Online Health Chat with Meeghan Hart, MD

October 13, 2017


Description

Asthma is the leading cause of chronic illness in children. It affects as many as 10 to 12 percent of children in the US and, for unknown reasons, is steadily increasing. It can begin at any age, but most children have their first symptoms by age 5. Risk factors include a presence of allergies, family history of asthma or allergies, recurrent respiratory infections, low birth weight, exposure to tobacco smoke before or after birth and more.

No one really knows why a growing number of children are developing asthma. Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution and second-hand smoke. Others suspect that children are not exposed to enough childhood illnesses to build up their immune system. And still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed onto babies.

Keep in mind that not all children have the same asthma symptoms, and these symptoms can vary from episode to episode in the same child. Also, note that not all wheezing or coughing is caused by asthma. In kids under 5 years of age, the most common cause of asthma symptoms is upper respiratory viral infections such as the common cold. If your child has problems breathing, take him or her to their primary care provider immediately for an evaluation. He or she may then be referred to a pediatric pulmonary specialist.

Based on your child's history and the severity of asthma, your child's doctor will develop a care plan, called an "asthma action plan." The asthma action plan describes when and how your child should use asthma medications, what to do when asthma gets worse and when to seek emergency care for your child. Make sure you understand this plan and ask your child's doctor any questions you may have. Your child's asthma action plan is important to successfully control his or her asthma. Keep it handy to remind you of your child's daily asthma management plan, as well as to guide you when your child develops asthma symptoms.


About the Speaker

Meeghan Hart, MD attained her medical degree from Jacobs School of Medicine in Buffalo, New York, followed by an internship in pediatrics at Women’s Children Hospital of Buffalo shortly after. She then completed her residency in pediatrics, also with the Women’s Children Hospital of Buffalo and her fellowship in pediatric pulmonology with University Hospital Case Medical Center. Dr. Hart joined Cleveland Clinic Children’s staff in 2017.


Let’s Chat About Asthma and Allergies

Medication Messages

cerim: Is there a specific type of medication on the market that will alleviate seasonal allergy symptoms without causing insomnia?
 
Meeghan_Hart,_MD : There are several over-the-counter antihistamines available that are non-sedating and can be taken in the morning. Options include Claritin, Allegra and Zyrtec. If there is a lot of nasal congestion, you could try an inhaled nasal steroid daily to help with the symptoms. Many are over-the-counter these days.

swol: My daughter has been on Qvar and Ventolin for the past two years. So far this fall, we have not had to use this. Is it possible she may have grown out of the asthma?

Meeghan_Hart,_MD: I am happy to hear your daughter is doing well. Her asthma sounds like it has gotten milder. Even though she seems well controlled at this time, you should have her Ventolin available in case her asthma flares. People with intermittent asthma do not need to be on a daily controller therapy. However, they could still have an exacerbation.

mill1840: I've tried Claritin and Zyrtec with my daughter, but she still gets a chronic dry cough that seems to worsen with physical activity. (This has been going on for over a year.) She does not have difficulty breathing and is otherwise healthy and feeling well. Do you have any other suggestions on dealing with the cough?

Meeghan_Hart,_MD:: I am sorry to hear that this has been going on for a year. I would recommend seeing a pediatric pulmonologist. He or she can ask you lots of questions about her symptoms and try a pulmonary function test (breathing test). Allergy testing could be helpful in her evaluation, too. Her cough may not be secondary to allergies, and that may be the reason she is not getting better.


Form Features

JohnBear: Can my daughter still play sports if she is diagnosed with exercise-induced asthma?

Meeghan_Hart,_MD: I am happy to hear your daughter is interested in playing sports. Yes. She can still play sports even with exercise-induced asthma. Depending on her symptoms, your doctor can prescribe medications to take prior to exercise. There is testing to diagnose this problem as well. Sometimes, people can be misdiagnosed with exercise-induced asthma when they really have something called vocal cord dysfunction. A good history and physical by your doctor can help make the diagnosis and guide treatment.

JohnBear: My daughter is 5 and I think she has exercised-induced asthma. Normally, she has no problem breathing when doing everyday tasks, but whenever we do anything physically active (hiking, soccer, etc.), she gets these coughing fits. Do you have any advice? What would be the steps to get a diagnosis?

Meeghan_Hart,_MD: Patients with exercise-induced asthma ONLY have symptoms with exercise. Patients with persistent asthma have symptoms several times a week and can also have exercise-induced asthma, but not necessarily. A good history and physical exam can lead the doctor to the diagnosis. Sometimes, exercise testing is performed and can be helpful in making the diagnosis. However, it is usually done when children are close to 10 years of age. Your 5-year-old would likely be too young to do this. Your doctor can refer you to a pediatric pulmonologist for an evaluation.

EmmaMollieMom: With cold-induced coughing and wheezing, do you recommend cough medicine, especially through the night hours when the cough keeps her awake?

Meeghan_Hart,_MD:: No, we do not recommend using cough medications. Studies have NOT shown them to be effective. If your child has been prescribed an albuterol inhaler, you should use this.


Disorder Data

Lesliepeters: Are asthma rates rising? I heard women are more likely to have asthma than men. Is this true? If so, do you know why this is?

Meeghan_Hart,_MD: According to Centers for Disease Control and Prevention (CDC) data, there are 6.2 million children in the US who have asthma. Eight and four-tenths percent of children under the age of 18 have asthma. There are 18.4 million adults in the US with asthma, this turns out to be 7.6 percent of adult Americans with asthma. It is more common for women to have asthma than men. In childhood asthma, we see more boys than girls with wheezing.

Shaggy97: What's the difference between allergies and asthma?

Meeghan_Hart,_MD:: That's a great question. They are both inflammatory problems. In asthma, the inflammation is in the airways. With allergies, the inflammation is in the nose and sinuses.

EmmaMollieMom: How do you know the difference between a cold and allergies?

Meeghan_Hart,_MD:: It can be difficult to determine this, especially when it’s viral infection season. With allergies, some patients will complain of itchiness in the nose, eyes and ears. This goes along more with allergies. If you think symptoms could be consistent with allergies, you could try an over-the-counter allergy medication and see if the symptoms improve.


Activity Alterations

Sarawee: My son was recently diagnosed with asthma. Are there any changes I can make at home to help?

Meeghan_Hart,_MD: There are many things you can do to help your son. First, you should follow your son's asthma action plan. If he is recommended to take daily medications, you should give them every day as prescribed and use the appropriate technique for medication delivery. It is important that he is not exposed to tobacco smoke. Patients have different triggers. Some triggers can be avoided and others cannot (such as viruses or weather changes). If he is triggered by dust, you could vacuum frequently, wash bedding weekly in hot water and use special covers for his mattress and pillow. If he has stuffed animals, try to limit them and those that are loved wash frequently or place in the freezer during the day to kill dust mites.

Meeghan_Hart,_MD: Thanks everyone for joining us today. I hope you found the discussion to be interesting. Don't be afraid to reach out to your doctor for help when your child has a chronic cough.


Closing

That is all the time we have for questions today. Thank you, Dr. Hart, for taking time to educate us about Asthma and Allergies.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org.

For Appointments

To make an appointment with Meeghan Hart MD please call 216.444.KIDS or visit us at clevelandclinicchildrens.org for more information.

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Cleveland Clinic Children's Pediatric Allergy Department provides a variety of outpatient and inpatient services for children through the age of 21 suffering from common and unusual allergic and immunologic disorders.

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We provide pediatric patients easy access to either scheduled or emergency medical services. Pediatric allergy patients also have the choice of being seen at the main campus or at one of our community hospitals or family health center locations.

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