Asthma - Childhood

Asthma is a common respiratory illness in children that results in wheezing, coughing and trouble breathing. Childhood asthma leads to more missed school days and limitations on physical activity than any other childhood disease.

Childhood Asthma Treatment with Inhaler and SpacerAsthma in children has the same underlying cause as asthma in adults. It is due to inflammation of the airways. The inflammation causes the airways to become narrow, making it difficult for air to flow in and out of the lungs.

The inflammation may be present in the lungs for weeks or months. However, the breathing symptoms may only be noticeable for short episodes that last hours or days. An episode of worsening asthma symptoms is called an "asthma attack" or "asthma flare".

The symptoms of an asthma attack can range from mild to severe. Severe asthma attacks can be life-threatening and may require emergency treatment to restore normal breathing.

Treatment of asthma often involves the use of "controller" medications to bring the underlying inflammation under control, while providing "quick relief" medications to relieve symptoms during an asthma attack. (see below)

Although childhood asthma cannot be cured, asthma symptoms can be kept under control with the appropriate use of asthma medications, avoidance of asthma triggers, and regular doctor visits.

Many children “grow out” of childhood asthma as they go through puberty, and symptoms disappear in adulthood. However, some children will continue to have asthma symptoms as teenagers and adults. It is not known why some children develop asthma and others do not.

Symptoms of Childhood Asthma

Common symptoms of asthma include the following:

  • Wheezing is a high-pitched, whistling sound that your child may make during an asthma attack. If you hear this sound as your child breathes, be sure to let your doctor know. Not all people who wheeze have asthma, and not all those who have asthma wheeze. In fact, if asthma is really severe, there may not be enough movement of air through a person's airways to produce this sound.
  • Chronic cough, especially at night and after exercise or exposure to cold air, can be a symptom of asthma.
  • Shortness of breath, especially during exercise, is another possible sign. All children get out of breath when they're running and jumping, but most resume normal breathing very quickly afterward. If your child doesn't, a visit to your doctor is in order.
  • Tightness in the chest is a symptom that you may have to ask your child about. If you notice any of the signs just described, it's a good idea to ask your child whether he or she feels a tight, uncomfortable feeling in the chest.

Causes of Childhood Asthma

There are a variety of asthma triggers that can lead to an asthma attack. These vary from person to person, but common asthma triggers include exercise (exercise-induced asthma) cold air, viral infections, and allergens (things that cause allergies) such as dust mites, mold, pollen, and animal dander.

When the airways come into contact with one of these triggers, the bronchi and bronchioles become inflamed. At the same time, the muscles on the outside of the airways tighten up (bronchoconstriction), causing them to narrow. Then excessive mucus is released into the bronchioles Causing the breathing passages to narrow still more, and breathing becomes very difficult.

This process can be normal, up to a point. Everyone's airways constrict somewhat in response to irritating substances. But in a person with asthma, the airways are hyperreactive, meaning that their airways overreact to things that would just be minor irritants in people without asthma. To describe the effects of asthma, some doctors use the term "twitchy airways." This is a good description of how the airways of people with asthma are different from those without the disease.

Most people with asthma need medication to reduce the number and severity of asthma attacks. The need for asthma medication is based on how often asthma attacks occur and how severe they are. With the treatments available today, most children with asthma can do almost everything that children without the disease can do.

Diagnosis of Childhood Asthma

Your child’s doctor will ask you or your child questions about your child’s symptoms and family history of asthma and allergies. He or she will also listen to his or her breathing with a stethoscope.

Your child’s doctor may also recommend spirometry or a peak flow meter.

Spirometry is a test that measures how much air your child can blow out of his or her lungs after taking a deep breath, and how fast he or she can do it. The results will be lower than normal if your child’s airways are inflamed and narrowed, or if the muscles around his or her airways have tightened up. Spirometry is also used to check your child’s asthma over time to see how you are doing.

If your child’s spirometry results are normal but he or she has asthma symptoms, the doctor may order other tests to see what else could be causing symptoms. These may include a chest X-ray or an electrocardiogram (EKG).

Treatment of Childhood Asthma

Your child’s doctor will work with you and your child to develop an asthma management plan for controlling your child’s asthma on a daily basis and an emergency asthma action plan for controlling asthma attacks. These plans will tell you what medicines you should take and other things you should do to keep your asthma under control.

The asthma treatment plan may vary depending on your child’s age, type of asthma, severity of symptoms, responses to past asthma treatments, and existence of other medical conditions.

There are two main types of medications used in the treatment of asthma:

  1. Quick-relief medications (also called "rescue medication") that improve breathing within minutes. Rescue medications are short-acting bronchodilators that open the airways.
  2. Long-term control medications that are taken every day, usually over long periods of time, to prevent symptoms and asthma episodes or attacks. These do not offer any benefit until after several weeks of use. Asthma medications that provide long-term control of asthma symptoms include inhaled corticosteroids and leukotriene inhibitors.

Many people with asthma need both a rescue medication to use when symptoms worsen and long-term daily asthma control medicines to treat the ongoing inflammation in the lungs.

Most of these asthma medicines are inhaled by mouth through inhalers. There are many kinds of inhalers, and many require different techniques. It is important that your child knows how to use his or her inhaler correctly.

Some children require a special inhaler add-on called a spacer, or aerosol-holding chambers, when using an inhaler. Spacers are long tubes that slow the delivery of medication from the pressurized canister in the inhaler. Spacers can make it easier for medication to reach the lungs. They also prevent medication from being deposited in the mouth and throat where it can lead to irritation and mild infections, such as thrush.

Some asthma medications are be administered with a device called a nebulizer. A nebulizer changes liquid medicine into fine droplets (in aerosol or mist form) that are inhaled through a mouthpiece or mask. Some children use a nebulizer instead of an inhaler to make asthma medication easier to inhale. Portable nebulizers, powered by an internal battery or cigarette lighter, are available for children requiring treatments away from home.

Childhood Asthma Management in School

Many schools have an asthma management program that is responsive to your child’s needs when he or she is at school. Talk to the school administrators to see if your child’s school has an asthma management program in place.

It is important that your child’s teachers know that your child as asthma. If you have an asthma action plan, give a copy of it to each of your child’s teachers.

If you do not have an asthma action plan, talk to your doctor about creating one.

A written asthma action plan is a good way help your child and your child’s teachers know what to do to best manage his or her asthma symptoms. This plan should include daily management guidelines and emergency steps in case of an asthma episode. The plan should describe the student’s medical information and specific steps for responding to worsening asthma symptoms.

The asthma action plan should contain:

  • A list of medications the student receives, noting which ones need to be taken during school hours. Also, medications needed during school activities “off-site” and “off-hours” should be noted and available.
  • A specific plan of action for school staff in case of an acute episode that includes guidance for monitoring peak flow.
  • Identified triggers that can make asthma worse.
  • Emergency procedures and phone numbers.

Outgrowing Childhood Asthma

It is impossible to determine whether your child’s asthma symptoms will dissipate after adolescence or continue into adulthood. Some children grow out of childhood asthma because their immune systems become more tolerant and their airways become less hyperreactive. It is important to treat asthma symptoms as they appear.

Your child will have a better chance at maintaining a healthy airway if he or she manages the asthma symptoms by following the treatments recommended by your doctor.

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Last updated: 5/13/2022