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Could your child's chesty cough be deadly asthma
Recently I have been taken to labelling myself as a terrible mother — because for years I ignored my nine-year-old son’s breathing problems.
Lucas would have frequent slight breathlessness, occasional difficulties breathing plus numerous, persistent heavy coughs. Even after a nasty bout of pneumonia when he was four years old, which saw him in hospital for several days, I thought Lucas was simply ‘chesty’ and sometimes, if I’m honest, a bit of a hypochondriac.
‘This is the worst day of my life’, ‘Every bone in my body seems to be broken’ and ‘I think I’m going to die’ are among his most used phrases.
Lizzie Enfield withe her son, Lucas, who she thought was a bit of a hypochondriac before he was diagnosed with asthma
I thought ‘I feel like I can’t breathe’ was just more infantile hyperbole, designed to get my attention rather than an accurate description of how he felt.
I never thought Lucas could have asthma, because he had never had an asthma attack.
However, my attitude was swiftly corrected by the asthma nurse I finally took him to a few months ago.
‘That is like assuming you don’t have a heart condition because you haven’t had a heart attack,’ she said.
‘The condition comes first — and if it’s treated you might never have an attack, but if it’s not, the likelihood increases that you will have an attack.’
I’d seen children with asthma being brought into the local children’s ward when I was there with my son for other reasons. They were struggling to breathe; one had turned blue and needed to be given oxygen along with their regular asthma medication.
They also, sadly, seemed to be regulars on the ward. The nurses knew them by name. This, I thought was ‘real’ asthma.
Not only was I mistaken, but by ignoring my son’s wheezing I could have unwittingly been making his condition worse.
Asthma causes inflammation of the airways to the lungs, and if untreated this can cause lasting damage. Three people die of the condition every day in Britain.
Lizzie never thought Lucas could have asthma, because he had never had an asthma attack
When someone with asthma comes into contact with something that irritates their lungs, known as a trigger, the airways narrow and tighten, making it difficult to breathe.
Triggers vary from person to person, but include house dust mites, animal fur, pollen, tobacco smoke, exercise, cold air and chest infections.
‘Asthma is a variable condition and no two people present the same,’ says Delia Balan, a specialist asthma nurse with the charity Asthma UK.
‘The symptoms include breathlessness, wheezing and coughing, particularly at night.’
Of course, I was ignorant of all of this — I thought saying your child had asthma when they’re just a bit wheezy was taking something away from ‘proper’ asthmatics.
The danger of harbouring this misconception is underlined by Aileen Alexander, from Forres in Moryashire, whose 11-year-old daughter Kiera died after an attack in September 2010. ‘Kiera had a lot of allergies, as well as eczema and asthma,’ says Aileen.
‘She had a severe egg allergy and had to carry an EpiPen, so asthma was the least of her worries.
‘She was diagnosed when she was two, after a bout of pneumonia. She used an inhaler occasionally, but it never seemed that serious. She just got breathless sometimes and coughed a lot.
‘On the day she died, she’d been to a dance class, ridden her bike home and then she’d been on the trampoline with her siblings before dinner. She was a bit breathless and took a couple of puffs of her inhaler, as normal.
‘Later that night, she came into our room, saying she was finding it hard to breathe. We told her to take her inhaler and go back to sleep. She often came into our room at night like that and we didn’t think anything was different.
‘Not long after that her younger sister came in, saying Kiera wasn’t answering. I knew as soon as I saw her that she was dead.’
Kiera had never had an asthma attack before or needed an ambulance. ‘I never for a moment thought I’d lose her like that,’ says Aileen. ‘So many people have asthma and manage it, so it doesn’t interfere with their lives.’
Talking to Aileen is a salutary
warning of how easy it is, when your children appear robust and healthy,
to forget how fragile life can be. While the majority of children with
asthma remain healthy and can control the condition, some can see
their asthma suddenly get worse, says Somnath Mukhopadhyay, professor
of paediatrics at Brighton & Sussex Medical School.
Asthma causes inflammation of the airways to the lungs, and if untreated this can cause lasting damage. Three people die of the condition every day in Britain
proportion will grow out of their asthma while others will get more
serious and we don’t know why that is. Children with so-called mild
asthma can get ill quickly, too. When we look at the medical history of
children who have died from an asthma attack, we sometimes find that
their asthma had been mild, had been managed by their GP and had never
been serious enough to require referral to the hospital asthma
‘This is a tragic scenario and underlines that it can be difficult to definitively diagnose the severity of a child’s asthma.’
For me, it was only when a friend whose son’s symptoms are similar to Lucas’s told me he had asthma that I decided to take him to the asthma nurse at my GP surgery.
The nurse recommended a few weeks of
recording and monitoring his symptoms, while testing twice daily how
fast he could blow air out of his lungs in one breath.
was done with a hand-held peak-flow meter, which has a marker that
slides up a scale, when you blow out. Peak flow readings are measured in
litres per minute.
My trumpet-playing older daughter was easily able to record a score of 600 while poor Lucas managed only about 200.
was nothing that would have ever made me think Lucas could be at risk. A
food allergy or hay fever is one of the factors that increase the
likelihood of developing asthma.
include a family history of the condition, exposure to tobacco smoke,
being born prematurely or a childhood lung infection such as
There is no
history of asthma in my family, no smokers and no allergies. And though
Lucas was hospitalised for a few days after his bout of pneumonia aged
four, he was never referred to a specialist asthma nurse.
we now have a rainbow of inhalers that he uses twice a day as a matter
of course and more often if his coughing or wheezing is bad.
The number of children admitted to hospital every hour in the UK due to asthma
I wish I’d taken him to the asthma nurse before and so does he. It’s hard to say how effective the treatment is, but it definitely seems to reassure him and help him get back to sleep when he is coughing badly.
An earlier diagnosis might have helped alleviate lots of nights of nasty coughing — but as Asthma UK’s Delia Balan explains, childhood asthma is often difficult to diagnose.
‘There is no simple test to diagnose asthma so you have to do a bit of detective work to identify recurring patterns of symptoms, such as breathlessness or coughing, and try to work out what triggers these. But these symptoms may not always be obvious.
‘If asthma is undiagnosed or not treated properly there is a danger of worsening symptoms and an asthma attack — which may be severe or even life-threatening.’
As I finish writing this piece, I can hear my son gargling loudly in the bathroom. Lucas is nothing if not a drama queen and he performs this ritual, which follows taking his twice-daily dose of a steroid inhaler, with a flourish.
I suspect his enthusiasm comes from the pleasure he gets making the gurgling, bubbling sound, but he puts me right.
‘Nope,’ he says, spitting into the sink, when I ask him. ‘It’s because my chest doesn’t hurt as much since I’ve been doing this.’
My guilt returns, but at least I know he does have asthma. To ignore the symptoms, just because they appear mild, is to take a huge risk with your child’s health.
For more information see asthma.org.uk or call 0800 121 62 44. Lizzie Enfield’s latest novel, What You Don’t Know, is published by Headline Review, 6.99.