Approximately 17 million Americans have asthma. The cost of illness related to asthma is around $6.2 billion per year in the United States. Each year, an estimated 1.81 million people with asthma require treatment in the emergency department with approximately 500,000 hospitalizations. Children younger than 18 years of age account for 47.8% of the emergency department visits and 34.6% of the hospitalizations due to asthma exacerbations. The magnitude of the impacts of asthma in children is illustrated by the fact that asthma accounts for more hospitalizations in children than any other chronic illness. Moreover, asthma causes children and adolescents to miss school and causes parents to miss days at work. As might be expected, asthma also accounts for more school absences than any other chronic illness.
Asthma is a disorder caused by inflammation in the airways (called bronchi) that lead to the lungs. This inflammation causes airways to tighten and narrow, which blocks air from flowing freely into the lungs, making it hard to breathe. Symptoms include wheezing, breathlessness, chest tightness, and cough, particularly at night or after exercise/activity. The inflammation may be completely or partially reversed with or without medicines.
Symptoms of Asthma
Coughing: Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma. Cough due to nocturnal asthma (nighttime asthma) usually occurs during the early hours of morning, from 1 a.m. to 4 a.m. Usually, the child doesn't cough anything up so there is no phlegm or mucus. Also, coughing may occur with wheezing.
Chest tightness: The child may feel like the chest is tight or won't expand when breathing in, or there may be pain in the chest with or without other symptoms of asthma, especially in exercise-induced or nocturnal asthma.
Other symptoms: Infants or young children may have a history of cough or lung infections (bronchitis) or pneumonia. Children with asthma may get coughs every time they get a cold. Most children with chronic or recurrent bronchitis have asthma.
Treatment of Asthma
The goals of asthma therapy are to prevent your child from having chronic and troublesome symptoms, to maintain your child's lung function as close to normal as possible, to allow your child to maintain normal physical activity levels (including exercise), to prevent recurrent asthma attacks and to reduce the need for emergency department visits or hospitalizations, and to provide medicines to your child that give the best results with the fewest side effects.
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Medicines that are available fall into two general categories. One category includes medications that are meant to control asthma in the long term and are used daily to prevent asthma attacks (controller medications). These can include inhaled corticosteroids, inhaled cromolyn or nedocromil, long-acting bronchodilators, theophylline, and leukotriene antagonists. The other category is medications that provide instant relief from symptoms (rescue medications). These include short-acting bronchodilators and systemic corticosteroids. Inhaled ipratropium may be used in addition to inhaled bronchodilators following asthma attacks or when asthma worsens.
In general, doctors start with a high level of therapy following an asthma attack and then decrease treatment to the lowest possible level that still prevents asthma attacks and allows your child to have a normal life. Every child needs to follow a customized asthma management plan to control asthma symptoms. The severity of a child's asthma can both worsen and improve over time, so the type (category) of your child's asthma can change, which means different treatment can be required over time. Treatment should be reviewed every one to six months, and the choices for long- and short-term therapy are based on how severe the asthma is.
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