Expert: Marc Rubin, RPh Asthma Educator - 1/20/2008

Question
QUESTION: My 3 1/2 yr. old granddaughter Dixie was recently hospitalized with breathing difficulties.  Since infancy, every time she gets a stomach virus (vomiting), she will have breathing problems.  Her chest sucks in and out and this last time her lips turned almost blue.  She was non-responsive by time we got her to ER, then in hospital for a day.  They gave her steroids and she was on oxygen.  She got to come home when her blood oxygen level was 94 consistently, off oxygen.

Dr. diagnosed reactive airway disease.  Now, is this asthma?  What type of asthma is it? Does it have a specific name?  Could pets at home (cats) be a contributing factor?  This latest episode was frightening, and we want to do all we can to keep her safe.  She has had a bit of a weight problem since infancy (3 siblings are normal or under weight), and has had her tonsils and adenoids removed because of sleep apnea.

ANSWER: My first question would be: Does she have any breathing problems develop whenever she gets a viral infection, or just when she throws up? If it is only when she throws up, it is probably a reaction to the acid stimulating a nerve in the esophagus (the vagus nerve)which also runs through the lungs. When the nerve in the esophagus (throat) is triggered, it can cause the airways to react and close. This is one of the triggers for asthma. If she does not have any breathing problems aside from the acid reflux trigger, a further evaluation by an allergist or pulmonologist.
 Her weight problem is another issue that can contribute to her difficulty breathing and the sleep apnea. This is due to the pressure the added weight puts on her diaphragm, restricting normal inhalation.
  Family history of allergies would help be a guide as to her potentially having asthma (which is a reactive airway disease). I have a feeling that in addition to her tonsils and adenoids being removed, she has a history of chronic ear infections, and may have had tubes put in her ears to relieve the pressure. We often see a direct correlation between chronic ear infections in children, and an allergic tendency. If this is the case, she probably does have asthma.
 Now, concerning the cats....if it is discovered that she does have allergies, the odds are pretty good that the cats would be contributing to this. Your first action would be to keep the cats out of her bedroom. Lung function goes down at night, and inhaling the dander increases the amount of inflammation in the airways. This brings us to the next question...does she awaken at night due to wheezing or coughing, and if so, how often. Many asthmatics do not have any daytime symptoms (or they are too adjusted to poorer breathing to recognize any difficulty).
 So the bottom line is, a thorough evaluation by a specialist would be in order. If is proven that she does have asthma, this is a great web site for families to become educated at: Mothers of Asthmatics> http://www.aanma.org/breatherville.htm

Hope this has helped you!

Marc

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for your help!  yes, she did have tubes put in her ears.  She weighs 50 lbs. and is 36 inches tall.  She put on the weight as an infant, because of a doctor's recommendation for feeding.  She has weighed this much for quite some time, at least a year.  Has seen a geneticist and endocrinologist for her weight, no causes.  So we are just supposed to watch what she eats, get exercise, and hope she has growth spurt, I guess.

we will follow your advice and get her to a specialist to get a definitive asthma diagnosis.  Her mother did have exercise induced asthma as a preteen and teen, but has outgrown it.  Thanks again!

Answer
A family history of asthma, and persistent ear infections in your granddaughter lead me to believe she does have an allergic nature. One more question.. while you were pregnant with your daughter, were you a smoker, and smoked during the pregnancy? Research today seems to indicate that if a woman smokes during pregnancy, and the fetus was a female, the egss that the fetus is forming during development, when fertilized, have a 25% chance of producing an offspring (grandchild) with allergic tendencies. Unlike men, who continually produce fresh sperm, all of a womans eggs were formed while developing as a fetus. If this was the case, don't feel guilty! It was a different time, and we did not know then what we knew now about tobacco. In addition, many doctors recommended smoking in those days to calm the pregnant mother. We've come a long way!

Another note, your daughter should not be surprised if her asthma should redevelop as she progresses into her 30's. Hormonal changes and the environment may trigger its return. Therapies today allow for a near normal life..just need a proper education about the disorder, and the appropriate medications.

Good luck!

Marc