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A cardinal rule in any illness is to identify its underlying cause, because only then can specific treatment be given. In asthma the wheezing is produced by narrowing of the bronchial airways, mainly caused by muscle spasm in the walls of the tubes. The degree of this’ constriction determines whether the child has only minor symptoms or has extreme shortness of breath. But what causes this muscle to narrow in the first place?
It has been well proven that there are certain stimuli that will provide tightening of the airways. These are:
• Allergy
• Emotion
• Pollution
• Infection
• Exertion
Why, however, do these trigger factors not cause asthma in every child? The reason is that some children have an underlying general irritability of their breathing tubes, which means that the tubes constrict very easily on exposure to one of, or a combination of, these factors. This is undoubtedly an inherited trait which is present before birth and shows itself predominantly in the first ten years of life. After that age, the airways gradually become less sensitive and the child then ‘grows out’ of the asthma. Sometimes the bronchial muscles are so irritable that not only do they react to the inhaling of major stimuli but also to the accidental breathing of simple irritants like cold air and smoke. Even such commonplace disturbances as laughter or exercise can be followed in the asthmatic child by an embarrassing wheezing and tightness in the chest.
If you can identify which of these factors produce wheezing attacks in your own child then it is quite possible either to avoid them or dampen them down in some way so as to prevent the asthma starting. A few children are only sensitive to one of these groups, but more commonly it is a combination. Exposure to only a single stimulant may not be sufficient to create problems but as soon as another is thrown in, then the attack will start.
Before looking at these causes in more detail let us first consider 10 year-old Simon. Simon’s first major attack was a severe one in the middle of the night, but talking to his parents produced some interesting information about Simon’s prior symptoms. For the past three summers Simon had suffered quite marked hay fever, which is a condition produced by an allergy to pollen. His mother commented that he tended to worry about things, especially returning to school after the holidays. If he ever caught a cold he would have a troublesome cough for some weeks which was much worse if he was in a smoky atmosphere. During games periods Simon sometimes had to stop to catch his breath.
If we look for the precipitating causes for his actual asthma attack, it is easy to see that Simon has sensitivity to all the main groups of trigger factors; he has an allergy to pollen, is very emotional, has a persistent cough when in a polluted atmosphere or following a cold, and becomes short of breath on exertion. I suppose it is surprising therefore that Simon did not have a serious bout of asthma before the age of 10.
Four year-old Julie had suffered with eczema since she was a baby and seemed to have a constant runny nose. Eczema at this age is nearly always allergic in nature, and the repeated infections in her nose did not – as in most children – clear up in a couple of days, but always left her with an irritating cough. Thus Julie had only two of the major causes of asthma, i.e. allergy and infection, but they were still sufficient to give her a severe bout of wheezing.

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