Asthma

Asthma is an airway disease that can be classified physiologically as a variable and partially reversible
obstruction to air flow, and pathologically with overdeveloped mucus glands, airway thickening due to
scarring and inflammation, and bronchoconstriction, the narrowing of the airways in the lungs due to the
tightening of surrounding smooth muscle. Bronchial inflammation also causes narrowing due to edema
and swelling caused by an immune response to allergens.

According to the leading experts in asthma, the symptoms of asthma and best treatment for you
or your child may be quite different than for someone else with asthma.
The most common symptom is wheezing. This is a scratchy or whistling sound when you
breathe. Other symptoms include:
Shortness of breath
Chest tightness or pain
Chronic coughing
Trouble sleeping due to coughing or wheezing
Asthma symptoms, also called asthma flare-ups or asthma attacks, are often caused by allergies
and exposure to allergens such as pet dander, dust mites, pollen or mold. Non-allergic triggers
include smoke, pollution or cold air or changes in weather.
Asthma symptoms may be worse during exercise, when you have a cold or during times of high
stress.
Children with asthma may show the same symptoms as adults with asthma: coughing, wheezing
and shortness of breath. In some children chronic cough may be the only symptom.
If your child has one or more of these common symptoms, make an appointment with an allergist
/ immunologist:
Coughing that is constant or that is made worse by viral infections, happens while your child
is asleep, or is triggered by exercise and cold air
Wheezing or whistling sound when your child exhales
Shortness of breath or rapid breathing, which may be associated with exercise
Chest tightness (a young child may say that his chest hurts or feels funny)
Fatigue (your child may slow down or stop playing)
Problems feeding or grunting during feeding (infants)
Avoiding sports or social activities
Problems sleeping due to coughing or difficulty breathing

Patterns in asthma symptoms are important and can help your doctor make a diagnosis. Pay
attention to when symptoms occur:
At night or early morning
During or after exercise
During certain seasons
After laughing or crying
When exposed to common asthma triggers
Asthma Diagnosis
An allergist diagnoses asthma by taking a thorough medical history and performing breathing
tests to measure how well your lungs work.
One of these tests is called spirometry. You will take a deep breath and blow into a sensor to
measure the amount of air your lungs can hold and the speed of the air you inhale or exhale. This
test diagnoses asthma severity and measures how well treatment is working.
Many people with asthma also have allergies, so your doctor may perform allergy testing.
Treating the underlying allergic triggers for your asthma will help you avoid asthma symptoms.

Asthma Treatment & Management

There is no cure for asthma, but symptoms can be controlled with effective asthma treatment and
management. This involves taking your medications as directed and learning to avoid triggers
that cause your asthma symptoms. Your allergist will prescribe the best medications for your
condition and provide you with specific instructions for using them.
Controller medications are taken daily and include inhaled corticosteroids (fluticasone (Flovent
Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), ciclesonide
(Alvesco), flunisolide (Aerobid), beclomethasone (Qvar) and others).
Combination inhalers contain an inhaled corticosteroid plus a long-acting beta-agonist (LABA).
LABAs are symptom-controllers that are helpful in opening your airways. However, in certain
people they may carry some risks.
LABAs should never be prescribed as the sole therapy for asthma. Current recommendations are
for them to be used only along with inhaled corticosteroids. Combination medications include
fluticasone and salmeterol (Advair Diskus, Advair HFA), budesonide and formoterol
(Symbicort), and mometasone and formoterol (Dulera).
Leukotriene modifiers are oral medications that include montelukast (Singulair), zafirlukast
(Accolate) and zileuton (Zyflo, Zyflo CR).
Quick-relief or rescue medications are used to quickly relax and open the airways and relieve
symptoms during an asthma flare-up, or are taken before exercising if prescribed. These include:

short-acting beta-agonists. These inhaled bronchodilator (brong-koh-DIE-lay-tur) medications

include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and
pirbuterol (Maxair Autohaler). Quick-relief medications do not take the place of controller
medications. If you rely on rescue relief more than twice a week, it is time to see your allergist.
Oral and intravenous corticosteroids may be required for acute asthma flare-ups or for severe
symptoms. Examples include prednisone and methylprednisolone. They can cause serious side
effects if used on a long term basis.
Visit the AAAAI Drug Guide for a complete list of medications commonly used to treat asthma.
If you are pregnant, you may be hesitant about taking medications, including those for asthma.
This can be a mistake for your health and that of your baby-to-be. Continue taking your
prescribed asthma medications and make an appointment with your allergist to discuss
treatments that will help you have a healthy pregnancy. Additionally, you may want to enroll in a
study designed to monitor medications and pregnancy.
People with asthma are at risk of developing complications from respiratory infections such as
influenza and pneumonia. That is why it is important for asthma sufferers, especially adults, to
get vaccinated annually.
With proper treatment and an asthma management plan, you can minimize your symptoms and
enjoy a better quality of life.

Gastroenteritis
You probably called it the flu or stomach flu when you were a kid. But that
common, uncomfortable illness marked by nausea, vomiting and diarrhea isnt
really the flu at all. Flu is short for influenza and is a respiratory illness. The
stomach flu, on the other hand, is a viral infection of the digestive tract. Its proper
name is gastroenteritis gastro refers to the gastric system, and the itis part
means inflammation and irritation but people sometimes also call it a stomach
bug.

Symptoms
Nausea, vomiting and diarrhea are the classic signs of a stomach bug. Your little one
will probably have a decreased appetite, which is good because when the stomach
is that upset, whatever goes in almost inevitably comes out. Kids who have a
stomach bug may also have a low-grade fever, abdominal pain and muscle aches.

Test for gastroenteritis

Most of the time, the stomach flu is diagnosed based on babys symptoms. (Is he throwing up
frequently? Having lots of loose, runny stools? He probably has a stomach bug especially if
symptoms subside in a day or so.)
If your childs symptoms arent improving and you take him in to the doctor, they may collect a
stool sample, which can be sent to a lab to determine the cause of infection. A stool sample can
be helpful in ruling out a bacterial or parasitic infection (which could cause similar symptoms).

How did baby get gastroenteritis?

Stomach bugs are contagious. The viruses that cause stomach upset are present in the stool and
vomit of infected people. Thats probably why stomach infections spread so easily among little
kids. Diapers can leak, and its hard sometimes to clean things up thoroughly before another
child comes into contact with the area. Many stomach bugs can survive for hours on surfaces.

Stomach bugs can become airborne when a child with one vomits, so if your child is present
when another child throws up, he could swallow airborne particles that contain the virus.
Kids can also catch a stomach bug by sharing cups and eating utensils with infected children.

Treatment
Most stomach bugs are relatively harmless, but watch out for dehydration. Kids who are
vomiting and having lots of loose stools may not take in enough to equal whats going out. Your
job as parent is to encourage frequent, small sips of liquid to replace any lost fluid.
I tell parents to follow the Rule of 20, says Natasha Burgert, MD, FAAP, pediatrician at
Pediatric Associates in Kansas City, Missouri. When a child vomits, the stomach is very
sensitive for the next 20 minutes even a sip of water can make them vomit again. So wait 20
minutes, and then give them an ounce or two, and wait 20 minutes. If they keep that down, go
ahead and give them another ounce, and wait 20 minutes. If they tolerate that, you can go to two
ounces. Just wait another 20 minutes before you start increasing the volume, using that Rule of
20.
Breast milk is the best fluid replacement for nursing babies, so go ahead and breastfeed baby
every 20 minutes or so. Formula-fed babies and older toddlers can drink an electrolyte solution.
(Formula is okay, too, if your baby can tolerate it.)
Frequent bowel movements can irritate your childs bum, so be sure to apply a thick layer of
barrier cream at each diaper change even before you notice any sign of irritation. In fact, its a
good idea to ramp up the barrier cream as soon as your child starts vomiting, because loose
stools are usually next.

Magnetic Resonance
Imaging (MRI) Scan
A magnetic resonance imaging (MRI) scan is a painless procedure that
lasts between 15 and 90 minutes, depending on the size of the area being
scanned and the number of images being taken.
Before the scan

On the day of your MRI scan you should be able to eat, drink and take any medication as usual,
unless advised otherwise.
In some cases, you may be asked not to eat or drink anything for up to four hours before the
scan, and sometimes you may be asked to drink a fairly large amount of water beforehand. This
will depend on the area being scanned.
When you arrive at the hospital you will usually be asked to fill in a questionnaire about your
health and medical history. This will help the medical staff performing the scan be as sure as
possible that you can have the scan safely. Read more about who can and can't have an MRI scan
Once you have completed the questionnaire, you will then usually be asked to give your signed
consent for the scan to go ahead.
As the MRI scanner produces strong magnetic fields, it's important to remove any metal objects
from your body, including:

watches

jewellery, such as earrings and necklaces

piercings, such as ear, nipple and nose rings

dentures (false teeth)

hearing aids

wigs (some wigs contain traces of metal)

Any valuables can usually be stored in a secure locker.

Depending on which part of your body is being scanned, you may need to wear a hospital gown
during the procedure. If you do not need to wear a gown, you should wear clothes without metal
zips, fasteners, buttons, underwire (bras), belts or buckles.
Some MRI scans involve having an injection of contrast dye. This makes certain tissues and
blood vessels show up more clearly and in greater detail.
It's possible for contrast dye to cause tissue and organ damage in people with severe kidney
disease. If you have a history of kidney disease, you therefore may be given a blood test
to determine how well your kidneys are functioning and whether it is safe to proceed with the
scan.
An MRI scan is a painless procedure, so anaesthesia (painkilling medication) is not usually
required. You can ask for a mild sedative to help you relax if you are claustrophobic. If you
would like a sedative, you should ask your GP or consultant well in advance of having the scan.
If you decide to have a sedative during the scan, you will need to arrange for a friend or family
member to drive you home afterwards as you will be unable to drive for 24 hours.
General anaesthetic (medication that makes you unconscious) is often used when young children
and babies have an MRI scan. This is because it is very important to stay still during the scan,
which young children and babies are often unable to do when they are awake.
During the scan

An MRI scanner is a short cylinder that is open at both ends. You will lie on a motorised bed
that is moved inside the scanner. You will enter the scanner either head first or feet first,
depending on the part of your body being scanned.
In some cases, a frame may be placed over the body part being scanned, such as the head or
chest. This frame contains receivers that pick up the signals sent out by your body during the
scan and it can help to create a better quality image.

A computer is used to operate the MRI scanner, which is located in a different room to keep
it away from the magnetic field generated by the scanner.
The radiographer operates the computer, so they will also be in a separate room to you. However,
you will be able to talk to them, usually through an intercom, and they will be able to see you at
all times on a television monitor.
While you are having your scan, a friend or family member may be allowed to stay in the room
with you. Children can usually have a parent with them. Anyone who stays with you will be
asked whether they have a pacemaker or any other metal objects in their body. They will also
have to follow the same guidelines regarding clothing and removing metallic objects.
To avoid the images being blurred, it is very important that you keep the part of your body being
scanned still throughout the whole of the scan until the radiographer tells you to relax.
A single scan may take from a few seconds to three or four minutes. You may be asked to hold
your breath during short scans. Depending on the size of the area being scanned and how many
images are taken, the whole procedure will take between 15 and 90 minutes.
The MRI scanner will make loud tapping noises at certain times during the procedure. This is the
electric current in the scanner coils being turned on and off. You will be given earplugs or
headphones to wear.
You are usually able to listen to music through headphones during the scan if you want to, and in
some cases you can bring your own CD of music you would like to listen to.
You'll be moved out of the scanner when your scan is over.
After the scan

An MRI scan is usually carried out as an outpatient procedure. This means that you will not need
to stay in hospital overnight. After the scan, you can resume normal activities immediately.
However, if you have had a sedative, a friend or relative will need to take you home and stay
with you for the first 24 hours. It's not safe to drive, operate heavy machinery or drink alcohol
for 24 hours after having a sedative.
Your MRI scan will need to be studied by a radiologist (a doctor trained in interpreting scans and
X-rays) and possibly discussed with other specialists. It is therefore unlikely that you will know
the results of your scan immediately.

The radiologist will send a report to the doctor who arranged the scan, who will discuss the
results with you. Unless they are needed urgently, it usually takes a week or two for the results of
an MRI scan to come through.