What Is the Main Idea?

Antibiotics are frequently prescribed to children experiencing acute worsening of their asthma, but are they always needed? Published in the International Archives of Allergy and Immunology, the research article “Antibiotic Treatments Prolong the Wheezing Period in Acute Exacerbation of Childhood Bronchial Asthma” focuses on this question and shows that antibiotics might even make it harder to recover from an asthma attack.

What Else Can You Learn?

The post describes the symptoms of asthma, why attacks occur, and gives some advice on what to do if you’re having an asthma attack.

What Is Bronchial Asthma?

Bronchial asthma is commonly known as asthma. It is an incurable condition that affects the airways (i.e., the trachea, bronchi, and bronchioles). During an episode of asthma, referred to as an asthma attack, the airways swell, narrow, and may produce extra mucus.

Symptoms of an asthma attack include trouble breathing, a tightness across the chest, a cough, and wheezing. The attack can be mild, moderate, or severe, with the differentiation based on the person’s ability to speak, lie down, or sit, and the presence of retractions (where the ribs pull in during a breath). A diagnostic device called a peak flow meter can be used to precisely differentiate the three states. While asthma doesn’t directly cause fevers, there is an association between bronchial asthma and bronchitis that can lead to a fever co-occurring with prolonged or frequent asthma attacks.

Wheezing is a required symptom for a diagnosis of asthma. Described as a high-pitched whistling or purring noise that is particularly noticeable on exhale, wheezing must occur during multiple instances of difficulty breathing.

Asthma can flare up due to allergens in the air (e.g., pollen, dust mite droppings, dander from animals), allergens in the body (e.g., an insect sting, medication, food proteins), irritants in the air (e.g., chemical fumes, sawdust, cigarette smoke), environmental changes (e.g., moving into colder air), or physical exertion.

What Should You Do If You Have an Asthma Attack?

If you have already had a diagnosis of asthma, you probably have an action plan from your physician. You may have an inhaler or other medication. That is certainly enough for a mild asthma attack and may be enough for a moderate attack. Because severe asthma attacks can be life-threatening, there are circumstances when calling an ambulance or seeking emergency care is vital.

For example, if an asthma attack comes on after exposure to allergens, the patient is struggling for every breath, the patient passes out or their lips turn blue, there is a co-occurring fever around 40 °C (104 °F), emergency care is absolutely essential. Attacks lasting longer than 24 hours, milder fevers lasting multiple days, and disruptions to sleep are also given as reasons to seek advice from healthcare professionals.

Antibiotics and Asthma

Managing asthma in children is naturally challenging, particularly when one considers the emotional distress that both child and parent or guardian experience during an asthma attack. This can prompt the desire to go further with attempts to treat the condition than are advisable or necessary.

The research article “Antibiotic Treatments Prolong the Wheezing Period in Acute Exacerbation of Childhood Bronchial Asthma” focuses on an effort to help that may actually do more harm. Medical guidelines in many countries state that antibiotics should not be routinely prescribed to children with worsening asthma symptoms. Nevertheless, children with acute exacerbation of asthma are prescribed antibiotics more frequently, even when they don’t have any signs of a bacterial infection.

The only reason to prescribe antibiotics to someone with asthmatic wheezing is if they have a bacterial infection in their respiratory system or are at a very high risk of developing one (for example, if a family member already has one). Prescribing an antibiotic when there is no presence or risk of bacterial infection is entirely unnecessary.

In the study described in “Antibiotic Treatments Prolong the Wheezing Period in Acute Exacerbation of Childhood Bronchial Asthma”, the researchers examined pharyngeal samples and took clinical information from over 100 children with acute exacerbation of asthma. The period of time when wheezing occurred was of particular interest. They found that over half the children had been given antibiotics and that the period of wheezing was longer in those patients than in the ones who didn’t receive antibiotics. Even in those patients with a bacterial infection (Streptococcus pneumoniae, which can cause pneumonia), the period of wheezing was longer when antibiotics were prescribed.

What Does This Mean for Me?

If you or your child has asthma and a physician suggests an antibiotic during a period when your asthma is worse, ask if it’s absolutely necessary. Although this study needs to be repeated with a larger cohort of patients, it is still a significant indication that antibiotics might hinder the calming of the asthma symptoms. Check if the antibiotic is needed, discuss the pros and cons, share the link to the article with your physician. It’s still possible that the antibiotic is needed: Unchecked pneumonia is dangerous! But this information may be helpful in making a decision that leads to the asthma coming under control sooner.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.

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