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Take a big, deep breath. Inhale slowly until your lungs are full. Exhale gradually. Normally, the air we inhale travels effortlessly through our nose and mouth, down the windpipe, through the bronchial tubes into the lungs, and finally into miniature air sacs, called alveoli. This is where fresh oxygen is exchanged for the carbon dioxide that's in your blood. Breathing is so natural that we take it for granted.

Now try running in place for a minute, then put a straw in your mouth, blocking your nose and trying to breathe through the straw only. That's what breathing feels like when a person is having an asthma attack. Although adults can suffer from asthma, it's most often seen in children and develops in childhood. Children will often outgrow their asthma.

During an asthma attack, airways get narrow and become blocked, making it difficult for air to move through them. Asthma can be frightening and even life threatening. Over 15 million Americans have asthma. It's the number-one reason kids are chronically absent from school. Asthma attacks are the most common cause of chronic emergency hospital visits by children. Some children have mild, occasional symptoms or only show symptoms after exercising. Others have severe asthma that can dramatically limit activity unless treated.

New medications and treatments mean that a child with asthma can live a normal life. Education and an asthma management plan make it possible today's sufferers to learn to control symptoms and attacks independently.

CAUSES AND DESCRIPTIONS OF ASTHMA ATTACKS

Asthma is a chronic inflammatory lung disease that causes airways to tighten and narrow. Anyone can have asthma, including babies and teens. Doctors don't know the main cause of asthma, but they suspect that asthma is inherited in many cases.

Many children with asthma can breathe normally for weeks or months between attacks. When an attack occurs, they can seem to happen without warning. An attack usually develops slowly over time, involving a process of increasing airway obstruction.

All children with asthma have airways that are extra sensitive, or hyperactive, to certain asthma triggers. Triggers that can cause asthma attacks and reactions vary from person to person. Some of the triggers can be exercise, allergies, viral infections, and smoke. The sensitive airway linings react by becoming inflamed, swollen, and mucus filled. The muscles lining the swollen airways tighten; narrowing and blocking them even more.

In an asthma attack three significant changes happen in the airways:
1) Inflammation
2) Excess mucus forms in the narrowed airways
3) Bronchoconstriction: muscle lining of the airways tightens up.

The inflammation, excess mucus, and bronchoconstriction narrow the airways and make it difficult to move air through. During an asthma attack, kids may experience coughing, wheezing, tightness of the chest, increased heart rate, perspiration, and shortness of breath.

HOW IS ASTHMA DIAGNOSED?

Diagnosing asthma is sometimes difficult because different children with asthma can have very different symptoms. Some kids cough all night but seem fine during the day, while others seem to get frequent chest colds that won't go away. Kids may have these symptoms for months before being seen by a doctor.

When considering a possible diagnosis of asthma, the doctor tries to rule out every other possible cause of a child's symptoms. The Physician needs to know the family's asthma and allergy history, conduct a physical exam, and maybe order chest x-rays, blood tests, and allergy skin tests. During this process, the doctor will need as many details as possible about things such as:

SYMPTOMS: how severe, when and where they occur, how often they occur, how long they last, and how they stop.
ALLERGIES: the child's and the family's allergy history
ILLNESSES: how often the child gets colds, how severe they are, and how long they last
TRIGGERS: exposures to irritants and allergens, recent stressful events, or other things that seem to lead to an attack.

This information helps the physician understand a child's pattern of symptoms, which can be compared to the symptoms of different kinds of asthma.

An asthma specialist or allergist can perform breathing tests using a spirometer, a machine that does an analysis of a child's airflow through the large and small airways. A spirometer test can reveal if the child's breathing problems can be corrected with medication, a primary feature of asthma. If medication reverses airway narrowing significantly then there's a strong likelihood that the child has asthma.

Often other special tests are performed such as allergy skin testing, pulmonary function studies, and a stress test. These tests can verify that a child has asthma, and not something else that seems like asthma.

EXERCISE-INDUCED ASTHMA

Kids who have exercise-induced asthma (EIA) develop asthma symptoms after activity such as running, swimming, or biking. Some kids with EIA develop symptoms after physical exertion, while others have additional asthma triggers. With the proper medications, kids with EIA can usually play sports without a problem.

Not every type or intensity of exercise affects kids with EIA the same way. If exercise is the only asthma trigger, the doctor may prescribe a medication that the child takes prior to exercising to prevent the airways from constricting.

ALLERGY-TRIGGERED ASTHMA

About 75-85% of people with asthma has an allergy of some type. Even if the primary triggers are colds or exercise, allergies usually play a role in aggravating the condition. Children inherit allergies from their parents, who pass along the genes to make abnormally large amounts of immunoglobulin E (IgE). The IgE antibody senses small quantities of allergens such as dust mites and molds and generates allergic reactions to these usually harmless particles. When allergens enter the body, they attach to the IgE antibody, which causes mast cells to release histamine to defend against the allergen invader. Histamine is what causes the sneezing, runny nose, and watery eyes associated with most allergies. These are the ways the body attempts to rid itself of the invading allergen. In a child with asthma, histamine can also trigger asthma symptoms.

An allergist can usually identify any allergies a person has. Clearing allergens out of the home can help reduce asthma attacks. When allergens can't be avoided, antihistamine medications help to block the release of histamine in the body. Nasal steroids may be prescribed to stop allergic inflammation in the nose. An allergist can also prescribe allergy shots that make the body unresponsive to some allergens.

CATEGORIES OF ASTHMA

Mild Intermittent Asthma
A child who has short spells of wheezing, coughing, or shortness of breath happening twice a week or less has mild intermittent asthma. The child rarely has symptoms between these spells, with the exception of one or two times per month of mild symptoms at night. Mild asthma should not be ignored; even between attacks, there is airway inflammation. There are asthma management strategies to treat mild asthma.

Mild Persistent Asthma
Children with episodes of wheezing, coughing, or shortness of breath that happen more than twice a week but not daily are said to have mild persistent asthma. Symptoms occur at least twice a month at night and can affect normal physical activity.

Moderate Persistent Asthma
Children with moderate persistent asthma have daily symptoms and need daily medication. Nighttime attacks happen more than once a week. Wheezing, coughing, or shortness of breath occur more than twice a week and may last for several days. The symptoms affect normal physical activity.

Severe Persistent Asthma
Children with severe persistent asthma have continuous symptoms. They have frequent wheezing, coughing, and shortness of breath that may require emergency treatment and even hospitalization. Many children with severe persistent asthma have frequent asthma attacks at night and can handle only limited physical activity.