Asthma - children

Causes

Asthma is caused by swelling in the airways. When an asthma attack occurs, the muscles around the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by.

Asthma is commonly seen in children. It is a leading cause of hospital stays and school absences. Asthma and allergies often occur together. The allergic response plays a strong role in childhood asthma.

Common asthma triggers include:

• Animals (hair or dander)
• Aspirin and other medicines
• Cold air, such as changes in weather (most often cold weather)
• Chemicals in the air or in food
• Dust
• Exercise
• Mold
• Pollen
• Strong emotions
• Tobacco smoke
• Viral infections, such as the common cold

Symptoms

Breathing problems are common. They can include:

• Shortness of breath
• Feeling out of breath
• Gasping for air
• Having trouble breathing out
• Breathing faster than normal

When breathing gets very hard, the skin of the chest and neck may suck inward.

Other symptoms of asthma in children include:

• Coughing that sometimes wakes the child up at night; it may be the only symptom
• Dark bags under the eyes
• Feeling tired
• Irritability
• Tightness in the chest
• Wheezing, a whistling sound made when breathing, that may be more noticeable when the child breathes out

The type and pattern of your child's asthma symptoms may vary. They may occur often or only when certain triggers are present. Some children are more likely to have asthma symptoms at night.

Exams and Tests

The health care provider will to listen to the child's lungs. Asthma sounds may be heard. However, lung sounds are often normal between asthma episodes.

The health care provider will have your child breathe into a device called a peak flow meter. Peak flow meters can tell you and your health care provider how well the child can blow air out of the lungs. If the airways are narrow and blocked due to asthma, peak flow values drop.

You and your child will learn to measure peak flow at home.

Tests may include:

• Allergy testing
• Chest x-ray
• Eosinophil count (a type of white blood cell)
• Lung function tests 

Treatment

You and your child's pediatrician or allergist should work together as a team to create and carry out an asthma action plan.

This plan should outline how to:

• Avoid asthma triggers
• Monitor symptoms
• Measure peak flow
• Take medicines

The plan should also tell you when to call the nurse or doctor. It's important to know what questions to ask your child's doctor.

Children with asthma need a lot of support at school.

• Give the school staff your asthma action plan so they know how to take care of your child's asthma.
• Find out how to let your child take his or her medicine during school hours. (You may need to sign a consent form.)
• Having asthma does not mean your child cannot exercise. Coaches, gym teachers, and your child should know how to recognize and treat asthma symptoms caused by exercise.   

MEDICATIONS

There are two basic kinds of medicine used to treat asthma.

Long-term control drugs are taken every day to prevent asthma symptoms. Your child should take these medicines, even when he or she does not have symptoms. Some children may need more than one long-term control medicine.

Types of long-term control medicines include:

• Inhaled steroids (these are usually the first choice of treatment)
• Long-acting bronchodilators (these are almost always used with inhaled steroids)
• Leukotriene inhibitors
• Cromolyn sodium

Quick relief, or rescue asthma drugs work fast to control asthma symptoms.

• Children take them when they are coughing, wheezing, having trouble breathing, or having an asthma attack.
• Examples of quick relief medicines include Proventil, Ventolin, and Xopenex.

Some of your child's asthma medicines can be taken using an inhaler.

• Children who use an inhaler should use a "spacer" device. This helps them to get the medicine into the lungs properly.
• If your child uses the inhaler wrong way, less medicine gets into the lungs. Have your health care provider show your child how to correctly use an inhaler.
• Younger children can use a nebulizer instead of an inhaler to take their medicine. A nebulizer turns asthma medicine into a mist that you breathe in.

ELIMINATING TRIGGERS

It is important to know what things make your child's asthma worse. These are called asthma "triggers." Avoiding them is the first step toward helping your child feeling better. Learn more about:

• Avoiding exposure to plant pollens
• Controlling molds, indoors and outside
• Reducing dust and dust mites

Keep pets outdoors, or at least away from the child's bedroom.

No one should smoke in a house or around a child with asthma.

• Getting rid of tobacco smoke in the home is the single most important thing a family can do to help a child with asthma.
• Smoking outside the house is not enough. Family members and visitors who smoke carry the smoke inside on their clothes and hair. This can trigger asthma symptoms.
• Do not use indoor fireplaces.

Keep the house clean. Keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks. Detergents and cleaning products in the home should be unscented.

KEEPING AN EYE ON YOUR CHILD'S ASTHMA

A peak flow meter is a simple device that you and your child can use at home to tell you if an attack is coming. Checking "peak flow" is one of the best ways to control asthma. It can help you keep your child's asthma from getting worse. Asthma attacks do NOT usually come on without warning.

Children under age 5 may not be able to use a peak flow meter well enough for it be helpful. An adult should always watch carefully for a child's asthma symptoms. It's a good idea to start using peak flow meters before age 5 to get the child used to them.

Outlook (Prognosis)

With proper treatment and a team approach to managing asthma, almost all children with asthma can live a normal life. However, poorly controlled asthma may lead to missed school, problems playing sports, missed work for parents, and many visits to the doctor's office and emergency room.

Asthma symptoms usually occur much less often or disappear as the child gets get older. However, if the child’s asthma is not well controlled, it can lead to permanent changes in lung function.

Asthma can rarely be a life-threatening disease. It is important for families to work together with health care professionals to develop a plan to care for the child.

When to Contact a Medical Professional

Call your health care provider if you think your child has new symptoms of asthma. If your child has been diagnosed with asthma, call the doctor:

• After an emergency room visit
• When peak flow numbers have been getting lower
• When symptoms are more frequent and more severe and your child is following the asthma action plan

If your child is having trouble breathing or having an asthma attack, seek medical attention immediately.

Emergency symptoms include:

• Difficulty breathing
• Bluish color to the lips and face
• Severe anxiety due to shortness of breath
• Rapid pulse
• Sweating
• Decreased level of alertness, such as severe drowsiness or confusion

A child who is having a severe asthma attack may need to stay in the hospital and be given oxygen and medicines through a vein (intravenous line or IV).

Alternative Names

Pediatric asthma; Asthma - pediatric

References

National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publications 08-4051.

Castro-Rodriguez JA, Rodrigo GJ. Efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing and asthma: a systematic review with meta-analysis. Pediatrics. 2009 Mar;123(3):e519-25.

Bush A, Saglani S. Management of severe asthma in children. Lancet. 2010 Sep 4;376(9743):814-25.

Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010 Sep;126(3):466-76.

McMahon AW, Levenson MS, McEvoy BW, Mosholder AD, Murphy D. Age and risks of FDA-approved long-acting beta-adrenergic receptor agonists. Pediatrics. 2011;128(5):e1147-1154.

Update Date: 5/16/2012

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.