How Does Laryngitis Affect Children With Asthma?

Overview   

Laryngitis, also known as a type of vocal cord dysfunction, is a viral infection triggered by other infections. It primarily manifests as a painful cough caused from an inflamed and swollen voice box (larynx.)

Asthma is a chronic lung and respiratory disease that can affect any individual, there is no particular age bracket that asthma has been found to be prevalent in. It is where the airways (bronchioles, bronchi, and alveoli) become inflamed and narrow making it difficult for the asthmatic individual to breath. This causes wheezing and coughing.¹

In this article, the correlation between children with asthma and laryngitis, as well as how the two conditions interact, will be explored. First, the two conditions will be outlined separately, we will examine their causes, symptoms, triggers, irritants, and possible remedies. Then, this article will examine how and when laryngitis affects asthmatic children.

Overview of laryngitis in Children

How is laryngitis developed?

Laryngitis is a viral infection triggered from other infections, like: 

• Rhinovirus (common cold)
• Parainfluenza (flu)
• Respiratory syncytial virus (causes the common cold)  
• Coronavirus
• Adenovirus
• Influenza. 

Symptoms and irritants

The manifestations of laryngitis (as also mentioned in the previous paragraph) do not just include a loss of voice; there are other characteristics that can lead up to the voice loss too, some include:

• A husky voice which ends up worsening into a complete loss of the voice
• Difficulty speaking 
• Sore throat 
• Mild fever 
• hoarseness

In addition to these symptoms, when an individual is infected with laryngitis, irritants can end up worsening the symptoms. Examples of irritants are:

• Straining your voice 
• Acid reflux 
• Dust, hay fever, fumes, pollutant allergies
• Smoking 
• Any sort of medication that involves inhalation
• Smoking or vaping 

Pathophysiology 

Pathophysiology is the understanding of what, and how, changes in bodily processes and functions occur to further the development of a disease or pathogen. In the context of laryngitis, there are two types that can be developed: acute laryngitis and chronic laryngitis. Their pathophysiology is almost identical; the only difference is that acute laryngitis lasts for 3-7 days, and develops, and manifests over a much longer period of time lasting for months or even years. 

Pathophysiological signs of laryngitis are:

• Severe inflammation in the vocal folds, larynx , the middle of the neck in front of the food pipe (esophagus), and above the windpipe (trachea.)²
• Edema in the vocal cords is another reason for the loss of voice, and for the swelling seen in the throat. An edema occurs when too much fluid is trapped in bodily tissues³
• The vocal cords, since being inflamed and under a lot of pressure, will change shape thus triggering the change in the sound of the voice^4,5

Overview of asthma in Children

How does asthma develop?

The exact causes of asthma have not been determined yet; however, there are multiple genetic and environmental factors that feed into the development of asthma. Often genetics plays a more pivotal role than environmental factors, so here are some reasons and factors that increase the risk of developing asthma:⁶

• Genetic and family history
• Other associative allergies. Having other particular allergies such as eczema, hay fever, and food allergies increases risks of developing asthma
• Air pollutants and irritant exposure at a young age can stunt lung development and might cause wheezing, which can develop into asthma
• Viral infections during infancy in particular, increases risk of developing asthma. Since the lungs are still developing during infancy and childhood any infections can severely damage and harm their growth resulting in asthma

Symptoms and irritants 

Symptoms vary from patient to patient, and the severity of asthma plays a large role in which symptoms are present and how prevalent they are. However, with this information in mind, here are some common symptoms seen amongst many patients:⁷

• Coughing 
• Wheezing 
• Short breath 
• Tight chest 
• Difficulty breathing a regular basis 
• Difficulty sleeping due to poor breathing 
• Symptoms listed above worsen when sick

Moreover, once asthma has been developed in an individual, similar to laryngitis, there are going to be certain environmental irritants that can trigger asthmatic attacks (fits of wheezing, intense coughing and difficulty breathing.) Some of these irritants include:

• Particular medications such as aspirin, beta blockers, or NSAIDS (non steroidal antiinflammatory drugs) can all aggravate patients and trigger asthmatic symptoms
• Environmental pollutants. If the air quality is poor and there is lots of smoke, fumes, and pollution, asthmatic attacks are very likely to occur
• Sometimes seasonal shifts and weather changes are strong triggers of asthmatic symptoms since some individuals might suffer from hay fever, wheeze more and the pollen worsens the coughing, furthermore, temperature changes and humidity also trigger asthma
• Exercising heavily can trigger asthma 
• Certain foods and drinks with particular chemicals, or preservatives can aggravate asthma

Pathophysiology 

The way the respiratory system is affected from asthma is life threatening. In the respiratory system, the windpipe (the trachea) is broken into two pipes (the bronchi), which then diverge into many smaller pipes (bronchioles), ending with alveoli (air sacs.)⁸

During an asthmatic attack, symptoms (as listed above) are caused from the bronchi and bronchioles getting inflamed. This inflammation limits the amount of air that is able to enter into the lungs (and alveoli) thus resulting in wheezing, coughing and severe difficulty in breathing.⁹

The inflammation is triggered from smooth muscle, found in the walls of the windpipes, contracting and preventing air flow, furthermore, there is an increase in mucus production which also limits the amount of space for air to flow through the system.^9,10

The connection between asthma and laryngitis

It is clear that there are similarities between asthma and laryngitis. There are overlaps in symptoms, causes, triggers, and irritants for these conditions.

Overlapping Symptoms

All shared symptoms (listed below) are triggered from the respiratory system and larynx combined.^11,12

• Hoarseness
• Cough
• Severe difficulty breathing 

Triggers for Both Conditions

Both conditions also have very similar triggers, it is clear that any environmental irritant that affects the ability of an individual to breath will affect both laryngitic and asthmatic patients.^11,12 

• Viral infections as a trigger for laryngitis and asthma exacerbations
• Environmental irritants (smoke, pollution) that aggravate both conditions

Increased Inflammation

Inflammation is a hallmark symptom and a very prominent factor in both conditions. Inflammation is a key culprit as to how the symptoms come about and why they come about.^11,12

• Laryngitis causes inflammation in the larynx and upper respiratory tract
• Asthma triggered inflammation in the lower airways causing difficulties in breathing, coughing, and wheezing

Impact of Laryngitis on Children With Asthma

Worsening of Asthma Symptoms

Since both conditions are so similar, it is predictable that children with asthma who end up contracting laryngitis will appear to have exacerbated symptoms of asthma, almost making onset laryngitis more difficult to diagnose. Due to the similarities of the conditions, practitioners can sometimes think that the exacerbated ‘asthmatic’ like symptoms could just be asthma instead of onset laryngitis.

Nevertheless, laryngitis has long been known to have a negative impact on asthma symptoms, for example:

• Laryngitis frequently exacerbates wheezing and makes breathing difficult
• The average frequency of asthma attacks increases, especially in children during and post acute laryngitis 

Strain on Breathing

One main symptom that is life threatening for asthmatic children who contract laryngitis is the strain on breathing. Breathing naturally in asthmatic children is already quite difficult, with asthma inhalers being a great treatment tactic for preventing throats from constricting, closing up and preventing airflow. However, in laryngitis, the narrowing of the throat will be exacerbated, meaning asthma inhalers may be less effective, or in worst case scenarios, completely ineffective. Since both conditions result in the narrowing of the airways, the downstream effect of airway blockages are decreases in oxygen inhalation, this increases the likelihood of respiratory distress occuring.^13,14,15

Respiratory distress, in particular, is dangerous. As explained in the previous paragraph, respiratory depression is triggered because inflammation of the larynx which compresses airflow in the airways and asthma constricts airway muscles. However, there is also an increase in mucus production which triggers respiratory depression too, this is because it causes blockages in the airway and worsening of asthmatic symptoms.^13,14,15

Summary 

Asthma, as established in this article, is very similar to laryngitis; both in symptomatology, triggers, and pathophysiology. In children, laryngitis has been found to worsen asthmatic symptoms that are already present, or induce asthmatic symptoms such as breathing difficulties by inflammation all throughout the respiratory tract. This inflammation with both conditions present can worsen over time and result in respiratory distress/depression since wheezing, coughing and asthmatic attacks become more common with both conditions in children.

As a result of children contracting acute laryngitis, there is a large increase in the likelihood of asthma attacks during and after acute laryngitis, and potential for asthma to worsen if laryngitis is recurring in childhood.