By Dr Udaya S 

Mangaluru, Aug 26: Asthma and allergy is a very old disease. Allergy had no good explanation for almost 50 years ago. Later there were discovery of pollen -hay fever, atopy, Asthma, serum igE and so on. This led to the discovery of allergy as an immunological process. So atopy means patient is genetically wired to be predisposed, when patients’ immune system recognises the allergen and produces mediators of allergy is sensitization and when this causes clinical symptoms, it is called clinical state, which might be Asthma, atopic dermatitis, allergic rhino conjunctivitis etc. There are of course some non-allergic causes of asthma, which are also rising with an alarming trend, especially obesity leading to asthma. 

Common Causes behind Childhood Asthma 

Numerous genetic and environmental factors contribute to development of asthma in childhood.

1. Allergies: most commonly dust mites, pollen, mold in humid climates, pet dander especially cats, certain food like nuts, berries, seafood. Important to note is the“ hygiene hypothesis“ which in its essence states reducing microbial exposure during early childhood interrupts normal immune development, increasing susceptibility to asthma and allergic diseases. This is predominantly seen in developed countries with higher sanitization at home and nuclear families with no siblings, as exposures are less. It was noted that kids brought up in rural areas with exposure to mud, farms, and animals early on had fewer allergies. 

2. Family history of Atopy: Having parents or siblings with asthma or allergies leads to genetic predisposition.

3. Respiratory infections: repeated airway infections with common cold viruses like rhinovirus and respiratory syncytial virus damage the lining of airways and impair mucociliary clearance leading to inflammation and airway remodelling, mucus production if not treated properly can trigger the development of asthma

4. Indoor and Outdoor pollution : Children’s lungs are more sensitive during development, Airborne Irritants like smoke, pollution, chemical Fumes, strong Odours, dust cause direct irritation of the airway lining, making the airways more reactive and leads to bronchspasms. Similar effect is seen with smoking during pregnancy.

5. Obesity: causes a generalized inflammatory state in the body including lung, increased body fat increases restriction on lung causing reduced lung capacity. Moreover, children with asthma might have more symptoms during exercise and physical activity, causing fear of the same leading to more weight gain. Being overweight can increase susceptibility to asthma and its complications.

6. Environmental factors: Cold, dry air and sudden changes in temperature can provoke bronchospasm, similarly damp, moldy environments act as a trigger of asthma 

Daily Care and Preventive Steps for Children with Asthma 

Effective asthma management revolves around avoiding triggers and having an asthma action plan.

1. Identify what particular allergy your kid has and make a note of it each time there is an episode. If there are any specific triggers causing life-threatening anaphylactic reaction, always keep a laminated card in the kid's bag or ID card and inform teachers as well.
2. Keeping home dust free by regular vacuuming, avoidance of carpets, velvet upholstery. Ensuring bedrooms and sofas are pet free zones. Use of air purifiers when indicated.
3. Medication adherence: Ensure to consult a pulmonologist / paediatrician who categorizes the symptoms and severity and prescribes controller medications like inhaled corticosteroid and bronchodilators, not just rescue inhalers. If life-threatening anaphylaxis has been reported, ensuring that epinephrine injection pens are available handy and proper education of caregivers about utilisation of it.
4. Preventive hygiene practises: Regular handwashing and staying updated with vaccinations such as flu shots help prevent severe respiratory infections, along with use of masks and social distancing in public spaces.
5. Environmental measures: Keep living areas clean, well ventilated, and free of smoke or strong odours. Avoid using humidifiers and monitor air quality.
6. Physical activity: Under medical guidance, it is very much possible to be active in sports and other activities. 

Asthma Challenges during the Festive Season & Firecracker Exposure 

India has numerous festivals, which we celebrate, with much fanfare and the resultant health issues associated are a nightmare to quite a few parents

Outdoor pollution: bursting of firecrackers releasing toxic fine particulate matter, which leads to worsening of air quality index, worsening breathing issues in asthmatics.

Festival seasons, especially those involving fireworks like Diwali, can present unique risks:

Overcrowding: during processions, visiting religious places results in exposure to viral infections for the vulnerable population.

Exposure to strong odors, perfumes from incense, smoke exposure from holy pyre, mold accumulation on decorative trees, pollen exposure from decorative flowers all add to the insult.

Precautions during festivals:

- Limit outdoor exposure when firecrackers are being burst or air quality is poor.

- Use masks (especially N95) if venturing outside is unavoidable.

- Keep windows and doors closed to avoid indoor smoke entry.

- Ensure the child’s asthma medications and inhalers are readily available.

- Seek prompt medical attention if symptoms worsen during the festive period.

- Use eco-friendly products and limit use of triggering agents at home. 

It’s always possible for kids to enjoy the true spirit of festivities without falling sick with some mindful precautions and maturity by the society as a whole.

Dr Udaya S is a consultant pulmonologist at KMC Hospital , Mangaluru.