Asthma in children

Asthma is relatively common in children. Although it is a serious medical condition, asthma can be well controlled, allowing your child to live a full and active life.

Symptoms of asthma in children

Children with asthma most commonly have symptoms of:

  • wheeze (a whistling sound in the chest when breathing out);
  • cough;
  • difficulty breathing; and
  • a feeling of tightness in the chest.

Often these symptoms are most apparent at night-time, first thing in the morning and with exercise.

Asthma triggers

Asthma symptoms in young children can be ‘triggered’ (aggravated or precipitated) by a wide range of factors, including:

  • viral respiratory infections such as colds;
  • exposure to allergens (including dust mites, pets and pollens);
  • exercise;
  • exposure to cold or dry air;
  • laughing and strong emotions;
  • cigarette smoke; and
  • some medicines (including aspirin, non-steroidal anti-inflammatory drugs (NSAIDS) and Echinacea).

Less commonly, an allergy to a particular food additive can trigger asthma. However, it is very important that you do not eliminate important foods from your child's diet unless your child has been tested and diagnosed by a specialist doctor as having an allergy. If you eliminate foods unnecessarily and without guidance, you risk causing a nutritional deficiency in your child.

Diagnosis and tests

Your doctor will examine your child and take a thorough history of your child's symptoms, including episodes of wheezing and coughing. Episodes of wheezing and coughing are common in young children, but not all young children who wheeze have asthma. Wheezing that is persistent or recurrent make the diagnosis of asthma more likely. Among younger children, if symptoms only occur when the child has a cold, a diagnosis of asthma is less likely.

The main breathing test used to diagnose asthma is called spirometry. This test measures how much air you breathe in and out of your lungs, and how quickly you can exhale. It can also test the effect of asthma medicines on your breathing. Spirometry is often not suitable for children younger than 4 to 5 years.

Another way to help determine whether asthma could be causing your child’s symptoms is to have a trial of asthma medicine. A clear improvement in your child's symptoms with the use of asthma medicines can help to confirm a diagnosis of asthma.

Your doctor will also ask about allergies, and whether other family members have asthma or allergies. Sometimes your child may be advised to have skin-prick tests to confirm whether an allergy is triggering their asthma symptoms.

What causes asthma in children?

Although the exact causes of asthma are not fully understood, asthma is more common in children who have a parent or other close family member who has asthma or in children who are themselves showing symptoms of allergies, such as atopic dermatitis (eczema) and allergic rhinitis (hay fever).

The chance that a child will develop asthma is increased if that child lives in a house where someone smokes. If a mother smokes when she is pregnant the chance that her baby will develop asthma later in life is increased. For these reasons, families are advised not to smoke near babies and children, and not to smoke inside a house where children live or in the family car. Pregnant women should avoid exposure to cigarette smoke throughout pregnancy and avoid exposure of their newborn baby to cigarette smoke.

Asthma treatments for children

The key to treating asthma is to control the asthma symptoms so that your child can lead a full life, and to minimise the number of asthma attacks. This is achieved by:

  • understanding what triggers your child's asthma;
  • avoiding exposure of your child to these triggers;
  • understanding and helping your child to take the asthma medicines that have been prescribed by your doctor; and
  • regularly reviewing the treatment and management of your child's asthma with your doctor.

Asthma action plan

Your doctor will provide you with information about how to recognise worsening asthma symptoms in your child and what to do in this situation. This information will usually be in the form of a written asthma action plan, which is a vital part of managing your child's asthma.

This plan is developed by your doctor and will explain to you which medicines your child is to take and how often; how to recognise when your child's asthma symptoms are worsening and how to increase medicine doses in this situation; when to see your doctor or go to a hospital in case of worsening asthma symptoms; and what emergency steps to take in case of a severe asthma attack.

Asthma medicines

The main types of asthma medicine are:

  • reliever medicines (taken to treat asthma symptoms when they occur and also used to prevent exercise-induced symptoms); and
  • preventer medicines (taken regularly to control asthma and prevent symptoms occurring).

Some children with mild, infrequent asthma who only occasionally experience symptoms may be prescribed a reliever medicine only, which is used when symptoms appear. Relievers are prescribed for all children with a diagnosis of asthma.

Children with more frequent asthma symptoms are usually prescribed a preventer medicine in addition to a reliever medicine. Preventer medicine is taken every day, even when your child is well, to keep the asthma symptoms at bay.

There are also other medicines that are occasionally used to treat asthma in specific circumstances, such as severe flare-ups and difficult-to-treat asthma.

It is very important that you do not change your child's medicine without talking to your doctor first, even if your child does not appear to have symptoms at the moment.

Inhalers, spacers, nebulisers and tablets

Most medicines for children with asthma are breathed in (inhaled). The 3 main types of inhalers for asthma treatment are:

  • standard pressurised metered-dose inhalers (also called ‘puffers’);
  • breath-activated pressurised metered-dose inhalers; and
  • dry powder inhalers.

Parents and children need training to ensure inhaler devices are used properly.

Children (especially children younger than 6 years) have difficulty using inhalers properly, and should use a ‘spacer’ attached to their puffer. A spacer is a clear plastic chamber that allows the child to breathe in a puff of airborne medicine over several breaths, rather than co-ordinating one big in-breath with the release of puffer medicine (which is how most adults and some older children use a puffer).

Spacers are recommended for children of all ages when using relievers for an asthma flare-up, and for using puffers that deliver inhaled corticosteroids (a type of preventer medicine).

Children younger than 2 years of age need to use a small face mask with their spacer; children aged between 2 and 4 should use a mask until they can use a spacer mouthpiece properly.

Children with severe asthma may need to take medicine using a nebuliser, which is a small machine that delivers liquid medicine as a fine mist via a face mask.

Some asthma medicines are taken as tablets.

As your child grows up

For many children, their asthma improves as they get older. Asthma is more likely to persist into adulthood if it is severe than if it is mild. A family history of asthma or other allergies also increases the risk that asthma will remain when a child grows up.

Be aware that asthma that has improved can reappear at any time, as the tendency for asthma remains. It is therefore important for people who have had asthma at any time in their life to consider scheduling regular check ups with their doctor to assess symptom control and treatment requirements.

How can I help my child?

Unfortunately, some children remain reluctant to use their puffers at school. So what can the parent of a reluctant child with asthma do?

Firstly, see your child's doctor or specialist for an individualised written asthma action plan that takes into account any special needs that your child has.

Then use this checklist as a guide to help your child manage their asthma at school — you may need to do more than the advice listed here, depending on the severity of your child's asthma. Consult your doctor to help you compile a checklist specifically for your child.

  • Ensure that the school, and your child's teacher in particular, know of your child's asthma.
  • Give the teacher and/or school nurse a copy of your child's asthma action plan along with a spare inhaler that is labelled with your child's name and instructions for use.
  • Provide the teacher/nurse with your contact details.
  • Make sure your child always carries their medicine, knows who to go to if they experience asthma symptoms at school, and where the spare inhaler is kept.
  • Be aware of possible triggers in and around the school.
  • Ensure you have spare asthma kits available at home or work or kept in the car in case of emergency.

Also remember that being exposed to tobacco smoke can make your child's asthma worse. If you are a smoker, you can help improve your child's asthma by quitting. Aim for a smoke-free home, and talk to your child as they get older about how they can keep healthy by remaining a non-smoker.

Asthma and school sport

Exercise is important for children's health, even though it can trigger asthma symptoms. Seek your doctor's advice if your child is getting a tight chest, breathlessness, cough or wheeze when they exercise. A thorough assessment is important to see whether asthma is causing the symptoms — if it is, your doctor can suggest ways to help control your child's asthma.

Last Reviewed: 29 July 2014
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References

1. National Asthma Council Australia. Australian Asthma Handbook, Version 1.0. National Asthma Council Australia, Melbourne, 2014. Website. Available from: http://www.asthmahandbook.org.au (accessed May 2014).
2. National Asthma Council Australia. Australian Asthma Handbook – Quick Reference Guide, Version 1.0. National Asthma Council Australia, Melbourne, 2014. Available from: http://www.asthmahandbook.org.au (accessed May 2014).
3. MayoClinic.com. Spirometry (updated 9 Jul 2011). http://www.mayoclinic.org/tests-procedures/spirometry/basics/definition/prc-20012673 (accessed May 2014).
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