Question:
I have a 4 year old and a 7 month old and both of them have been diagnosed
with asthma. The thing that is so bizarre is that neither me nor my
husband have asthma or smoke. We have been advised to remove our
carpets, get air purifiers, and try to keep our house 'dust free." We
have done all of these things and still we get no positive results. I
was just wondering if anyone else has this problem. If you have kids
with asthma and you and your spouse are asthma free and you have any
comments or suggestions please help.
Answer:
I assume you are a very knowledgable patient.
We have many such persons visiting our clinic.
I would like to add some comments, because of the difficulties
presented in diagnosising children. The study you quoted made national
headlines in the lay press and had both good and bad effects upon patient
care in my opinion.
The diagnosis of asthma is made primarily through history taking.
Objective testing is often difficult to perform in children.
For example there is little point in measuring serum IgE levels in infants
< 2 years old as there is a low rate of of IgE antibody to inhaled allergen
even in kids who are atopic.
As I mentioned before the primary triggger for wheezing in children less than
two is thought to be viral infection. After 2 years old sensitization to
inhaled allergens may occur, comprising a significant risk factor for wheezing
and development of asthma in children who are atopic.
In addition it is often very impractical or difficult to do skin testing on
small children and in many practices, only food allergy testing is done before
the age of 5-6, where skin testing is then performed.
Think of the whole world and not just the USA. In fact the in the USA
asthma prevalence is disproportionally higher amongst disadvantaged and
minority children in the inner cities. These kids often lack access to
specialists and good healthcare. Shame!
The conclusions your cited were from THE study, not a world wide concensus.
Some questions about the study include, why do serum IgE levels on
cords and 9 month olds when we know that they are probably not statistically
relevant, were the questionaires statisically graded? how reliable is the
method of measuring lung function that they used and whose predicted values
were used. Measuring lung function in infants is notoriously unreliable.
Only 75-85% of asthmatics have a positive skin test, what is the equivalent
number in infants and children etc etc
There findings are very interesting, but the overall medical management of the
wheezy child is not that different from bona-fide asthmatic child.
I think there is growing evidence to suggest that if there is a history of
asthma or allergy in the family or child it is important to limit their
exposure to allergen early on.
Identifying these patients, chiefly through history is very important.
All that wheezes is not asthma was taught to me many years ago and
it was sound advice.
I think you maybe questioning the diagnosis of asthma given to Christy's
children and this may be appropriate.
She never mentioned the credentials of the physician and his rationale.
