Managing Kids' Asthma and Allergies During Stressful Times

[MUSIC PLAYING] Today on At the Forefront Live, we'll talk about the effects of both COVID-19 and how this impacts children with asthma and allergies. Also, what happens to kids if their asthma or allergy symptoms are not well controlled? How can parents best manage the symptoms? Dr. B. Louise Giles and Dr. Ruchi Singla will answer your questions during this live Q&A. That's coming up right now on At the Forefront Live.

 

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And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. We're going to start off with having each one of our two physicians introduce themselves and tell us a little bit about what you do here at UChicago Medicine. Dr. Singla, let's start with you.

 

Hi, Tim. Thank you. My name is Ruchi Singla. And I am an assistant professor at the University of Chicago. I am an allergist and an immunologist. And I see both kids and adults.

 

And Dr. Giles.

 

Hi, my name's Dr. Louise Giles. I'm a pediatric pulmonologist here at the University of Chicago Comer Children's. I'm an assistant professor. I'm also the medical director of the South Pediatric Asthma Center. I am the medical director for the Pediatric Respiratory Therapy Program here. And I'm also very involved with education, being the program director for our Pediatric Pulmonary Fellowship. And I've just taken over the reins of the Cystic Fibrosis Pediatric Clinic.

 

Fantastic. Let's get right into our questions. We want to remind our viewers that we'll take your questions for our two experts here. Just type them into the comments section. We'll get to as many as possible over the next half hour.

 

Let's start off just with some basics about allergies, and asthma, and the relationships between the two. And also, if you can tell us-- and Dr. Giles, will start with you on this question. Do children that have allergies and asthma-- are they often one in the same? Or do kids have one thing and maybe not the other?

 

That's a great question. And certainly, in children, a lot of children who have asthma will also have allergies. But not every child with allergies will have asthma. But there are many children who do struggle with both. And we also see children who have asthma, but who do not have allergies.

 

But the most common type of asthma. We see in the pediatric population is what we call atopic asthma or asthma with allergies. So the children not only suffer with allergy symptoms, but their allergy symptoms can interfere with their asthma control. So we certainly see that in our clinics. Both Dr. Singla and I would see that in our-- would see this difficulty with asthma management in our clinics.

 

And Dr. Singla, asthma and allergy, are those often perhaps inherited conditions? And if they are, does that help when you deal with the patient that has them?

 

That's a great question, Tim. So yes, they are certainly related. And as Dr. GIles alluded to, she mentioned atopic asthma, or ATP. This term is kind of an umbrella term for allergies, asthma, and eczema. Another name for eczema is atopic dermatitis. So this umbrella term refers to conditions that do run in families.

 

And ATP is the tendency to develop IgE antibodies or immunoglobulin E. And these antibodies-- basically, when people are sensitized to a particular allergen, when they're exposed to that allergen, these antibodies that are bound on cells can release different chemicals that can cause these allergic reactions. So it's helpful to know when these conditions are in families because when symptoms are present in a child early on, that can help come to a diagnosis earlier.

 

How do you know when it's a problem? Because I think, a lot of times, people will-- and I'm guilty of this myself. I'll go mow the lawn. I start sneezing afterwards. My eyes get a little irritated. But I just figure that's not that big a deal. And with children, maybe a little bit of a different situation-- when do you know that there's an issue and they need to see a physician?

 

Is that for me?

 

Well, either one of you can jump in on that one, yeah.

 

Yeah, yeah. I think anytime that you're having these symptoms frequently and you-- oftentimes, your primary care doctor can help with these symptoms. But a lot of times, it's helpful to know what are those particular triggers, so that you can start to avoid them. For instance, if you know that cutting the grass bothers you, maybe you need to wear a mask, which is convenient right now. Or maybe you need to have somebody else mow the lawn for you. But yeah, I think it's helpful when you're not having good control of your symptoms. And it'd be helpful to know how you could avoid them.

 

All right. And Dr. Giles, we are starting to get some questions from viewers. And I'm going to send this one your way. Is there any increased risk for allergy or asthma in children having multi-system inflammatory syndrome, in children with the coronavirus? And again, obviously that's on everybody's mind right now.

 

That's a great question. And the short answer is we don't know. Because there's so much that we don't know about coronavirus, we're learning about it more and more every day. That's why sometimes people feel confused because they said, well, we were told that we shouldn't wear masks. And now, we're told we should be. And that's just because we're learning about this virus as we go along.

 

We're not sure about the outcomes of these kids who've got this multi-system inflammatory syndrome and whether they're going to go on and have more issues with things like asthma, and ATP, and things like that. The biggest worry, for me, in that population is more directed not even for asthma, but maybe some other underlying pulmonary issues, or whether this is going to affect the vascular bed within the lungs, and then create other issues from that way. But the relationship between that and asthma, we're just going to have to follow these kids along and see what happens

 

Now, Dr. Giles does that increase-- if somebody has COVID, does that increase-- or asthma rather, does that increase their risk for getting COVID?

 

Yeah, that's age dependent, too. We were very, very worried, when this virus came to our continent, about our asthma patients. And we were really discussing this with both the kids and their parents about how they really need to take their medications. And I'm not going to shy away from that. They still need to take their medications.

 

But this was one population we're extremely scared for. And it hasn't panned out in children. And that's because children are not being infected and hospitalized at the same rate as our adult population. Certainly, if you're an older adult and you've got asthma, that definitely increases your risk of having severe COVID and needing hospitalization, or even dying from this. But we've not been seeing the same kind of numbers with children, thankfully, to date.

 

But we just don't know what the future's going to hold. But we're still-- even though we don't know and it hasn't looked like a child's risk for COVID disease is increased in the asthma population, we're still stating that precautions should be taken. We should still consider them high risk at this point in time because we're not sure what the future is going to bring with this.

 

So Dr. Singla, we have another viewer question. This one is, is it OK to use allergy medications, such as Zyrtec tech, everyday?

 

That's a great question. Yes, I get that question frequently. And it is a very safe medication. When in doubt, always check with your physician. But I frequently prescribe Zyrtec as well as Allegra, Claritin. And all of these medications are now over-the-counter and have generics, which are much more affordable. So yes, I would say it is safe to take daily.

 

Now, we have another question that just came in that I'm going to ask both of you because this is kind of the million dollar question here. And I know this is a tough one to answer, but if you can give your best ideas and thoughts on this. Is it safe for kids with asthma and food allergy to return to school this fall with the pandemic? And I think all parents are probably struggling with this one, but particularly parents who have children with these issues. I don't know who wants to start on that one.

 

Well, I can start with that. Yesterday, I was on a chemical panel with cystic fibrosis parents about the exact same issue. And they're incredibly nervous about their kids going back to school. And certainly, with our asthma allergy patients, that's the same thing. The American Academy of Pediatrics has put out a statement stating that the ultimate goal is to have children learning in person at school because there's a lot more to the educational process than just learning about math and reading, certainly the socialization and all the other benefits.

 

However, they also state that it depends on things like the rate of positivity, and so on and so forth with COVID out in the community. And that guideline is easy for anybody to see on their website. So that's the American Academy of Pediatricians.

 

What we're stating with our CF population and what we're stating also in our clinics here at Comer is that, ultimately, the best place for a child to learn is in the school. However, you can't take away the things like parent anxiety, individualized issues-- so a child might have much more brittle asthma. They might have asthma that's tougher to control-- and other factors that are in there that might make it unreasonable for somebody to have their child in the school system.

 

So what we have been saying for our cystic fibrosis population-- and I'm going to say that I've also been saying for my asthma population-- is that if you can do education at home and you want to do education at home, we will 100% support you. If you need a letter for that, we will write a letter stating that they should stay at home and have remote learning. And, also to keep an eye on what's happening.

 

If your child does go to school, they should follow the protocols. That is wearing a mask at school. Try to practice physical distancing. That's the six foot rule. And maintain really good hand hygiene while at school. And we can talk about masks as well. But certainly, what we're saying to parents is this is what the Academy is saying. Things are going to change, unfortunately. But we will be supportive of all of our families for whatever decision they want to make about returning to school.

 

Dr. Singla, your thoughts?

 

I couldn't agree with Dr. Giles more. I think she captured the essence of it, which is we really don't know. And so we have to be cautious. I think this becomes a very individual decision with patients and their families because not only do we have to think about kids and their exposures at school, but the teachers, the staff, the kids that the patients are-- I'm sorry the patients, the families that they're going home to. These are all important considerations.

 

And I think that if you're having trouble, talk to your doctor. But yes, we will support either way. And I think this is evolving. And I hope that we'll have more and more information as time goes on. But hopefully, this is a collaborative effort and flexible to change as we learn more about this novel virus.

 

And you make an excellent point there. You can talk to your physician, if you do have questions, if you have concerns. And one thing I do want to take just a couple of minutes here and discuss a little bit about accessibility for families, both here at UChicago Medicine and other places as well. But one of the things that we've been working really hard to do is implement this program that allows for video visits. And I know both of you-- we talked a little bit before the program. Both of you have done video visits. And if you can talk about the process and how that's worked for you-- that's a video that also illustrates this. And Dr. Giles, if you want to start us on this, talking about your experience with video visits.

 

I love video visits. I think it's a great way to see families. It makes it so easy for them to visit us from their home. We keep where-- there's no travel involved. Patients don't have to pay for parking or worry about other things, as long as they've got a way to connect with us.

 

Obviously, there are some disadvantages. We're not able to put our stethoscopes on their chest and have a listen. It's hard to get what we call their vital signs-- how fast their heart is beating, how fast they're breathing, getting their blood pressure, and those kinds of things. But as a good measure, there's absolutely no reason why we can't do video visits for an awful lot of our patient population, especially those kids that we know.

 

We've been doing new visits, return visits. And I say that it's been a really delightful experience. I feel honored that families will let me into their home because that's sometimes difficult. You want to always put on your best face for your physician. And sometimes, the visits are chaotic because the other kids want to get involved. But we're pediatricians, and we know that. So that can happen. So it's not a problem. So video visits-- I'm hoping that they're here to stay because I think this is a great way to reach out to our population and make it a lot easier.

 

And Dr. Singla, I know you've done some as well. And it is interesting to get that glimpse inside the patients' lives and home.

 

Absolutely. I completely agree. And I think it's interesting. As Dr. Giles pointed out, it's such an honor to be able to go into patients' homes. But also, a lot of parents, if they come to an appointment, if they're busy kind of trying to round up all of their children, that can be really challenging. And I think video visits allows them the comfort of being in their own home, and being able to focus on the interview without having to wrangle the kids while they're doing it.

 

So actually, I agree with Dr. Giles. I hope they're here to stay. And I've found them very enjoyable. And I think that there's just great options for patients, for both coming in and doing video visits.

 

We want to remind our viewers that we'll take your questions. If you just type them in the comments section, we'll get them to our experts and have them answer them in the program. Another question-- and this is one that's come up quite frequently. And that's about masks and children with masks, and in particular children with asthma wearing masks. What do you-- what would you tell parents in that situation? Is it safe to do that? Which way would you go with that? Dr. Giles, let's start with you on this one.

 

So masks are 100% recommend for all of our patients. And there's no reason why somebody with asthma cannot wear a mask. The main issue that we see is that there are some myths that are going around about mask wearing. And one of the myths is that somebody's oxygen levels could fall, or I won't have enough oxygen. And that's just not true.

 

There are plenty of people-- and I've done it myself. You put on what's called a pulse oximeter onto your finger that measures the amount of oxygen that's getting out to the small parts of your body. You put a mask on. It doesn't change. It's still as good as it was beforehand. So you don't get a reduction in your oxygen levels at all.

 

Some people worry about whether they'll rebreathe in carbon dioxide from our exhaled breath. And again, that doesn't happen. We can measure that. It does not happen. And it's not an issue.

 

I've heard somebody say, well, you'll get carbon monoxide poisoning. And you don't get carbon monoxide poisoning from wearing a mask. And the masses are very different. And if you don't mind, I've got a couple here.

 

The thing that people worry about the most is with this one called the N95 mask. And the N95 mask is the one-- I'm sorry. It's upside down. And the N95 mask is the one that we wear when we're in patients who are highly infectious. So this is what we wear in a room with somebody who we know has COVID-19, or who's got tuberculosis, or Ebola, or any of those big ones that we talk about.

 

So these are the ones that stick close to your face. It's got a foam part up here. And when it really goes up tight, it just prevents the movement-- I can't breathe in any virus or particles from somebody else. And I can't expel them to somebody else. So this is the ones that we wear in the hospital. You do not need to use this one out in the community at all. These should be truly saved for those of us who need it in the hospital setting.

 

Then we have procedural masks that are like this. And some have got flaps up. And those are the ones that the surgeons wear in the operating room. You can actually buy versions of these at CVS or Walmart or Walgreens or anywhere. I'm sure [AUDIO OUT]. So these are paper masks. They're good until they get soiled or wet. And then they're not effective anymore.

 

But if you sit there and you're thinking about it, if a surgeon is doing an operation, they're wearing this for hours on end. And they don't get low oxygen levels or too much carbon dioxide. They're able to breathe through these. And that's not an issue.

 

What we're trying to recommend that people do-- and I'm going to be very selfish about this-- is we wear cotton masks. And this is one that we have for our South Side Pediatric Asthma Center. It has two layers in it. You don't need a filter. As long as it covers up your mouth and your nose and fits around your face like this, it's perfectly fine.

 

And what this does it just prevents the exhalation of things that are coming out of us. So if you are infected with the virus and you don't know it yet, the virus can come out in your breath and infect somebody else. So this just prevents that transmission. If it's uncomfortable, then find another one. If it's too constricting, get one that's a little bit bigger.

 

There are plenty of options out there now. And there's absolutely no reason why anybody cannot wear a mask. The only population we say that should not wear one are those who cannot put it on and take it off themselves. So somebody who's too young, so the little kids; somebody who is developmentally delayed or they cannot do self care, they cannot take it off themselves, they should not have went on. But otherwise, everybody should be able to wear a mask.

 

Dr. Singla, it's interesting because I've heard some of the arguments from people who don't want to wear masks. And they'll say, well, they don't protect me. But what people don't get-- or some people don't get. I think they get it, but they don't want to get it. You're actually protecting other people as well. It's not just self-protection. But you're protecting other people.

 

If you're asymptomatic, you could be spreading the virus and not even know that. And I don't know. I don't know how we make that anymore clear for people. Maybe you have some thoughts on that. But that's part of what we're doing. We're trying to protect and care for other people, right?

 

Absolutely. Absolutely, Tim. And I think it's hard. We've gotten a lot of mixed messages, as Dr. Giles mentioned earlier. And I think that's why it's been such a tough conversation. But I've been very-- I would say-- happy in the last few days and reassured that I think people are starting to get the message. And they are starting to see the value in it.

 

And we do require it when you come to our clinic. And I think one thing people are mentioning is, oh, kids can't do it, or certainly not the very young ones, like Dr. Giles mentioned. But some of the school age children, if you talk to them about the importance of wearing it, they completely understand. And they will wear it proudly.

 

So I think have some fun with it. Find some cool material. And there's great patterns online. But yes, you are helping protect your community, in some cases, your friends and family that maybe are more vulnerable. You might be wearing them around them. So it's very, very important. And it's one of the most effective things that we can do right now to help protect everyone.

 

Great. We have some more questions that have come in from viewers. So we'll try to get to those now. Can you tell us how you make the home environment safe for kids with asthma or allergies? And I'm not sure which one of you would like to take a shot at that one.

 

You take a shot.

 

Yeah. So in terms of making the home environment safe-- so I think when it comes to allergies, we talked about identifying those triggers. In some cases, you can pick up on those triggers yourself. If you're always reacting to something like the cat or the dog, then making sure that you're trying to wash your hands and avoid taking those same allergens that-- you might be petting the dog, and getting them on your hand, and then moving them to the face, the same way that we talk about with the virus, that we want to make sure that we wash our hands with soap and water to protect transmission that way.

 

So I think, at home, the big thing is washing your hands frequently with soap and water and cleaning off surfaces. This is one of the things that we are still learning about. But we think that there may be some risk of transmission by fomites or viral particles on different hard surfaces. So wiping those hard surfaces that are commonly used, like doorknobs or faucets, those kinds of things are also a good idea.

 

So Dr. Giles, here's another one from a viewer. And this one, actually, I've been wondering about myself. I've seen this recently. It pops up on my phone sometimes. And we've seen this on the news about air quality warnings for the Chicagoland area. And lately, we've had some kind of dicey days there. How does that affect folks with asthma? And also, is there an impact on people that might have COVID?

 

Yeah. The summertime is always a bad time of year for air quality. And that's because of things like temperature, and humidity, and things like that. I actually monitor the air quality myself. I have an app on my phone. So I always know where air quality is for where I am. But we do know that.

 

And air quality refers to two things. One's called the ozone layer. And the other one is called our exposures to particulate matter 2.5, which is very, very tiny spectacles of pollution usually driven by diesel exhaust and exhaust from carbon products. But that can come into our lungs and certainly make us have a harder time breathing, even if you have no lung disease.

 

And we know that it can cause damage in lungs, limbs if you're exposed to too much pollution. So when there are-- so the air quality is either in the green zone, the yellow, the orange zone, or the red zone. And the red zone is obviously out. When it's too high, we usually recommend that you limit outdoor exposure to this-- windows closed, air conditioning units on, if you've got an air conditioning unit. If not, just try to really reduce your exposure to outdoor activity.

 

People with underlying lung disease, like asthma, should really limit their activity, even in the yellow zone. So it's really important to understand and look for air quality. And you can look at it on the Illinois EPA. Usually, the radio stations or the weather reports include what the air quality is. But that significantly can affect asthma control. And we know that

 

Certain neighborhoods are worse than others. You can imagine if you're closer to the Dan Ryan, you're going to have more pollution exposure-- that's going to be an issue-- than if you're sitting by the lake where the breeze is going. So it's one thing to really try to keep in touch with, as to air quality.

 

With COVID, it's certainly-- we do wonder whether there is increased chance of having more severe COVID if you are around pollution. We certainly know that people who smoke cigarettes and smoke other substances are at higher risk for severe COVID disease if they are to become infected with COVID. So there's no reason to sit there and think that something like pollution would be protective. In fact, it probably is the same as smokers. If you're around a lot of pollution, you're probably going to get more severe COVID disease if you become infected.

 

And not only should you limit your exposure, but should you also limit strenuous exercise if you're--

 

Definitely, definitely, yes.

 

Tim, can I just tag on one thing? As far as the staying safe in the home, one big thing that I didn't mention-- and Dr. Giles reminded me-- was smoking in the home, actually. And this is something where we are very familiar by now how addictive smoking is. And I know there are many parents and family members that want to quit. And I really, really encouraged this because smoke exposure, secondhand exposure can certainly affect children and adults' asthma. And so I would absolutely encourage you that if you are thinking about quitting, talk to your doctor. There are so many options for help with cessation these days. So that's really, really important in a big way that you can change your child and your family's life.

 

Another question-- go ahead, I'm sorry.

 

One other thing. I want to talk about with both pollution and smoking is cleaning products as well. Some cleaning products are very caustic to the lungs. And so we do recommend what we call green cleaning techniques. And you can just look that up on the internet. There are plenty of resources.

 

We have a website for the University of Chicago Associated South Side Pediatric Asthma Center. And they've got good green cleaning suggestions in that. So we recommend using non-caustic cleaning-- like bleach can be a real trigger for some kids' asthma. And so can perfumes and colognes.

 

Excellent. We are about out of time. But I have one more question I want to get to from a viewer that I think is a good one. And it gets back to masks. What are your thoughts on masks with vents? And either one of you can take that.

 

So the masks with the vents-- so we're talking about a mask that's got these things on them, right? The little vent systems on them. I'm not sure how well you can see that. But it's got a thing. And it's an exhalation valve.

 

And the thing is that just this doesn't protect as well. You would absolutely have to put in a filter behind it. So this is the filter for that one. We don't allow these on campus. We don't allow them in hospital because they're just not as protective. So you don't have to spend big money on a mask. Just get a $5 cloth mask. As long as there's a minimum of two layers, that's fine.

 

That is all the time we have for the program. You guys did an awesome job. We'll have another At the Forefront Live in a couple of weeks. Please remember to check out our Facebook page for our schedule of programs coming up in the future.

 

Also, if you want more information about UChicago medicine, take a look at our website, uchicagomedicine.org. If you need an appointment, you can give us a call at 888-824-0200. And remember, you can also schedule your video visit by going to the website. Thanks again for watching, and I hope you have a great week.

 

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