Q) My daughter’s asthma always seems worse during the month of September. Is it just her or are there other factors involved?
A) Unfortunately, your child’s experience is not unique. Canadian researchers have found that there is a massive spike in the hospitalization rate for children who already have asthma during the month of September.
In fact, 25% of all asthma related hospitalizations occur in this one month alone. There are multiple reasons for this but they mainly centre, not surprisingly, around the activity that most of us associate with the month of September, the return of school. This, of course, brings about the clustering together of not only young budding minds but also runny noses, unrestrained coughing and less than ideal hand washing habits. ,
While we think of the winter as being flu season, there are as many, if not more, viral infections running rampant in Canada during the month of September. These infections often take a few weeks to incubate leading to a full out onslaught of colds peaking during the third week in September. Kids with asthma are more likely to both get an infection and to have a more severe case of it.
The increased severity arises from the fact that asthma is already associated, to differing degrees, with an underlying level of inflammation within the airways. As such the child is hit with a “double whammy” to some extent when they get infected as these also tend to result in inflammation and swelling on their own leading to even more symptoms of breathlessness, coughing and wheezing.
The increased susceptibility seems to be based on the fact that people with asthma have a deficient early immune response when compared to non asthmatics leaving them less likely to be able to fight off the infection. The statistics seem to support this as Canadian research shows that somewhere between 60 to 85% of children admitted to emergency rooms with asthma are also suffering from run of the mill viruses such as the rhinovirus (i.e. the common cold).
Regrettably, the onslaught of infections is just one of the challenges asthmatic kids face this month. With the opening of books and papers that have sat untouched for months, dust mites and moulds are released into the air making them easier to inhale. These particles cause the muscles that circle your airways to tighten (in an attempt to minimize your inhalation of these foreign particles) which in turns shrinks these tubes leading to symptoms of asthma.
At the same time, the breathing in of dust mites and moulds causes some degree of inflammation within the tubes similar to what we described when we are attacked by a virus. These types of attacks are considered a form of allergy induced asthma and they are especially prevalent in children as more than 90% of kids with asthma also have allergies as compared to 50% of adults with asthma. To make matters worse, ragweed season usually kicks into high gear sometime in September as well which causes the same two problems within our airways as the dust does.
Lastly, as the fall season approaches, the air turns colder which can trigger those same muscles around our airways to tighten once again in order to limiting our ability to breathe easily. How does one tell if their child who is having breathing difficulties is battling just a chest cold or in fact may be an undiagnosed asthmatic?
It’s not always possible to spot the difference and in fact many doctors will start treatment right away with inhalers and then perform the pulmonary function tests sometime down the road in order to rule in or out an asthma diagnosis. This is because it is not harmful to use asthma type inhalers in kids who are not asthmatic in order to reduce their breathlessness and chest tightness and they can go a long way towards speeding the child’s recovery and minimizing inappropriate antibiotic use (remembering that antibiotics do not treat viruses).
All that being said, the key to diagnosing asthma is to look for a distinctive pattern. Asthmatics tend to have wheezing (or more likely a cough in older kids whose airway tubes are larger), shortness of breath and/ or chest tightness that often gets worse in the evening (as our tubes naturally constrict in the evening). However, at other times in the day these same symptoms may not be present to any noticeable degree. That is why asthma is described as a reactive airway disorder. The airways react to different triggers (i.e. dust, ragweed…) and then relax when the trigger goes away. Kids with colds, tend to be more consistently sick with symptoms over the full 24 hours.
The key to managing all of this, beyond the proper use of inhalers lies in minimizing our exposure to triggers. Viruses like the common cold are often transmitted by an infected person touching their runny nose and then touching someone or something else or by coughing with their mouth open sending virus particles everywhere.
When uninfected kids bring their virus covered hands to their own faces or breathe in the droplets spread by coughing, they are exposing their airways to the virus as well. The key is to work on hand washing, covering one’s mouth when coughing and not touching your face with your hands. Not an easy teaching task for parents to take on with their kids, but worthwhile all the same.
In order to reduce allergy triggers, parents of asthmatics should minimize outdoor time on high pollen days, consider air filters for use at home, consider purchasing special dust mite covers for their mattresses and pillows and give their child’s hair a quick rinse before retiring for the night.
There is an excellent summary of this available on the CBC Ontario Morning podcast on September 13th where Dr. Peter Lin does his usual fantastic job explaining the September asthma spike phenomenon.