Respiratory advice: The increase in asthma among adults and children is a familiar story in western countries. In Ireland we have the fourth-highest number of asthmatics in the world, after Australia, New Zealand and the UK.
What's most alarming is the number of children who suffer the familiar symptoms of coughing, wheezing and shortness of breath. It is estimated there are 100,000 young Irish asthmatics.
"Population studies show at least 15 per cent of children have asthma, and in excess of 20 per cent of school-going children have symptoms consistent with it," said Dr Peter Greally, a consultant paediatrician who specialises in respiratory disorders.
As to why people develop asthma there is as yet no answer, although it is known that the tendency to develop the condition often runs in families.
Outdoor air pollution has not been proven to cause asthma although it can worsen symptoms, according to the Asthma Society of Ireland.
Neither do viral infections, house dust mites, cigarette smoke or food cause asthma but they can make symptoms worse.
Findings of the late Russian respiratory researcher, Prof Konstantin Buteyko, say that poor breathing habits such as breathing through the mouth and chronic hyperventilation exacerbate asthma triggers.
Asthma is a distressing condition, especially for young children and their parents.
People are more likely to ring the asthma society helpline seeking advice for their children than for themselves, said Mary Llewellyn, a nurse who works there part time.
Many queries relate to pre-school children, who, according to Dr Greally, account for a much higher rate of hospital admissions than other age groups.
"Questions range from 'what should I do with my two-and-half year old who coughs and chokes every time she starts exercising', to 'my child is constantly coughing and out of breath despite medication' and queries about the association between asthma and eczema," said Ms Llewellyn.
The demand for information about how to cope with very young children who develop asthma prompted the asthma society to produce an information booklet specifically focused on this age group.
Sponsored by the pharmaceutical company Merck Sharp & Dohme, it details the different medicines which can be used to treat very young asthmatics.
"Pre-school children can be quite difficult to treat for two reasons," explained Dr Greally.
Firstly, doctors tend to avoid labelling a very young child because at least one in five will have wheezing at some point during their early years.
"In children, asthma tends to get better. Two-thirds can grow out of it and of those who continue to have it many will improve," he said. Hence the reluctance to label very young children as asthmatics.
Secondly, difficulties in getting medication into very young children's lungs makes treatment of this age group a challenge. "Some of them are very reticent to allow a mask over their nose and mouth," said Dr Greally.
Asthma medicines can be divided into two main types - relievers and preventers - according to the booklet.
Relievers, which generally come in blue inhalers, are prescribed for children to take immediately when asthma appears. They act as bronchodilators, relaxing the muscles surrounding the narrowed airways, but do not reduce swelling of the airways.
Preventers are recommended for children who need to use a reliever more than once a day on a regular basis. They help calm down the swelling in the airways and reduce the risk of severe attacks.
The first choice of preventer is an inhaled steroid, according to the asthma society's booklet.
A newer type of preventer, a leukotriene receptor antagonist, or LTRA, is available as tablets, chewable tablets and as granules which can be given with food to children as young as six months.
"Children metabolise drugs differently to adults and it is encouraging that newer medicines have been studied and developed with this specific age group in mind," said Dr Greally.
The Asthma Society of Ireland booklet will be particularly useful for parents of small children, he said. He highlighted issues regarding childcare as of particular interest to parents of this age group.
"If a child is going to a child-minder or a child-minder is coming into the home, they need to know what to do in an emergency."
When asked why there is no reference in the booklet to the Buteyko method, which aims to reduce asthmatics' need for medication through changing breathing habits, Dr Greally said the medical board of the asthma society, of which he is a member, could not endorse it based on the evidence which they have seen.
For further information, see: www.asthmasociety.ie