What is the difference between a child having reactive airway disease and asthma?

This is a good question and can be a bit confusing. I’ll throw bronchiolitis into the mix just to make it a little more complex. In the end however, we will find the complexity comes from giving different names to much the same thing.

As most of us know we need oxygen to survive. We touched on this when we talked about how glucose is made into energy or ATP (adenosine triphosphate). I will spare the details of this complex cycle, but take my word for it that oxygen is a key component in what is called the kreb cycle and electron transport system that allows our cells to turn this glucose (sugar) into ATP.
The bottom line; we need oxygen to stay alive! No surprise there. Our respiratory system is how our body gets oxygen from the atmosphere to our cells. The primary organ that does this, as we might have guessed, is the lungs.

We have two lungs; right and left. Those lungs fit in a hermetically sealed compartment called the pleural cavity.

We can think of the lungs in two basic parts; the tubes with air and the vessels with blood. The air goes into our lungs through a series of tubes starting with the trachea then branching into increasingly smaller and more numerous tubes until it reaches a very small microscopic sac-like structure called the alveoli. This is called the bronchiole tree.

Alveoli can be thought of as the business end of the respiratory system. On the other side of things, the blood vessels, we can start in the right atrium of the heart. The blood flows to the lungs in a similar manner, starting with the pulmonary artery and then branching out into smaller vessels in the lung until these vessels become microscopic and run almost infinitely close to one of the millions of alveoli. For those who are paying attention the bronchiole artery and vessels are different than the pulmonary vasculature.

We can imagine what happens next. The oxygen in the alveoli crosses over to these tiny pulmonary vessels and off it goes back to the left side of the heart, out to the body and into the cells to make ATP.

Simultaneously, carbon dioxide crosses from the vasculature into the alveoli, back up the bronchiole tree (tubes in the lungs that deliver air), out of the mouth, into the atmosphere, picked up by trees that use it for food, then excrete oxygen back into the atmosphere and the whole system starts over. Amazing!

Now that we have a brief understanding of the respiratory system, let’s answer our question. As we know from previous articles, when our immune system is triggered it releases an inflammatory response.

Part of that response is white blood cells that fight foreign intruders. Otherwise known as congestion and snot. The lungs are no different.

In addition, the bronchiole tree can constrict in an attempt to limit these unwanted guest. As a result we get a disruption in the smooth flow of air through our lungs. This manifests itself by causing the person to wheeze.

So the wheezing can be a result of an established overactive immune system and in time the person may be diagnosed with asthma. As a result true asthma is not the result of an infection although they can be set off by such.

In addition a respiratory infection such as the flu or other viral infection can also produce wheezing. In young children we often call this bronchiolitis.

Reactive airway on the other hand is much the same response as asthma or non-infectious bronchiolitis except in this case the child will typically grow out of this very quickly and does not continue into later childhood.

So to simplify. In all these conditions the common denominator is our immune system. The difference is slight and often related to age and consistency of systems. In any of the above cases the treatment is almost always the same.

We need to get those bronchioles open and clear of inflammatory cells. Albuterol is often used with great success as it is a type of medicine called a beta agonist. The simple explanation is that beta agonists cause bronchioles to open. In addition, steroids are often used as well as the help stop the inflammatory response and clear congestion.

While there is much more that can be said on this topic I think that’s more than enough for now. Thanks for staying with me and feel free to send a question!

Ask Dr Berry a question.
(Email Dr. Berry: dberry@hotmail.com)