by Adam Sugerman I vividly remember that autumn day in grade school: we were playing soccer under a blazing, hot sun and a Santa Ana, the hot, dry winds from the desert, typical of Southern California, scattered dust and litter across the blacktop. Concentrating on our herculean task of defending our slim one-goal lead against a team composed of older boys, we hardly noticed when one of our forwards stopped playing and looked uncharacteristically forlorn. Unresponsive to our calls, we called time-out. Suddenly, realizing he was struggling to breathe, we summoned the schoolyard monitor who took him to the nurse. Later we learned that he had suffered an asthma attack.
In many countries, instances of childhood asthma are increasing by alarming rates. Over the past twenty years, reported cases of asthma have increased by 20 percent. At a 1997 conference held in Ischia, Italy, health care professionals discussed this increased prevalence of bronchial asthma and allergic disorders. According to the National Institutes of Health, asthma is the most common pediatric diagnosis for admittance to U.S. hospitals. It is also the most common reason children lose class time. Parents need to know what asthma is, how to identify it, know what action to take if an attack occurs, and implement prevention as well as treatment strategies. Asthma is a chronic disorder of the respiratory system, specifically, the airways (bronchi) in the lungs become irritated. As the bronchi swell, the airways narrow as the muscles surrounding the airways tighten in spasm, the lung lining becomes inflamed and produces an excessive amount of mucus. An attack may impede the ability to breathe. During an acute attack, it is imperative to consult a physician immediately.
Symptoms of asthma may include wheezing, coughing, shortness of breath, and a tight chest, to name a few. During a physical examination, a physician may detect asthma by listening, through a stethoscope, to a wheezing sound during inhalation and exhalation. Sometimes, during a severe case of asthma, obstruction is so severe that wheezing is not detected. In other childhood asthma cases, coughing has been the only outward manifestation. There are many ways doctors confirm a diagnosis of asthma. One of these is by performing spirometry. A spirometer is an instrument designed to determine the capacity of the lungs. During spirometry, a patient takes a deep breath and then blows the air out as fast as possible into a spirometer. Then a health care professional calculates the amount of air exhaled during the first second and the total volume of air blown. A patient with symptoms of asthma will not be able to move air as quickly as a person with normal-width airways. The test is given three to eight times because producing the exact same breathing patterns is difficult, if not impossible. The results from the best maneuver are taken and compared to a range of values determined by age, gender, height, and other factors. A low volume of air exhaled in the first second confirms obstruction in the airways. Next, the physician might instruct the patient to inhale a bronchodilator. After waiting 15 minutes, the spirometry test is repeated. Asthma, thus, might be diagnosed if the volume of air exhaled in the first second increased by more than 15 percent indicating a benefit from bronchodilation.
One of asthma’s characteristics includes rapid changes in airway narrowing. If a patient who has suffered an attack before the time of the tests felt fine during the test, the results may turn out negative. If this occurs, the options available include using the ratio of the amount of air exhaled during the first second to the total amount of air exhaled, performing a methacholine (broncoconstrictor) challenge test (the patient inhales a series of methacholine chloride solutions and the volume of air is measured after 1, 3, 5, and 10 minutes), or taking the spirometry test as the symptoms occur. The profile of an asthma sufferer is difficult to delineate. Researchers believe that some children develop asthma genetically. Another study followed 7000 newborns in five German cities and found that exposure to allergens during infancy led to development of asthma, regardless of family history. Children are not the only ones who suffer from asthma; sufferers may go through their first asthma attack as adults—perhaps due to allergies, stress, climate, or other factors.
Both preventers and relievers help treat chronic asthma. Depending on one’s individual case, the American Lung Association recommends taking the following steps: avoid cigarette smoke and breathing in second-hand smoke, ease into strenuous exercise, minimize stress, cover the face with a scarf on cold days, avoid furry animals and birds, use special mattress covers to prevent mites, maintain living quarters free of bugs, wash pillows and soft toys frequently, stay indoors during smoggy days, and humidify indoor winter air. Many foods, over-the-counter drugs, pneumonia, and other upper respiratory infections may also lead to acute asthma attacks.
Traditional medicine utilizes drugs to provide relief from acute attacks, including anti-inflammatory drugs, inhalers, bronchodilators, and immunotherapy. Regularly included in the arsenal are proventil, intal or chromalyn, and steroids. Intal is also used prophylactically. An increasing number of people are turning to complementary therapies such as yoga, acupuncture, new breathing techniques, and herbal remedies. For the last three years, Dr. Joanne Lowey, a music therapist, and Dr. Zvi Ben-Zvi, a pulmonary specialist, have been investigating the use of wind instruments by asthmatic children, ages 6-18. At the Beth Israel Health Care System in New York, Dr. Ben-Zvi performs two spirometry readings on all the children in the study before and after a 30-45 minute period. Between the two readings, only half the children receive music therapy. Dr. Ben-Zvi does not know which children receive the therapy. Citing the reasons for the dismal growth in pediatric asthma cases, Dr. Loewy stresses poor management and poor compliance in traditional treatment. “Children don’t know what to do; they don’t want to carry an inhaler. Some of the medicines they take may make them hyperactive.” The focus of music therapy is to get children to work with the therapist in reducing stress, slowing breathing and gaining control over breathing. Older children play Pachelbel’s Canon on a recorder while young children play a four tone whistle to the tune, I’ve Been Working on the Railroad. Unofficially, the results seem to ease a child’s ability to control his or her breathing. The context of a musical theme provides a safe framework in which the breathing function can be addressed and often improved. There is a psychological and physical incentive for control. The ultimate goal is to offer complementary modalities on an outpatient basis, especially music therapy, from one to three times per week so that children may have better socialization skills, an enhanced interest in music and better health.
Marisol Culshaw is a registered nurse who has been working with asthmatic children for the past eight years at Beth Israel Health Care Center. She uses therapeutic touch, clinical imagery and drawings and story telling as complementary techniques to help children lower anxiety levels and breathe more easily. Therapeutic touch was originally a part of Chinese medicine. Pioneered by Dr. Dolores Krieger at NYU Medical Center, its goal is to balance energy fields. For example, the practitioner places his or her hands about three to four inches away from the body and starting at the top of the head, outlines the body down to the toes. The purpose is to smooth away congestion. Clinical imagery is evoking the imagination while using all one’s senses. An example is to envision what the lungs look like when they’re sick and draw them. Then the patient imagines what healed lungs look like and sketches them. Two to three times a week at home, the patient should look at the healed lung and send breath to it. The goal of this activity is to raise oxygenation. Drawing and story telling bring illness and health to a level of awareness. The lungs, for example, become more real and tangible resulting in more control by the patient. According to Ms. Culshaw, a combination of treatments is most effective. “Using medicine is very important; we need to do more about self-help strategies and harnessing the power of the mind.” Ms. Culshaw adds, “It’s important to try different approaches and have flexibility, to assess people individually, and bring them to a state of wholeness. The word healing comes from the Anglo-Saxon word halen which means wholeness. A combination of mind, body and spirit are important.”
If helping children with asthma to lead better lives is our goal, then indeed we should incorporate every useful therapeutic modality to achieve that goal. Hopefully, “the day that asthma struck” my friend, will become a less frequent occurrence for other children around the globe.