When does it begin	Treatment
Diagnosis	Don't despair

Not everything that wheezes is asthma.

That's a lesson I was taught long ago by a very smart pediatric lung expert. Most doctors aren't totally aware of this and so it's no surprise that parents often worry about the "wheeze" in their child's breathing and wonder if they have asthma.

Actually the wheeze most young children develop with colds that can be heard with the naked ear is not the same as the wheeze of true asthma and is merely the high pitched sound air makes as it moves back and forth through a mucus filled airway. It is upper airway noise and true wheezing comes from deep in the chest. If in fact you can feel vibration when you put your hand on your child's chest and you also hear a wheezing sound from their mouth, they are most likely making upper airway transmitted sounds and they are really just fine.

True wheezing comes form the middle to deep airways in the lungs and can usually not be heard without a stethoscope (if a child's asthma is so severe that you can hear audible wheeze without a stethoscope that child is in considerable respiratory distress and you won't miss it. They are not having fun trying to get air in and out of their lungs and look terrible and fearful).

Other causes of wheezing, including the kind of wheeze that can be heard through a stethoscope, are aspiration of an object - in children it is usually a food culprit such as a peanut or popcorn kernel (big no no's for young children) - or a reaction to an allergen such as a new food or a bee sting. The former usually causes only one-sided wheezing and your doctor will need a set of x- rays to figure this out (and then have to go get the offender since it does not belong in your child's lung and can cause damage if left behind). The allergen story is usually very dramatic and often comes with a rash and is dealt with as an emergency, often needing a shot of adrenaline (epinephrine) to reverse.

Typical asthma can begin in infancy or show up at any other point in your life. Usually, it first appears along with a typical cold and just seems to be a cough that won't quit in a child who seems to have run out of energy more than they usually do during a simple cold. In some cases the wheezing or coughing (or both) come and go and is not severe enough to get you to the doctor and as the cold resolves, so does the asthma attack. For most children asthma is mild and can be managed with attention to colds and occasional use of broncho dilating medicine, either in liquid form, or inhaled - my personal preference. There are also preventative medicines that can be given to children who are known to wheeze during certain seasons or situations (such as during gym). What is actually happening is three pronged. First there is a swelling in the airways that is caused by the release of certain chemicals into the bloodstream and into the bronchioles (the little airways that carry oxygen from your mouth to the bloodstream and eventually to the circulation).

This inflammation causes a sense of discomfort with each breath and an increased effort starts to be necessary to take ordinary breaths. Next other body chemicals and signals from the brain cause broncho spasm which results in narrowing of the airways, making it even harder to breathe comfortably, and then , to add insult to injury, the lung starts producing mucus in some kind of misguided attempt to fix things. Of course that really just clogs things up and can be the most difficult issue in the asthma of young children. The latest medications address some of these problems and treatment should be tailor made to your child since no two asthmatic children are alike. Only with your help as the parent, in observing and describing what is happening to your child can the pediatrician help to pick the right combination of medicines or of medicine and exercise, to help your child. The newest language for asthma has changed drastically - the disease has not. You might hear the term "reactive airways disease" and this generally translates to asthma, sometimes of a not so typical variety. Cough variant asthma is one of the untypical presentations we see in kids so if your child coughs constantly be sure to have the pediatrician check out the possibility of asthma, especially if it runs in the family. Be aware that eczema and allergies "live" very close by on the genes and you or your husband may have only the skin manifestation and never the lung component yet still your child can have the whole bag.

The diagnosis of asthma is usually done by examination, observation and history. There are no absolute tests for asthma, at least not until your child is old enough to participate in special pulmonary function testing. These tests measure his lung function before and after several maneuvers designed to bring out the worst in his lung functioning. Sometimes the child is asked to run on a treadmill - this can cause an asthma attack in many children - sometimes we even administer a substance called methacholine by mist and if the measured lung function decreases significantly as a result, your child can be defined as having asthma. Most children are quite young when first they wheeze and since there are also some respiratory viruses (RSV is the most frequent culprit) that can cause temporary wheezing, young children are often only given a tentative diagnosis until time passes and the situation begins to become more clear. It is very important that children not be treated like lung invalids because of a diagnosis of asthma since good general nutrition and healthy exercise (swimming is the best!) Are the cornerstones of the management of childhood asthma.

More and more often doctors are turning back to steroids for the management of asthma and there are reasons for concern on this issue. Frequent use of even inhaled steroids can lead to side effects which may be long term and dangerous. Before accepting your doctor's suggestion to put your child on any form of steroids, get a consultation with a pediatric pulmonary specialist (I just happen to be one) and find out if there are better options. To save a life steroids are definitely an integral part of treatment but most situations do not require it. If your child is highly allergic it may help to figure out if there are specific allergens that can be avoided (like feather pillows) and only then can his asthma management be modified.

In the past asthma was a dirty word, a sentence to a sedentary boring lifestyle. Today some of the best Olympic athletes have asthma and serve as role models for how well a body can do given the right guidance. Do not despair at the mention of the diagnosis and learn as much as you can in order to help in the decision making process for the management of your child's health. Also don't forget, not everything that wheezes is asthma so check it out first.