Unexpected Bronchial Asthma Trigger Factors in Children and Treatment Through Compounding

Unexpected Bronchial Asthma Trigger Factors in Children and Treatment Through Compounding

i-stethoscopeImagine a classroom filled with energetic children. Now consider this—one in every ten of those kids suffers from asthma. In fact, asthma attacks cause 10.5 million missed school days every year, with parents also needing to stay home to ensure that kids continue to breathe normally. When attacks are over, families must go back to avoiding triggers, a task that demands extreme diligence. Frustration can peak when parents can’t determine all the triggers that set off their kids’ asthma. Pharmacists can help by educating about unknown triggers, like sunscreen, and they can continue to make life easier by offering compounded solutions.

Symptoms of Asthma in Children and Adolescents

A significant proportion of children with asthma face long-term illness. When recurrent symptoms occur by age six, asthma is likely to continue throughout childhood. Even though it tends to go into remission during puberty, at least half of all children continue to experience attacks during adolescence and young adulthood. Severe asthma during childhood means they’re 12 times more likely to still have asthma at age 50.1

Symptoms are always related to a trigger, which causes inflammation, bronchial restriction and reversible airway narrowing. As a result, children experience a dry cough, wheezing, chest tightness and/or difficulty breathing.2

The disease is staged according to symptom severity guidelines developed by the 2007 National Asthma Education and Prevention Program.3 Frequency of using a short-acting beta agonist, the overall impact on normal activities, measures of lung function and nighttime awakening are included in staging criteria, along with these key classifications for symptoms:

  • Intermittent: Symptoms occur two days or less weekly
  • Mild persistent: Symptoms occur more than 2 days weekly but not daily
  • Moderate persistent: Symptoms occur daily
  • Severe persistent: Symptoms occur throughout the day

Don’t let the neat delineation of symptom severity fool you—asthma isn’t that simple. The characteristics can overlap and a patient’s classification can change. Any child at any stage may experience mild, moderate or severe exacerbations. Even children with intermittent asthma can have a life-threatening exacerbation between periods of normal lung function and minimal symptoms.

Common Asthma Triggers

Most kids with asthma—and their parents—are well-versed in the triggers they need to avoid to prevent an asthma attack. It may take some experimentation to identify the triggers specific to each child, but at least parents can begin with a list of common triggers:

  • Upper respiratory infections – The common cold is the most common trigger in children.
  • Environmental – Includes cold air, changes in barometric pressure, rain, wind, pollution, exhaust fumes.
  • Irritants – Paint, perfume, tobacco smoke, room deodorizers, aerosol sprays, cleaning products and paint.
  • Exercise – Symptoms usually develop within 5 to 10 minutes after the activity stops, but could occur during exercise. Exercise isn’t avoided; it’s managed with an extra dose of medication if necessary.
  • Allergens – House dust and mites, pollen, mold and animals (especially cats and dogs, but any furry critter can be a trigger).
  • Strong emotions – From stress to laughing and crying, emotions cause a change in breathing similar to hyperventilation, which can trigger asthma.
  • Food additives – Parents should watch for preservatives, food colorings and flavoring agents, such as sulfites and nitrates.

Unexpected and Less-Well-Known Triggers

It’s especially important for pharmacists to be sure that parents of their young asthma patients know about these unexpected asthma triggers:

  • Sunscreen: Several ingredients in sunscreens—benzophenone, octocrylene and para-aminobenzoic acid—can trigger asthma.4 Parents should also avoid using sunscreen sprays, which can be inhaled and irritate lungs.
  • Aspirin: Pharmacists are familiar with aspirin-exacerbated respiratory disease, but most parents don’t realize that aspirin and other NSAIDs can trigger asthma.
  • Acid reflux: About half of children with asthma also have gastroesophageal reflux disease. Acid reflux may trigger a reaction in airways. Some asthma medications, such as theophylline, can worsen acid reflux.
  • Bisphenol A (BPA): BPA is used in plastic bottles, sport equipment and other products.  The Columbia Center for Children’s Environmental Health recruited 568 pregnant women, took urine samples during the third trimester and tested their children at ages three, five and seven. They found that pre- and postnatal levels of urinary BPA were associated with asthma in children.5
  • Limonene: Limonene is a cyclic terpene hydrocarbon naturally produced in the rind of lemons, limes and other citrus fruits. When inhaled, it can irritate lungs and trigger asthma.
  • Spices: Pepper, oregano, dill, paprika, cumin, poppy seeds, coriander and other aromatic spices can cause an asthma attack. If parents are struggling to identify triggers, suggest they remove one spice at a time to see if it helps.
  • Thunderstorms: Parents may associate thunderstorms with asthma, but they probably chalk it up to an emotionally-triggered response due to fear of thunder and lightning. It turns out that pollen grains rupture during electrical storms, leading to an asthma attack in allergic children.6

The Role of Compounding

Patient outreach and education is one of the most important roles for pharmacists. Back in 1995, the Director of the National Heart, Lung and Blood Institute said that he hoped pharmacists would make an effort to improve the overall health of people with asthma. 7 The action plan proposed then still applies today, with advice to instruct patients in the use of inhalation medications and monitor refill intervals to identify poorly controlled asthma.

Another significant advantage of compounding is the ability to formulate the right agents at the right dosages to achieve the best results in young patients. Current pharmacologic therapies include short-term and long acting beta2-agonists, inhaled and systemic corticosteroids, leukotriene modifiers, methylxanthines, anticholinergic agents and monoclonal antibodies. In other words, children require a precise formula containing multiple agents to treat asthma. Compounding can make it easier for parents and children to comply with the regimen.

Pharmaceutica North America provides a diverse selection of high-quality bulk APIs, prescription drugs and custom compounding kits with everything you need to customize topical medications. Contact us today to talk about how we can help you serve young patients with asthma.

Show 7 footnotes

  1. “Asthma Facts,” August 2015, https://www.epa.gov/sites/production/files/2015-10/documents/asthma_fact_sheet_eng_july_30_2015_v2.pdf
  2. “Pediatric Asthma,” September 2015, http://emedicine.medscape.com/article/1000997-overview
  3. “Overview of Changes to Asthma Guidelines,” May 2009,  http://www.aafp.org/afp/2009/0501/p761.html
  4. “Five Lesser-Known Asthma Triggers, October 2015, http://www.pharmacytimes.com/resource-centers/asthma/5-lesser-known-asthma-triggers
  5. “Prenatal and Postnatal Bisphenol A Exposure and Asthma Development Among Inner-City Children,” March 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3643970/
  6. “Thunderstorm-Related Asthma: What Happens and Why,” March 2016, http://www.ncbi.nlm.nih.gov/pubmed/26765082
  7. “Role of Pharmacist in Improving Asthma,” July 1995, http://msdh.ms.gov/msdhsite/_static/resources/2106.pdf
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