Reactive Airway Disease And Its Relationship With Asthma

Strictly speaking, reactive airway disease is not a disease itself but rather a term used to describe a “symptom” similar to having a headache or a runny nose. Having reactive airway disease does not necessarily mean having asthma, but individuals with asthma are likely to experience reactive airway disease. Reactive airway disease and asthma share similar characteristics, such as narrowing and inflammation of the airways during an episode, leading to difficulty breathing. However, reactive airway disease is typically transient, while asthma is a chronic condition. Asthma symptoms also include persistent coughing and a feeling of tightness in the chest. Reactive airway disease can be considered a precursor to asthma, but it is just one contributing factor. If reactive airway disease is not managed properly, it can potentially progress to asthma.

Often, parents tend to underestimate coughing in children, thinking that wearing more clothing, avoiding cold foods, or reducing physical activity will be enough to improve the condition. As a result, they may delay seeking medical attention, which can worsen the situation. It is important to remember that if coughing is caused by reactive airway disease or asthma, relying solely on cough medicine or avoiding cold foods will not solve the problem.

• Persistent or recurrent coughing
• Wheezing which is caused by narrowed airways.
• Shortness of breath
• Chest tightness
• Rapid breathing which often accompanied by shallow breaths.

Reactive airway disease does not occur without a cause. It is triggered when children with sensitivity come into contact with allergens. Common allergens include dust mites, pollen, animal fur, and polluted air, among others. In addition, environmental changes such as catching a cold, fluctuations in temperature and humidity, emotional fluctuations (sudden crying or laughing), and strong odours, among other factors, can potentially trigger various levels of tracheal allergies.

The answer is not necessarily. Children of different ages can develop reactive airway disease due to various environmental factors. In children under 2 years old, reactive airway disease is mostly triggered by viral infections. As children between 2-6 years old begin attending school, they are exposed to a greater variety of bacteria and allergens. As children grow older, their lung function and airway development gradually mature, reducing the chances of airway infections. The period between 6-12 years old is relatively stable in terms of development, making it easier to diagnose asthma during this time. There is a considerable time gap between reactive airway disease and the development of asthma. If there are signs of reactive airway disease in a child, seeking medical attention early and using appropriate medications for control is important. With proper management, it may even be possible to reduce medication usage or prevent its persistence into adulthood. On the other hand, parents should encourage healthy physical activity to enhance resistance, maintain cleanliness at home, and minimize exposure to allergens as an important part of managing reactive airway disease symptoms.

Asthma and allergic rhinitis are common allergic conditions in children. Research indicates that approximately 80% of asthma patients also have allergic rhinitis, and individuals with allergic rhinitis are more susceptible to developing asthma compared to the general population. If reactive airway disease is caused by allergic rhinitis leading to postnasal drip, it is crucial to address allergic rhinitis as a primary step.

Medications for treating reactive airway disease can generally be categorized into three groups:

1. Oral anti-inflammatory drugs, such as leukotriene modifiers, help alleviate inflammation symptoms in the airways.

2. Bronchodilators available in inhaler or oral form are used to dilate the airways. They provide immediate relief and improvement of asthma symptoms but do not reduce reactive airway disease.

3. Anti-inflammatory drugs, specifically inhaled corticosteroids, are used for long-term control of the condition and to stabilize the airways. The dosage of inhaled corticosteroids is significantly lower than that of oral corticosteroids. As long as the prescribed dosage is followed based on the doctor's advice, parents need not worry. It is crucial not to discontinue medication without medical guidance, even if the child's condition appears stable. Oral corticosteroids are generally reserved for short-term and emergency use.

In addition, certain lifestyle habits can also help reduce the risk of recurrent tracheal sensitivity:

• Regularly change bed sheets and bedding to minimize exposure to dust mites and mould.
• Store stuffed animals in sealed plastic bags to limit their contact with allergens.
• Clean pet hair regularly to reduce allergen accumulation.
• Avoid carpets, as they can harbour dust and allergens.
• Maintain good ventilation in the home to promote fresh air circulation.
• Engage in regular exercise to enhance overall respiratory health and strengthen resistance.

If the specific allergen cannot be identified, parents can consider having their child undergo a skin prick test to pinpoint the triggers. In Hong Kong, early utilization of sublingual or subcutaneous immunotherapy can be beneficial in improving reactive airway disease and preventing asthma.

Virtus Paediatric Immunology and Infectious Diseases Specialists

Virtus Respiratory Medicine Specialists