Asthma sufferers hyper-responsive to normal triggers

You wouldn’t realize Jae Gully has asthma the first time you meet her.

The kindergartener at Milam Elementary School in McAllen loves to dance, she said, to play with her toys and ride her bike outside. She spends time with her older brother, 10-year-old Ian, and plays with the family pets.

Such carefree play was not as simple three years ago, said Jae’s mother, Michelle. She and her husband Jason noticed their daughter struggling to breathe at certain times, especially when she was sick.

“We had no idea what it was,” Michelle Gully said. “We didn’t understand it. What seemed to be a normal cold would start with a runny nose, and then the next day she couldn’t breathe. It was just awful. It was a lot more than just a cold, and it was something we couldn’t let run its course, it was so bad.”

After an initial diagnosis of chronic bronchitis, Jae and her parents were finally told she has asthma. According to the Centers for Disease Control, asthma is a chronic lung disease “characterized by episodes or attacks of inflammation and narrowing of small airways,” making it hard to breathe. Symptoms of asthma include coughing, wheezing, shortness of breath and chest pains.

Asthma affects millions of people in the United States — more than 20 million, some estimates report — with 9 million U.S. children under 18 diagnosed with the disease, or pediatric asthma, according to the American Lung Association. If left untreated, asthma can cause death.

The good news is that the rate of mortality for children with asthma has decreased. The bad news is that asthma rates among children under age 5 have increased 160 percent in the past two decades. The reasons why, according to the ALA, are unclear.

There is no known cause for asthma, but there are certain conditions that are thought to contribute to the disease or to asthma attacks. Most children with asthma are hypersensitive to a variety of things that children with healthy lungs aren’t, said Iley Browning, a pediatric pulmonologist at Driscoll Children’s Hospital in Corpus Christi. For Jae Gully, her mother said windy days send her daughter indoors with an ugly cough. Other kids have different “triggers,” Browning said, including allergies, viruses, exercise and air pressure.

“When you define asthma, you might call it a hyper-responsiveness to normal triggers,” he said. “With temperature changes, and pressure changes, if you have normal lungs it shouldn’t bother you. One of the most common viral triggers is a bad cold in the winter. Most people recover in a couple days and within a week they’re back to normal. Patients with asthma do not. They become much sicker, and the illness takes longer to recover from. They’re wandering around with a cough for three to four weeks.”

In Texas, the number of children suffering from asthma is a lower percentage than those in other states: between 2001 and 2005, 7.9 to 8.5 percent of children in Texas had asthma, compared to more than 9.8 percent in neighboring Oklahoma. However, the Rio Grande Valley has a unique set of characteristics that contribute to asthma, said Humberto Hidalgo, a pediatric pulmonologist at the All Valley Children’s Lung Clinic in Edinburg.

“We have Reynosa and Matamoros. The prevailing winds in that area are southwestern for most of the year, but sometimes they sweep over Reynosa and drive into McAllen. Any kind of activity pollution-wise would come to visit us, as well,” Hidalgo said.

As many theories about asthma triggers are out there, so too exist as many asthma myths. One of the biggest falsehoods concerning pediatric asthma is that children outgrow the disease as they near adulthood. Symptoms of pediatric asthma may lessen or disappear, Browning said, but it doesn’t mean they’re gone for good.

“That’s one of the biggest myths passed along right now,” he said. “What we know is that lung function on children starts low and peaks in early adulthood. Studies of kids coughing that have asthma symptoms at 10 and 12 years old but not at 18, one-third to one-half of them have problems again by the time they’re in their mid-30s. That doesn’t say it’s gone. It says you got better, you did well, but it’s still there.”

Fortunately for parents and children, asthma medications have come a long way in the past two decades, with better therapy available for all ages. Bronchodilators are medicines that help stop asthma attacks once they’ve started, whereas anti-inflammatory medicines help control airway inflammation. Inhaled steroids are frequently used as anti-inflammatory drugs.

Since her diagnosis, Jae Gully now takes three types of medication for her asthma, said Michelle Gully. She takes Singulair, a control medication she takes as chewable daily pill. She also uses Flovent, a steroid inhaler, twice a day. Because children inhale differently than adults, Jae must take her inhaler with a mask, which helps her get the right amount of medicine to her lungs. For days when Jae has an attack, the doctor gave her an at-home nebulizer, which vaporizes medication and delivers it to Jae via a tube and mask. The nebulizer treatment usually lasts about 20 minutes, Michelle Gully said, and Jae said she feels differently after it.

“I talk better,” she said. “Before (using the nebulizer), I talk soft. After it, I can talk loud.”

In addition to medication, Browning and Hidalgo recommend eliminating potential triggers from the home, including cigarette smoke. The Gully family has followed their advice — after moving several months ago, their new home has hardwood floors instead of carpet, as well as little to no draperies. The family also keeps their pets outdoors. The change has helped eliminate dust and pet dander, which makes it easier for Jae to breathe.

Browning said the biggest obstacle to diagnosing children is educating parents. Not every child responds to asthma triggers in the same way, and their symptoms aren’t always obvious.

“When people come into my clinic, on of the most common comments I hear is, ‘My child can’t have asthma because it doesn’t look how I envisioned it.’ There is no single version of asthma that affects patients. Twenty-five percent of the kids I see never wheeze.”

While treatments and therapies have improved for children with asthma, both Browning and Hidalgo said some children suffer needlessly because of the stigma asthma carries. The biggest point to remember, they said, is that kids like Jae can have a completely regular life.

“People don’t like the idea that a child has a chronic disease,” Hidalgo said. “(However), asthma is fully compatible with a normal, healthy lifestyle.”

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Kate Lohnes covers features and entertainment for The Monitor. You can reach her at (956) 683-4427. For this and other local stories, visit www.themonitor.com.