What is asthma in children?

Asthma is a long-term (chronic) lung disease that causes your child’s airways to become sensitive to certain things (triggers). Several things happen to the airways when a child is exposed to triggers:

• The lining of the airways swells.
• The muscles around the airways tighten.
• The airways make more thick mucus than normal.

All of these things will cause the airways to narrow. This makes it difficult for air to go in and out of your child’s lungs, and leads to the symptoms of asthma.

Asthma Causes in Children

The exact cause of asthma is not known. Researchers think it is partially passed down through families. But it can also be caused by many other things such as the environment, infections and other exposures, like tobacco smoke.

Which children are at risk for asthma?

A child is more likely to be diagnosed with asthma if he or she:

• Is age 5 to 17 years old (though for many, symptoms start sooner)
• Has family members with asthma
• Has food allergies, eczema or nasal allergies
• Is around tobacco smoke
• Is around air pollution
• Has another health problem, such as being overweight

Asthma Symptoms in Children

Symptoms can occur a bit differently in each child. Many children with asthma have times when they have few, if any symptoms. They also have times when symptoms flare up. Symptoms may include:

• Cough (daytime, nighttime or both)
• Wheezing or whistling sound that is heard while your child is breathing
• Trouble breathing or shortness of breath while your child is active
• Chest tightness

The symptoms of asthma can be like other health conditions. Make sure your child sees his or her health care provider for a diagnosis.

Asthma Diagnosis in Children

Asthma is a clinical diagnosis. However, there are some tests that can be used to help support a diagnosis of asthma, depending on the age of the child and the clinical situation. To diagnose asthma, your child’s health care provider may recommend these tests:

• Spirometry. A spirometer is a device used to check lung function. It can typically be done starting around age 5. 
• Peak flow monitoring. A peak flow meter is used to measure the amount of air a child can blow out of the lungs. This measurement can be helpful in some, particularly older, children.
• Chest X-rays. This diagnostic test uses invisible energy beams to make images of internal tissues, bones and organs on film. This can help rule out other conditions that appear similar to asthma, but may appear normal if the child has asthma.
• Allergy tests. Allergy tests can help identify triggers for asthma, but are not themselves diagnostic of asthma.

Asthma Treatments for Children

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Your child’s health care provider may refer you to a pulmonologist. This is a doctor with special training to treat lung conditions. Your child may also be referred to an allergist. Both of these specialties have expertise in treating asthma. Your child’s treatment is based on how severe his or her symptoms are and how well they are controlled. Treatment includes finding triggers and ways to avoid them. It will also include medicines. Asthma medicines include:

Medications for quick relief of symptoms:

• Bronchodilators (beta agonists). These medicines are used for quick relief to help open the narrowed airways. They help relieve coughing, wheezing, shortness of breath or difficulty breathing. The most commonly used asthma medication, albuterol, is a bronchodilator.
• Combination inhalers with inhaled steroids and a certain long-acting bronchodilator (formoterol). Sometimes, in specific cases, these medications may also be used for quick relief.
• Steroids (oral or injectable forms). These are sometimes needed for short-term treatment of significant asthma flare-ups.

Asthma control medications to help control and prevent symptoms and reduce the frequency and severity of exacerbations:

• Inhaled steroids. These medicines help decrease inflammation in the airways, and reduce asthma symptom frequency and severity of exacerbations (flare-ups). They can be given via inhaler or nebulizer.
• Combination inhalers with inhaled steroids and long-acting bronchodilator. These are similar to inhaled steroids, but have a longer-acting bronchodilator (beta agonist).
• Long-acting muscarinic antagonists. This medication may be used as an add-on therapy for children whose symptoms are not controlled on first-line medications. It targets another receptor in the lungs to help open up the airways.
• Anti-leukotrienes. These medicines are anti-inflammatory, and target a specific pathway that is involved in asthma. These are usually given by mouth.
• Asthma biologics. These medications target specific molecules that are involved in asthma, including inflammatory molecules and cell receptors, to disrupt inflammatory pathways involved in asthma. They are typically given by injection.
• Immunotherapy. Immunotherapy that is targeted against specific allergens in children who are allergic to them and exposed to them are helpful in some patients.

Asthma Complications in Children

Asthma that is not well controlled may cause:

• Severe asthma attacks
• Lasting damage to the airways
• Increased time in the hospital or the emergency department
• Missed school or other activities

Asthma Prevention for Children

Asthma can’t be completely prevented. There are steps you can take to reduce the chance of your child developing asthma. They include:

• Avoiding secondhand smoke
• Avoiding air pollution

In most children, asthma flare-ups can be prevented by:

• Avoiding known triggers
• Carefully managing symptoms
• Taking medicines as instructed

How can I help my child live with asthma?

You can help manage your child’s asthma by:

• Finding out your child’s triggers and keeping him or her away from them.
• Giving your child medicine as directed to prevent symptoms.
• Creating and keeping an Asthma Action Plan.
• Closely watching asthma signs and symptoms to know when they are getting worse.
• Knowing what to do when asthma gets worse.
• Making sure your child has proper emergency medication (typically albuterol) and paperwork on file with his or her school.

Work with your child’s health care provider to find the best way to take care of your child’s asthma. There are guidelines for children from newborn to age 4, ages 5 to 11, and ages 12 and older.

The more information a person with asthma has, the better the asthma can be controlled.

When should I call my child’s healthcare provider?

Call your child’s health care provider if your child’s symptoms are not well controlled. For example, if your child is waking at night with symptoms or is having trouble with daily activities.

Call your child’s health care provider or get medical help right away if your child has severe symptoms. These severe symptoms can include trouble:

• Breathing
• Sleeping
• Walking
• Talking