Persistent asthma is most effectively controlled with daily, long-term-control medication, specifically anti-inflammatory therapy. To that end, several new drugs have been introduced in the pediatric market for administering to children in the campaign against asthma. These are Accolate, Pulmicort, and Singulair. Dr. Phyllis Weiner, chairperson of pediatrics and acting chairperson of the Ambulatory Care Center at Jamaica Hospital Medical Center, sees thousands of children yearly who are admitted to the hospital for asthmatic occurrences. In fact, "it's the number one admission to the hospital in pediatrics," she reports. Dr. Weiner lends her expertise on the subject and on the latest developments: Different classes of asthmatic medications work in different ways.
Leukotriene receptor antagonists block the action of the 'leukotrienes', messengers of inflammation that cause muscles to constrict and mucus membranes to become swollen. Because these messengers are believed to be responsible for the characteristic airflow obstruction, bronchial hyperactivity, and airway inflammation of the disease, stopping them can shut off the inflammatory process, increase airflow and produce overall improvement. Accolate and Singulair are both leukotriene receptor antagonists.
Accolate, prescribed in a tablet form, can be used for children ages 12 and older. Taken twice daily one to two hours following meals, it can effectively and significantly improve lung function in patients with mild to moderate asthma.
For the younger child, age six and up, Singulair is conveniently prescribed in a 5 mg, cherry chewable tablet. Taken once daily in the evening, it has been clinically shown to improve all parameters of asthma control and decrease daytime and nighttime symptoms.
Another class of preventive medications is the steroid. Steroids can be given orally or inhaled, sending the spray directly to the lungs, thereby calming down the inflammation.
Used with great success in Europe, the Pulmicort Turbuhaler is now available in the United States. Approved for patients six years and older, "it's an innovation of a tried and true method," says Dr. Weiner. "It contains a medicine called budesonide, a synthetic corticosteroid, a substance found in the body that helps fight inflammation by reducing the swelling and irritation in the walls of the small air passages in the lungs. Instead of being an aerosol spray, it's packaged as a powder and doesn't have propellant. To use, you twist in a measured amount, put your lips around it and inhale deeply. It requires some coordination and therefore must be taught properly."
Why choose one over another? Some children could have trouble with the inhaler, and if it doesn't get into the lungs, it's worthless. Also, the term 'steroid', while medically unproven, causes some trepidation.
Unfortunately, Dr. Weiner sees a lot of children with asthma caused by a multitude of factors - including the environment, genetic disposition, and a susceptibility to viral infections which can trigger asthmatic attacks. "But when people are educated towards self- care and use the right medication," she says, "they can be symptom-free and suffer no school or work loss."
To accomplish this, she recommends keeping your home as clean as possible; exercising; and staying away from cigarette smoke, cleaning sprays, and hair, perfume and deodorant sprays. And, of course, scheduling regular visits to the doctor to ensure that control of the disease is maintained.
There are many levels to asthma severity and always strict asthma guidelines to follow. As with any medication, it is vitally important that you consult your physician before using any of these drugs.
An Alternative Treatment By Mara Weisman
Seven-year-old Yakov Merkin breathed in through his nose and exhaled. He pinched his nostrils closed with his fingers and began walking across the living room, his mother counting each step. At about 94 steps, when he couldn't hold his breath anymore, he fell to the floor, triumphant yet nearly exhausted.
Yakov, an asthmatic who suffered severe coughing fits, is practicing a new method of breathing called Buteyko. It incorporates exercises, like the one described above, to monitor progress, and shallow breathing through the nose.
"It's the best thing he ever did," says Dr. Linda Merkin, Yakov's mother. Before he began practicing Buteyko, he was taking Albuterol (a broncho-dilator) through a nebulizer (an electric pump that converts medications into a fine mist) twice a day for about 20 minutes. "I just wanted his asthma fixed," Dr. Merkin recalls.
So she and her husband took to the Internet and conducted searches on alternative treatments for asthma. They found Buteyko, a drug-free treatment currently used in Australia, New Zealand and England. "It sounded very different," Dr. Merkin says, "because each story was just as good as the last."
Since Buteyko is virtually unknown in the United States, Dr. Merkin traveled to London to treat her son's asthma. There she met with Dr. Christopher Drake, a Buteyko practitioner, and convinced him to introduce the method in New York.
Buteyko is named after a Russian professor, Konstantine Buteyko, who developed the method over 40 years ago. It is based on the physiological fact that asthma sufferers, as well as others with breathing disorders, breathe a greater volume of air per minute than healthy people. But their levels of oxygen and carbon dioxide are off balance, causing the body to react by constricting the breathing passages. This is due to lower levels of carbon dioxide, which is not only a byproduct of respiration, but also necessary for the maintenance of pH levels in the body's fluids. "All asthma symptoms are mechanisms to defend or compensate against the body's excessive loss of carbon dioxide," Dr. Drake says.
Conventional asthma treatments usually require the use of a broncho-dilator, which opens the breathing passages. Buteyko is nearly the opposite; it is designed to recondition breathing and reduce the total volume of air breathed per minute to normal levels.
"This method is contrary to everything we've ever learned about breathing," says Alyssa Slomovic, whose 10-year-old son, Chaim, suffers from asthma. What they learned was that Chaim should be breathing deeply through his mouth and that he should take more medicine when he feels an attack coming on. "It's upsetting," says Chaim, "because everything the doctors give you makes you worse." By practicing the Buteyko method of taking shallow breaths through the nose, Chaim is able to run, he sleeps better, and his concentration in school has improved.
"I'm confused, to be honest," says his mother. "I have nothing except my own observations to verify it."
She is not alone. Heidi, whose three children suffer from asthma and other symptoms, finds it equally baffling. "It's wild; their noses are so clear now," she says.
Reactions to the method by professionals are mixed. Yakov's pediatrician encouraged him to try alternative approaches, but the Slomovics encountered resistance. Dr. Sicklick of Cedarhurst, who did not return calls, refused to treat them. "He called it witchcraft," says Linda Merkin.
While the Buteyko method boasts a 90 percent success rate in patients, it is not a medical treatment and practitioners encourage patients to continue medical treatment. Buteyko is taught in workshops, which cost $450 for five sessions, including individual meetings with a certified Buteyko instructor if necessary. A full refund is guaranteed if there is no improvement in breathing.
For more information, call the Respiratory Health Institute at (212) 984?, or Dr. Linda Merkin at (718) 853?.
OPEN AIRWAYS Letting Students Breathe Easy By Helyne Klauck
An asthma attack. Not a pleasant time for anyone involved, especially if the one having the attack is your child. Just the thought of the last attack sends your heart racing, fearful of the next one, maybe more serious than before.
"Open Airways for Schools", a new program created by the American Lung Association of Queens, in partnership with Columbia Presbyterian's Drs. Robert Mellins and Robert Evans, and Glaxo-Wellcome Pharmaceuticals, is designed to ease some of the burden for young asthma sufferers. Tailor-made for second through sixth graders, its goal is to train and equip school nurses (so far in Districts 25, 28, and 29) to teach students just how to react when an attack occurs. Training for the nurses is a two-day process, covering relaxation techniques combined with the basic triggers of an attack.
While many factors can trigger an asthma attack - from extreme cold and exertion, to pollution and second-hand smoke - often an attack can be eased by relaxation techniques, practical approaches (deep cough exercises, tensing and relaxing exercises), and focusing until medical attention is available.
Carlos Alvarez, executive director of the American Lung Association of Queens, proudly comments, "Last year, Open Airways covered only 110 schools. This year, we are in all 600 schools." With asthma the number one cause of school absences, Dr. Gloria Gasper, American Lung Association program associate for school programs, couldn't have been happier seeing the nurses complete their training. "All have done extremely well," she states enthusiastically. "There is such a need for everyone involved in the student's life to be educated about their condition. Both parental involvement and schools play a vital role in containing attacks as much as possible."
"Open Airways for Schools" is recommended by the National Association of School Nurses, and most of the school nurses in Districts 25, 28 and 29 have completed their training. Parents in these districts with children who are diagnosed with asthma are encouraged to speak with their school nurse and get involved in the "Open Airways" training. Says Maxine Ferguson, RN, school nurse at P.S. 160Q in District 28: "The feedback from parents has been very helpful. When the kids do go into a crisis, the classes taught are put into practice without a second thought. The kids make pictures and do skits to help them realize that when an attack occurs, they are in control."
If you are interested in the program, or if your child's school doesn't yet have this asthma self-management program, contact the American Lung Association of Queens at 1?- LUNG-USA or (718) 263?. Free in schools with pre-trained nurses, it's a program which may just be as precious as your child is - and as every breath she takes.