal with attacks and how to administer medication. It is also important for parents to learn to recognize the signs that may indicate an impending attack or a worsening of mild asthma, as Dr R., a Melbourne pediatrician, emphasizes:

Most children have episodic asthma that does not require them to be on medication all the time. Adult assessment and medication relies on lung function results. Many children with asthma are below the age when they can be tested on a peak flow meter or a spirometer. Therefore, it is very important for parents to be taught how to recognize asthma symptoms in their children so they can report them. When a child is very young and not yet able to explain how he or she feels, you have to rely solely on signs to make an assessement. I cannot stress enough how important it is that parents and teachers be taught to recognize these signs.

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