Round Table Discussion

Abstract

Chairman Smyth: It is our purpose at this Round Table Discussion to discuss asthma in children with special emphasis on the practical aspects of such care. A literal interpretation of the word asthma is "to breathe hard." This is the symptom in labored respiration after violent exercise, with oxygen lack in high altitudes, so also the lack of oxygen caused by circulatory and cardiac disturbances. Such usage of the term, "labored breathing" also implies a primary obstructive phenomena in the lungs, or a pneumonia. Thus, we find our differential definition requires further limitation. Asthma is really a symptom with many possible causes. So, for our own purposes of definition, we are going to limit the subject of asthma to those patients whose labored breathing is due to edema, secretions, and smooth muscle spasm induced by allergic sensitivity. No element in the diagnosis is more important than the history of the patient. A good history cannot be obtained in one interview but is the result of persistence by the physician and of cooperation and understanding by the parents. A diary-like history kept by the mother will be invaluable. Many times we have interviewed anxious parents when the child was having an acute asthmatic attack, and got nowhere on the family history. You suspect there may be a bilateral allergy inheritance but you can elicit no information as to a constitutional inherited factor. This is equally true of the initiation of symptoms. The parents may deny any other allergic symptomatology, but as they begin to understand the problem, you will obtain further information extremely valuable for your study. The physician wants to know the season of the year in connection with the onset of symptoms, the locus of the first attack, has the child had repeated colds, any dermatitis of an allergic nature, etc. Once the intelligent mother has understood the problem, her observations can be as accurate as those of the physician, and in several instances, I have seen her come up with a solution of certain phases of the problem which has been very apt. It seems unnecessary to mention the importance of the physical examination. In a sense, it is the clinician's scientific approach, i.e., accurate observation which not only clarifies the differential diagnosis to a great extent, but also brings to light the nutritional status, contributing infections, and the general make-up of the child. These are often of the utmost significance in any program designed to bring relief from the asthma, as well as to assure robust health.