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Intrinsic or non-allergic asthma is common in preschool children. The symptoms occur when children have a cold and presents as difficulty breathing and coughing, often with mucus. If the child does not receive treatment, the cough can often persist for many weeks, or months. Intrinsic asthma which occur in children with allergies, often disappear as the child grows older. On the other hand, extrinsic asthma or allergic asthma often continues into adulthood.
Symptoms of intrinsic asthma
All children cough when they have a cold. However, children with intrinsic asthma cough more, and for a longer period of time. Often, but not always, children with intrinsic asthma have difficulty breathing. You can see what this looks like in the post about children with difficulty breathing (see video links).
Children who cough all night
What about the cough then? Coughing at night that lasts for many weeks after each cold can be a sign of intrinsic asthma. When a child is not cough-free between colds it can also be a sign of intrinsic asthma. Many children produce mucus while coughing, and sometimes they can cough until they vomit up the mucus.
What happens in the lungs in intrinsic asthma?
In the case of intrinsic asthma, two things happen in the lungs when the child gets a cold. One, the muscles around the smallest trachea begin to spasm and causes narrowing of the airways. This makes it difficult for air to pass and leads to breathing difficulties, wheezing and coughing.
The other thing that happens is that the mucous membrane on the inside of the lungs become inflamed and swells. It is this swollen mucosa that causes the prolonged coughing and mucus production.
How do you treat intrinsic asthma?
To treat intrinsic asthma, you need to treat both the bronchial contractions and the swollen mucosa. The bronchial contractions are treated with inhalers also known as ‘relievers’ as they relieve or ease the symptoms of asthma. Examples of these inhalers are Airomir, Ventoline, Buventol etc. As a general rule, these sprays or inhalers are blue. The effect of the blue spray is felt immediately, and it is therefore used in the symptomatic relief and emergency treatment of asthma.
To treat the swollen mucosa, anti-inflammatory medicine is needed. There are two types of medications used to treat asthma: cortisone sprays/ inhalers and Singulair/montelukast. Firstly, the cortisone inhalers. Examples of cortisone inhalers can include Flutide, Giona, Pulmicort etc. These inhalers are generally orange or brown in color. The effects are not felt right away, but it is in fact the cortisone spray that reduces the inflammation and heals the lungs in the long run.
Secondly, another anti-inflammatory medicine is montelukast, or some may recognise it’s brand name as Singulair. Singulair comes as oral granules which can be dissolved in water and swallowed or as a chewable tablet. It can be given instead of, or in combination with cortisone sprays.
Cough medicines, such as Cocillana, Mollipect or Lepheton, does not help with intrinsic asthma.
Giving inhalers to young children
Asthma inhalers are never given directly in the mouth to young children. The inhalers must be used in conjuction with a spacer, or breathing container. This is to ensure effective delivery of medications to the lungs. First, assemble the spacer or breathing container and attach a mask. Next, hold the inhaler upright and shake. Attach the inhaler to the spacer and place the mask tightly around the child’s nose and mouth. Spray one dose at a time and allow the child to take 5-6 slow, deep breaths after each dose. Some kids don’t mind it, others hate it.
When a child has a cold, give the blue spray first via a spacer and allow the child to take 5-6 slow, deep breaths before giving the orange spray. The blue spray will open up the airways so that the orange spray can be delivered effectively throughout the lungs.
How long should your child use their asthma medication?
The severity of intrinsic asthma differs in every child, therefore treatments may differ between children. Usually, the first step in the ‘treatment staircase’ is to treat the asthma with the blue inhaler for ten days in the event of a cold. Then, you take a break and start again when the child has a cold again. You should begin treatment immediately when there are signs of a new cold and not wait until the child has difficulty breathing or coughs heavily.
If the child has problems between colds or if the breathing problems become very severe during a cold, then either cortisone spray or montelukast may be needed. Some children need a combination of both of these drugs. The number of cortisone sprays varies from child to child but often you will take more at the beginning of a cold and a litte less later on.
How do you know if the treatment is working?
The child should be trouble-free between colds and during colds. The breathing problems should not be particularly severe and the cough should not be too strained. If the child is not in control of the asthma, seek the child’s doctor again to adjust the treatment.
If home treatment does not help and the child has difficulty breathing, the child needs urgent medical care.