Asthma in Children
What Is Asthma?
Asthma is a chronic (long term) disease of the airways that carry air to the lungs when we breathe. The symptoms of asthma are caused by swelling, irritation, increased mucus, and tightening of the muscles around the airways in the lungs. When this happens, a child with asthma may have trouble breathing and/or develop a tight feeling in the chest. Other asthma symptoms are fast breathing, coughing, wheezing or needing to use extra muscles in the neck, chest, or abdomen to bring air into the lungs.
Asthma flares or “attacks” can be triggered by different things in different people. Children with asthma are more sensitive to irritants in the air than other people so when they breathe in these substances, it can trigger asthma symptoms. Potential triggers include illness, dust, mold, animals, pollens, cigarette smoke or cold air. These symptoms may occur daily, several times a week or only during certain times of the year.
Asthma Program at Lurie Children's
Our experts provide thorough evaluation and comprehensive testing for asthma, including education on avoiding common triggers and extensive treatment options.
Is Asthma Common?
Asthma is the most common chronic illness in children. One of every 10 children in the United States has asthma, and asthma is one of the main reasons children miss school or have to go to the hospital. Asthma is more common in African American and Hispanic children and people who live in cities. In early childhood, more boys than girls have asthma, but by the teen years, the number of girls and boys with asthma is about the same. People of any age, including babies, can have asthma.
Recently, asthma has become more common and more severe in some children. More children have to go to the hospital and asthma can be life-threatening. Don't be frightened by these facts! Most children with asthma have symptoms that can be controlled by following your doctor’s guidelines and taking the proper medication. If your child has severe asthma that is hard to control, you and your doctor can work together to develop a plan to keep your child healthy and out of the hospital. Learning about asthma is the best way to know how to deal with your child’s symptoms.
What Are the Symptoms of Asthma?
Asthma causes difficulty breathing because of narrowed, mucus-filled airways. This may cause a child to have trouble breathing and/or develop a tight feeling in the chest. Other asthma symptoms include fast breathing, wheezing, coughing, or needing to use extra muscles in the neck, chest, or abdomen to bring air into the lungs.
Symptoms of asthma are not the same for everyone. Some children have symptoms nearly every day and need to take medications. Other children may only have occasional symptoms, one or two times a week. These people may only need medications when they have asthma symptoms.
Mild Asthma Symptoms
- Breathing is a little difficult and only slightly faster than usual.
- Your child can easily speak in complete sentences.
- Your child has a slight wheeze, cough, shortness of breath and/or tightness in the chest.
- Skin color is good.
- Your child is alert and knows what's going on.
- The child is not drawing in the rib cage muscles to breathe.
Moderate Asthma Symptoms
- Breathing is more difficult and somewhat faster than usual.
- Your child speaks in short phrases because it's hard to breathe.
- Your child has a wheeze, cough, shortness of breath and/or tightness in the chest.
- Asthma symptoms awaken your child or prevent sleeping more than twice a month.
- Your child is missing school often or skipping activities due to asthma symptoms.
If your child has is experiencing any of the above warning signs, please contact your child's physician.
How Does the Doctor Know if My Child Has Asthma?
There is no simple test to diagnose asthma. However, there are some signs that may help your child's physician decide if your child has asthma:
Wheezing (a high-pitched whistling sound) is a common symptom of asthma. You hear wheezing when air is moving through narrowed airways. Be sure to tell your doctor if your child wheezes. (Not all children who wheeze have asthma, and not all children with asthma have wheezing. If asthma is severe, there may not be enough air movement to produce a wheeze.)
Chronic cough is another hint that your child might have asthma. Be especially alert for coughing at night, after exercise, or after exposure to cold air.
Another clue to look for is shortness of breath during exercise. Naturally, all children get out of breath when they’re running and jumping, but most begin to breathe normally very quickly after exercise. If you child take a long time to breathe normally after exercise, please tell your doctor.
Having a long-lasting cough after a cold or viral infection may be a sign that your child has asthma.
What Triggers Asthma?
The substances that cause asthma symptoms are called triggers. Triggers include tobacco smoke, pollen dust, mold, chemicals, perfumes, and animal dandruff. Viral infections, cold air, extreme emotion, and exercise also bring on asthma attacks.
Exercise is a common trigger of asthma especially in cold air. Usually symptoms don't appear until the child has been exercising hard for at least five minutes. If symptoms appear sooner, it may mean that their treatment isn’t working well and may need to be adjusted. Symptoms brought on by exercise usually disappear on their own within a few hours. With proper treatment, children with asthma can be physically active.
Different people have different asthma triggers. Some people react to many triggers; others, to only a few. Not all asthma attacks occur immediately after exposure to a trigger. Sometimes attacks are delayed. Your doctor will work with you to figure out what triggers your child's asthma, but you can help by keeping track of exposures that seem to cause symptoms.
Once you know the triggers you can help your child avoid them. (If you smoke, work on stopping! Exposure to tobacco smoke worsens your child’s asthma and is likely to trigger an attack.) If you're not sure what triggers your child’s symptoms, write down what your child was doing and where they were when symptoms occurred.
Removing asthma triggers, prevention, and early treatment of symptoms are the best ways to keep your child healthy, so they can go to school, play with friends, sleep well at night, and do the things that other children do.
Learn more about asthma in the video below.
What is Viral-Induced Wheezing?
Some children will wheeze only when they are sick with viral infections. This typically happens in children under the age of 3 and as they get older, they will wheeze less and less with viral infections. The difference between these children and children with asthma is that children with asthma have symptoms even when they aren’t sick. Most children who only wheeze with viral infections will not end up having asthma.
How Do I Know if My Child’s Asthma is Uncontrolled?
- Your child requires more than two courses of steroids taken by mouth (Prednisone, Orapred, etc.) on a yearly basis.
- Asthma symptoms awaken your child or prevent sleeping more than twice a month.
- Your child is using a reliever medication (albuterol, Xopenex, etc.) more than twice a week on a regular basis for asthma symptoms.
What Are the Treatments for Asthma?
Once your child has been diagnosed with asthma, they will be prescribed medications to control their symptoms. This plan may change over time as your child grows and changes. The doctor will also develop an asthma action plan for your child. Your child's asthma action plan should be available to all of their caregivers (at home, school, daycare, grandparents, etc.).
Medications used to prevent symptoms are called controller medicines. The medications used to treat symptoms when they occur are called reliever medications.
Controller medications decrease the swelling and inflammation in the airways. These medications also reduce mucus build-up in the airways. Controller medications can be given by inhaling them from a nebulizer, a metered dose inhaler or a dry powder inhaler.
Inhaled corticosteroids are the most effective controller medications. The most common side effects of inhaled corticosteroids are yeast infections in the mouth or a hoarse voice. To prevent these symptoms, your child should rinse their mouth after taking the medication. If they require a mask to take their medicine, you should wash your child’s face after they use it.
Leukotriene inhibitors are another type of controller medications that are taken by mouth.
Anti-IgE therapy is also a controller medicine. It binds allergic antibodies, decreasing some of the allergic causes of inflammation in the lungs. This therapy requires injections given every two to four weeks in a specialist's office. It is a treatment option for those with more severe asthma.
Bronchodilators are reliever medications that open up narrow airways by relaxing the muscles that constrict them. Bronchodilators relieve coughing, wheezing, breathlessness and the feeling of tightness in the chest. Albuterol is one of the most commonly prescribed bronchodilators. Other bronchodilators include Ventolin HFA, ProAir HFA and Proventil HFA. Xopenex and Maxair are other medications very similar to albuterol.
These medications work best when inhaled, either by nebulizer or metered dose inhaler. They may cause mild restlessness in some children. They work very quickly and should be effective for four to six hours. If your child needs a bronchodilator more often than every four hours or does not experience relief from the medication, it is important that you seek medical attention.
Asthma Medication Delivery
Watch the videos below to learn how to properly administer certain types of asthma medication.
Holding Chamber with Mouthpiece
Holding Chamber with Mask
Helping Your Child Use a Nebulizer Machine
Helping Your Child Use Nasal Spray