Asthma is a chronic condition in which a child has repeated asthma "attacks," episodes where air cannot get in and out of the lungs the way it normally does. This usually happens when a child with asthma is exposed to some "trigger" such as a viral infection (for example, the common cold), an allergen (for example, pollens or animals), an irritant (for example, cigarette smoke or air pollution), exercise or cold air. Different people have different triggers and some have more than one.
Inside the lungs, a trigger causes:
- The lining inside the small breathing tubes (airways) to become inflamed and swollen.
- The muscles around the airways to tighten up (constrict).
- More mucus to be made, which gets trapped in the airways.
Together, these things make the airway openings so much smaller than normal that it is hard for air to get through, and breathing becomes very difficult. Treatments for asthma are directed at reversing these problems.
Children with asthma often cough and make whistling noises when breathing (wheeze) as air travels through the narrow airways. Other symptoms may include fast breathing (tachypnea), chest tightness and difficulty breathing.
Asthma is the most common pediatric chronic illness, affecting millions of children younger than 18 in the United States. Most children develop symptoms before age 6, but many of them "outgrow" their asthma later in childhood. Certain risk factors make it more likely that asthma will last into adulthood, including having parents with asthma, also having allergies or eczema with it, or having had bronchiolitis requiring hospitalization during infancy.
Asthma attacks can occur every day or only once in a while, depending on a person’s triggers. Asthma is either intermittent (occurs only once in a while) or persistent (occurs more often than not), and ranges from mild to severe, depending on how often a child has symptoms:
- Mild intermittent — no more often than two days per week or two nights per month
- Mild persistent — more often than two days per week or two nights per month
- Moderate persistent — every day or more often than one night per week
- Severe persistent — all the time or many nights per week
All children with asthma, no matter what type, can experience severe symptoms.
Symptoms of asthma may include:
- Whistling noises when breathing out (wheezing)
- Dry cough, especially at night
- Breathing faster than usual (tachypnea)
- Having a hard time breathing
- Feeling tightness in the chest
- Having a hard time exercising or playing
- Stopping to take a breath between words when speaking
- Trouble sleeping
To know if your child has asthma, the doctor will:
- Ask about your child’s symptoms, including when and how often they occur, and what triggers them. Your child may not have any symptoms during the visit with the doctor, so how you describe the details of the illness will be important.
- Review your child’s medical history. The doctor will ask about any asthma-related conditions (for example, allergies, eczema or hives), and if there are other family members who may have these same conditions.
- Watch your child breathe. This means:
- Counting how many times your child is breathing each minute (respiratory rate). Asthma can cause him to breathe faster than normal (tachypnea).
- Checking if your child is showing signs of trouble breathing, such as using the muscles in his neck, chest or belly to help breathe (retracting), making grunting or whistling noises when breathing out, or flaring his nostrils when breathing in.
- Examine your child’s lungs carefully by listening to your child’s breathing with a stethoscope. Asthma can cause wheezing in the lungs, longer than normal breathing out time (expiration), and sometimes, poor air movement throughout the lungs.
- In children who are old enough (typically 5 or 6 years), a simple device called a peak flow meter is used in the office (and at home) to measure how much air the child is able to breathe out. This shows whether the airways are more narrow than usual, making it harder to get air out of the lungs.
- A special device called a pulse oximeter is used to check how much oxygen is in the bloodstream. This painless test measures the oxygen using a light sensor that is placed on the end of your child’s finger or toe.
- Consider further testing.
- A chest X-ray to check for complications of asthma (for example, pneumonia).
- Lung (pulmonary) function tests to accurately measure airflow and lung volumes.
If your child does have asthma, the doctor will:
- Write out an "asthma action plan" for your child that includes information about which medicines he should use and when, and what to do in case of emergency.
- Recommend ways to avoid being exposed to triggers to prevent more asthma attacks in the future.
- Discuss whether medications may help your child. If your child is wheezing, coughing or having trouble breathing, the doctor may start some of these medicines right away in the office.
- Bronchodilators open up the airways by relaxing the muscles around them, making it easier to breathe.
- Short-acting ones, such as albuterol (Ventolin), work quickly to treat asthma symptoms, but wear off in a few hours. Often called "rescue" or "reliever" medicines, they work best when breathed in (inhaled).
- Longer-lasting ones, such as salmeterol (Serevent), take longer to work, so these should NEVER be used for quick relief. These inhaled medicines are most useful for nighttime symptoms and to prevent exercise-related symptoms.
- Another bronchodilator called ipratropium bromide (Atrovent) sometimes is inhaled along with albuterol to treat severe asthma attacks.
- Steroids, also called corticosteroids, decrease inflammation and swelling in the airways. Used both to treat and prevent asthma attacks, they can be breathed in, taken by mouth, or given directly into the bloodstream or muscle. Inhaled steroids (for example, fluticasone or budesonide) are thought to be the most effective treatment for asthma.
- Cromolyn sodium (Intal) and nedocromil (Tilade) are inhaled medications that only help to prevent asthma symptoms by stopping certain areas of the body from releasing histamine and other chemicals that cause inflammation. Although very safe, to be most effective these medicines must be taken several times each day and for several weeks before exposure to a trigger.
- Montelukast (Singulair) and zafirlukast (Accolate) are a newer class of medicines called leukotriene inhibitors that help prevent asthma symptoms by blocking the effect of leukotriene, a chemical released in the body when someone is exposed to their asthma triggers.
- Methylxanthines (for example, theophylline or aminophylline) sometimes are used for severe asthma attacks, but must be monitored carefully for side effects such as headaches, hyperactivity and seizures.
- Discuss the things you should watch for at home.
- Discuss whether any over-the-counter medicines may be helpful.
- Tell you when your child should be seen again. The doctor usually will want to see your child regularly and hear about your child’s progress to be sure that his "asthma action plan" is the right one.
- If the doctor prescribed any medicines for your child, be sure they are used exactly as directed.
- Using too much albuterol may be a sign that your child’s asthma is not well-controlled. If your child is using albuterol every day, or goes through an entire canister in one month, call your doctor right away to check.
- Do not stop taking any asthma medicine before talking with your doctor. Certain medicines should be used regularly to work best at preventing an asthma attack.
- Inhaled steroids are safe for children when used as recommended. They are felt not to cause growth problems or other side effects that sometimes are seen when steroids are taken often by mouth.
- If your child must take a medicine by inhaler ("puffer"), be sure someone shows you how to use it correctly. Different types of inhalers use different techniques.
- Remember to shake the canister just before using.
- Spacers or holding chambers make it easier for inhaled medicines to get deep into the lungs where they are needed, especially for young children.
- Have your child rinse his mouth after using an inhaler, especially an inhaled steroid.
- At least once a week, wash the spacer with soapy water, rinse and air dry.
- If your child must take a medication by nebulizer ("mist"), be sure someone shows you how to use it correctly.
- To get the most benefit, infants must use a mask because too much medicine will blow away and not be breathed in if the tube is held in front of the face.
- Try to keep your child calm while using the nebulizer. Screaming or crying children may not get enough medicine into the lungs because they tend not to breathe as deeply.
- Medicines used to treat allergic rhinitis (for example, antihistamines, decongestants and some nose sprays), may be useful for children with asthma, especially those with symptoms triggered by allergies. It is best to ask your doctor before giving any over-the-counter medications to a child with asthma.
These over-the-counter medicines usually are not helpful:
- Cough suppressants (dextromethorphan) and expectorants (for example, guaifenesin) usually do not improve coughs from asthma.
Certain over-the-counter medications should not be used (unless directed by your doctor):
- Herbal remedies, such as Chinese skullcap, angelica and licorice root, have not been studied well for treating asthma in children or adolescents and may have unwanted side effects.
- Ephedra (ma huang) is chemically related to the bronchodilator epinephrine, but is not recommended for children due to its possible serious side effects.
- Never give your child aspirin or any products containing aspirin because it can trigger asthma in some children and also has been associated with Reye’s syndrome, a serious illness that affects the liver and brain.
Other things you and your child can do that may help your child feel better:
- Give your child plenty of liquids — breast milk, formula, or other warm (broth, apple juice, lemonade, or tea) and cool (milk, milk shakes, gelatin desserts, flavored ices) ones — to stay well hydrated.
- NEVER smoke around your child because it will make her asthma worse.
- Use a peak flow meter to monitor your child’s asthma. A change from the usual measurements is a sign that your child’s asthma is acting up.
- Avoid all things that trigger your child’s asthma.
- Is getting worse instead of better.
- Is having more trouble breathing.
- Develops blueness around the lips, fingernails or toenails at any time.
- Is not drinking much.
- Has not made any urine in six to eight hours.
- Seems too sleepy or tired (lethargic) at those times when he usually would be awake and active.
- Has high fever.
- Continues to have trouble breathing two to three days after having seen a doctor.
- Following your child’s "asthma action plan."
- Keeping track of your child’s symptoms.
- Taking medicines each day, if recommended, to prevent asthma symptoms in the future.
- NEVER smoking around your child.
- Keeping your child away from other children or adults with colds or flu.
- Making sure your child gets his flu shot in October or November every year, as well as the rest of the family to limit his exposure to the flu during the winter.
- Taking steps to avoid possible triggers, such as controlling how much dust is in his bedroom and keeping animals out of the bedroom.
- Teaching your child to always wash his hands regularly and well.
- Avoiding crowded day-care situations.
Check with your school or day care regarding specific policies about returning after any illness. Asthma is not contagious (spread from person to person), so children with asthma do not need to stay home from school or day care. If they do miss a day or two, they can go back as soon as they feel well enough.
Although the cold that often comes before an asthma attack is contagious, keeping children with respiratory symptoms out of school or day care may not decrease the spread of infection. Therefore, children with colds usually can go back to school or day care as soon as they have no fever for 24 hours and feel well enough to be there.
If your child needs to take a dose of his medicine during the school day, it can be helpful to ask your pharmacist to put the medicine into two different labeled containers. That way you can send one to school or day care and leave the other at home. Be sure to fill out any necessary forms, including a note from your doctor, with specific instructions for giving the medicine.