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Proventil, Ventolin (Albuterol, Salbutamol)

Julie is a young patient of mine who experienced her first serious asthma attack one evening when she was 4 years old. I remember visiting the following morning when her breathing had settled and Julie’s parents were able to relax. Neither of them had ever seen anything as frightening before and naturally they asked me to explain the condition to them. It is important to understand what asthma means, its causes and the sequence of events that take place. This knowledge makes it much easier to establish an effective plan for prevention and treatment for your child.
Asthma is a condition affecting the airways of the lungs; the main function of the lungs is to breathe air in and out of the body. Every time Julie inhales, a certain amount of air passes through her mouth and nose into a single tube called the windpipe. This descends downwards into the chest where it divides into the right and left lungs. The bronchial tubes, as they are termed medically, then gradually divide a further twenty five times until they reach all parts of the lungs. At its top end the windpipe is about 2 cm wide and at the extremities the width is reduced to about half a millimeter.
The bronchial tubes are not rigid like metal pipes, but soft and kept open by muscles in the walls. Unfortunately these muscles are not like the muscles in our legs, as we cannot move them of our own free will; if irritated they tend to involuntarily contract. This squeezes the breathing tubes resulting in a narrowing of the hollow area inside, and a consequent reduction in the amount of air which can move through them. The medical term for this narrowing is broncho-constriction.
I explained to Julie’s parents that their daughter’s airways were more twitchy than normal. The reason for this is unknown and may well be some form of development problem before birth. If Julie is then exposed to certain trigger factors the muscles in the bronchi will contract violently, causing marked narrowing of the airways. These trigger factors vary from child to child, although dust and pollen are the commonest. The situation is further complicated by the fact that the bronchi have a delicate inner lining which can become swollen if irritated. In addition this lining secretes a fluid called mucus or phlegm which can clog up the breathing tubes.
In summary, the breathing tubes in an asthmatic child such as Julie become narrowed both by contraction of the outer muscle tissue and by swelling of the inner lining, with an excess amount of phlegm further worsening the situation.
Obviously, once the narrowing of the bronchi reaches a certain severity it becomes difficult to breathe in enough oxygen or blow out sufficient carbon dioxide, and this makes the child short of breath. As I stressed to Julie’s parents, at the start of an asthma attack it is only the muscle contraction that is important, as the swelling of the lining takes a few hours to develop. Therefore the earlier the asthma is diagnosed the less complex it is to treat and the quicker it will settle.

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