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Reactive Airways Disease


What is reactive airways disease?

Reactive airways disease (RAD) is a term used to describe breathing problems in children up to 5 years old. It is common for infants and children to cough and wheeze when they have a cold. It may be hard to know if a child has asthma, bronchiolitis (virus that causes swelling of the airways), or airway hyperresponsiveness. Airway hyperresponsiveness is quick narrowing of your child's airways, making it hard for him to breathe. Your child may also have pneumonia (lung infection), or simply a cold. Your child's healthcare provider may say that your child has virus-induced asthma or RAD. Your child's symptoms may go away as he gets older, or he may have asthma, or another breathing disorder, later in life.

What increases my child's risk of reactive airways disease?

Your child is at higher risk if:

  • His mother has asthma, or someone in the family has allergies.
  • He was not breastfed, or he was breastfed fewer than 3 months.
  • He had a lung infection caused by a virus, such as respiratory syncytial virus (RSV).
  • He was treated in the hospital for bronchiolitis.
  • He is around secondhand smoke. He may also be at higher risk if his mother smoked while she was pregnant.
  • He is around anything that can trigger an allergic response, such as pollen and pets.

What signs and symptoms may mean that my child has reactive airways disease?

The signs and symptoms of RAD are similar to asthma. Your child may have trouble breathing. He may cough often or wheeze when he breathes. Your child's signs and symptoms may get worse when he is sick, or when he exercises. They may get worse when he is around animals, insects, or mold. Weather changes, pollen, smoke, dust, and chemicals can make the symptoms worse. Your child may start coughing or wheezing if he laughs hard or cries hard. His signs and symptoms may come only at night, or they may be worse at night, and even wake your child up. Your child may have any of the following:

  • Wheezing: Wheezing is a high-pitched whistling sound heard when a person breathes out. Your child's wheezing may come and go before he is 3 years old. Then it may go away altogether. Your child may wheeze only when he has a virus (germ), such as a cold. He may wheeze even when he does not have a cold. He may wheeze when he is around things such as pet hair. His wheezing may decrease as he gets older.
  • Trouble breathing: Your child may tell you that his chest feels tight. His nostrils may flare out as he tries to breathe. His stomach muscles or the skin over his ribs may move in deeply while he tries to breathe. He may also take shorter, faster breaths than usual.
  • Cough: Your child may have a cough that does not go away. You may hear crackles when he breathes or coughs.
  • Fast heartbeat: When your child cannot breathe as well, his heart may beat faster than usual.
  • Runny nose: Your child may have a runny nose along with other signs and symptoms of RAD.

Why are the symptoms of reactive airways disease common among children?

As a young child's immune system (ability to fight infection) develops, he is less able to fight off colds and other illnesses. Reactive airways disease symptoms can occur because of airway swelling. A child's airways are small and narrow, making it easy for them to fill and get blocked with mucus. These factors make it hard for healthcare providers to know what is causing your child's symptoms, or the best way to treat them.

How is reactive airways disease diagnosed?

Healthcare providers will ask you about your child's symptoms. Tell them if your child's symptoms get worse when he is around pets, or smoke. Tell them if the symptoms get worse at night, or in cold air. Tell them if your infant grunts or sucks poorly when he is feeding. If your older child has to miss school, often feels ill, or is too tired to exercise, tell healthcare providers. Your child may need one or more of the following tests to find the cause of his symptoms:

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your child's oxygen level is low or cannot be read.
  • Spirometry: A spirometer measures how well your older child can breathe. He will take a deep breath and then push the air out as fast as he can. This test measures how much air your child is able to push out. This is called forced expiratory volume (FEV). The test results show healthcare providers how small your child's airways have become.
  • Mucus samples: Fluid from your child's nose or throat may be collected and tested. The results may tell healthcare providers what is causing your child's symptoms.
  • Blood tests: Your child may need blood tests to give healthcare providers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.
  • Chest x-ray: This is a picture of your child's lungs and heart. A chest x-ray may be used to check your child's heart, lungs, and chest wall. It can help healthcare providers diagnose your child's symptoms, or suggest or monitor treatment for medical conditions.

How is reactive airways disease treated?

Healthcare providers may treat your child's symptoms with medicines. They may follow up with him as he gets older to see if his symptoms go away. Your child may need to use medicines every day or only when needed. He may need one or more of the following treatments:

  • Short-acting bronchodilators: Short-acting bronchodilators may be given to your child to help open his airways. These medicines start to work right away and are used to relieve sudden, severe symptoms, such as trouble breathing. These medicines may be called relievers or rescue inhalers.
  • Long-acting bronchodilators: Long-acting bronchodilators may be called controllers. This medicine helps open the airways over time, and is used to decrease and prevent breathing problems. Long-acting bronchodilators should not be used to treat your child for sudden, severe symptoms, such as trouble breathing.
  • Corticosteroids: These medicines help decrease swelling and open your child's air passages so he can breathe easier. Your child may breathe the medicine in or swallow it as a pill. He may need higher doses of corticosteroids if he has bad asthma attacks. Give this medicine as ordered by your child's healthcare provider. Do not stop giving your child this medicine without his healthcare provider's okay.
  • Breathing treatments: Breathing treatments open your child's airways so he can breathe more easily. Your child may need to use a nebulizer or an inhaler to help him breathe in the medicine. Ask healthcare providers for more information about these devices, and to show you and your child how to use them.
  • Oxygen: Your child may need oxygen to help him breathe easier. He may need a nasal cannula (small tubes placed in the nose) or mask. Your child may not like to use the mask, so healthcare providers may have you place it next to your child's face. Do not take off your child's oxygen without asking his healthcare provider first.

What can I do to help prevent my child from reactive airways disease?

  • Do not let anyone smoke around your child: Cigarette smoke can harm your child's lungs and cause breathing problems. Do not let anyone smoke inside your home. If you smoke, you should quit. You will improve your health and the health of those around you when you quit smoking. Ask your healthcare provider for more information about how to stop smoking if you are having trouble quitting.
  • Keep all follow-up visits: Tell healthcare providers about your child's symptoms. For example, tell them how often and how badly your child is wheezing or coughing. Make sure your child gets all of the vaccines suggested by his healthcare provider.
  • Avoid triggers: A trigger is anything that starts your child's symptoms or makes them worse. If you know that your child is allergic to a certain food, do not let him have it. The allergy can cause his airways to close. This can be life-threatening. Avoid areas where there is pollution, perfume, or dust. Remove pets from your home.
  • Breastfeed your infant: Breast milk helps protect him from allergies that can trigger wheezing and other problems.
  • Help your child get enough exercise and eat healthy foods: Follow healthcare providers' orders for how to manage your child's cough or shortness of breath while he is active. If his symptoms get worse with exercise, he may need to take medicine through an inhaler 10 to 15 minutes before exercise. Give your child healthy foods. Ask your child's healthcare provider what your child should weigh. If he weighs more than his healthcare provider says he should, his symptoms may get worse.
  • Avoid spreading illness: Keep your child away from others if he has a fever or other symptoms. Do not send him to school or daycare until his fever is gone and he is feeling better. Keep your child away from large groups of people or others who are sick. This decreases his chance of getting sick.
  • Make changes to your home: Your child's signs and symptoms may get worse when he is around dust mites, cockroaches, or mold. You can help keep your home free from these triggers. Keep the humidity (moisture level in the air) low. Fix leaks, and remove carpets where possible. Use mattress covers, and wash bedding every 1 to 2 weeks in hot water. Wash tables and other surfaces with weak bleach (1 tablespoon of bleach in a gallon of water).
  • Ask healthcare providers to create an asthma action plan: An asthma action plan may help you and your child manage his RAD symptoms at home. The plan will include signs to watch for that mean your child's symptoms are getting worse. The plan will state what to do if this occurs, and list emergency phone numbers. Your child's triggers will be on the plan so that you both know what to avoid. The plan will list any medicines your child takes. It will also state when your child should see his healthcare provider for a follow-up visit.

What are the risks of reactive airways disease or its symptoms?

Infants and young children who have RAD are at a greater risk of bronchial hyperreactivity as they get older. This is when the airways quickly overreact to triggers by narrowing or closing. If your child has severe symptoms of RAD, he is at a higher risk of ongoing wheezing and asthma. His risk of lung problems as an adult is also greater. If your child has asthma, he may need to use medicine often or all of the time. The medicine may have side effects. It may make your child shaky, hoarse, or nervous. He may also have a headache, upset stomach, or sore throat. His lungs also may not grow as they should. Infants or children may stop breathing if their symptoms get worse. Talk to your child's healthcare provider about these risks.

When should I contact my child's healthcare provider?

  • Your child is shaky, nervous, or has a headache.
  • Your child is hoarse, or has a sore throat or upset stomach.
  • Your infant often throws up when he coughs.

When should I seek immediate care or call 911?

  • Your child's wheezing or cough is getting worse.
  • Your child has trouble breathing, or his lips or fingernails are blue.
  • Your older child cannot talk in full sentences because he is trying to breathe.
  • Your child looks restless and is breathing fast.
  • Your child's nostrils flare out as he tries to breathe. His stomach muscles or the skin over his ribs may move in deeply while he tries to breathe.
  • Your child goes from being restless to being confused or sleepy.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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