Dr. Allan Becker has devoted much of his life’s work to the study of asthma and how it affects children who have it. (photo from Allan Becker)
As Jewish community member Dr. Allan Becker was starting his career as a general practitioner, his daughter was diagnosed with asthma. As a result, he has devoted much of his life’s work to the study of the condition.
“My interest really started when my oldest daughter began having a wheezing episode at about two years of age,” Becker told the Independent. “It was pretty obvious that this was an infection – something we call bronchiolitis, which is fairly common in young children.”
Becker was working in Dauphin, Man., at the time of his daughter’s diagnosis, in the 1970s, and was beginning to see more and more kids with asthma coming into the emergency room.
“Since 1980, when I returned to academics, I’ve been trying to understand why the epidemic started – what the developmental origins of asthma and allergies are,” said Becker, who is now based in Winnipeg. “And, really, they’re the canary in the coal mine when you think about the increase in chronic diseases.
“Asthma is by far the most common chronic disease in children and it’s the earliest to start,” he said, “but we’re seeing parallel increases of other chronic diseases, like diabetes, inflammatory bowel diseases, various forms of arthritis, and others.”
Over the course of a five-decade career, so far, Becker has seen chronic diseases become more prominent. And, while the reasons for this change remain elusive, it seems clear that it involves genes and the environment.
In the early 1990s, Becker and Vancouver-based Dr. Moira Chan-Yeung embarked on a study of ways to potentially prevent the development of asthma.
“Think about the environment in terms of things we breathe and eat … and things like pets in the home, like tobacco smoke exposure, like pollution, like bad nutrition, Western-style diets, etc.,” said Becker. “We started a multifaceted prevention of asthma program in 1994.”
While that study did not reap substantial results, it did eventually lead to a current study examining the environmental impact on expectant mothers in all areas, including the benefits of decreasing stress, which Becker feels may be the most important factor.
Information about the study, called Canadian Healthy Infant Longitudinal Development (CHILD), can be found at childstudy.ca.
“CHILD started in 2008 and is an observation study, because we don’t believe we know enough to prevent the disease as yet,” said Becker. “We’re now seeing the children at 8 and 9 years of age, and we’re looking way more broadly at the environment. We’re looking at stress very specifically, both for parents and children.
“We’re looking much more in terms of diet, but also at the microbiota, the bacteria and other organisms that live in us, with us and on us, and which are likely extremely important – maybe critical – in helping to shape children’s immune responses in early life.”
According to Becker, there are more bacteria in our gut than there are cells in our body, and microbiota are now being considered as the cause of and potential cure for all sorts of illnesses.
One of the biggest hurdles is trying to determine if a young child who is wheezing has asthma and should be treated as such, or if the child has a respiratory infection that causes wheezing. Becker said part of the problem is how to more accurately define wheezing, which is described as a whistling noise coming from the chest.
“The key thing is that it’s not just the whistling noise in the chest,” said Becker. “It’s also that tugging in, particularly tugging in under the ribs, with the tummy pulling in when breathing. That’s a very good indication that those airways are narrowed and that the child has to work hard at moving air, particularly moving air both in and out. That’s what we teach our trainees to work on with the families they see.
“And, obviously, any time a child is distressed – if they’re looking distressed, particularly if there’s a change in colour of the lips – those are urgent issues. And, some children have such severe narrowing of the airways that you don’t hear wheezing, because they’re not moving enough air, but they will be struggling to breathe. You’ll see them pulling in their tummy and you’ll see their shoulders heaving,” he said. “And you’ll often see toddlers and older kids with their hands braced on their knees, hunched forward, trying to get air in. That type of tripoding is really a worrisome sign, as is a change in lip colour – that’s an emergency. Those children need to be brought to emergency quickly.”
If it gets to the point that the child is given inhalers, Becker pointed out that blue puffers are for particularly bad episodes, while orange or red puffers are for management.
For a bad episode, he said, two inhales from the blue puffer should be taken. “An inhalation and a bit of a pause, and then a second puff and inhalation … in many cases, that will be enough to help control things,” said Becker. “If it doesn’t help make things better, then, in five to10 minutes, it should be repeated. If the child is still distressed, that’s an indication they need to be brought to a hospital.”
The blue puffer should not be used for asthma management, he warned, as the body will develop resistance to it. So, if the controller medications are not providing enough control, he said parents should talk to the doctor who prescribed the puffer to determine a solution.
“If people are needing to use the blue puffer on an ongoing basis, even once or twice a week, week after week, that’s really telling you that you don’t have control of what’s going on and is very worrisome,” said Becker. “There should never be a death from asthma. But, sadly, every year there are some. And, these deaths are – rather surprisingly – not necessarily in kids with the most severe, persistent asthma; they’re in kids who are thought to have mild asthma. But, in fact, when you look at it, if you are using the blue puffer and need to get a new one every month or two, that’s a big red flag … needing to use the blue puffer in the middle of the night, that’s a big red flag. Nighttime symptoms are really a worry – those are kids who need to be seen and properly assessed and, in most cases, they need to be using controller medication.”
Becker is proud of having led the development of a national certification for asthma educators in Canada – Canada was the first country to provide this type of certification.
“We have a children’s allergy and asthma education centre in Winnipeg attached to our children’s hospital,” he said. “It’s one of the only real free-standing ones in North America. The website is asthma-education.com.”
Rebeca Kuropatwa is a Winnipeg freelance writer.