Chilhood Asthma

Definition
Childhood asthma has become more widespread in recent decades. As the most common chronic illness in children, childhood asthma causes more missed school and places more limits on activity than does any other disease in the United States. Childhood asthma and adult asthma have the same underlying cause — inflammation of the airways. This inflammation makes the airways overly sensitive, leading to signs and symptoms that range from minor coughing or wheezing to serious flare-ups that interfere with breathing.


Fortunately, childhood asthma is treatable. Although childhood asthma can't be cured, you and your child can keep symptoms under control with a written plan, monitoring, regular doctor visits and making treatment changes as needed.



Symptoms

Childhood asthma can be very disruptive, causing bothersome daily symptoms that interfere with play, sports, school and sleep. In some children, unmanaged asthma can cause serious or even life-threatening asthma attacks.


Common childhood asthma symptoms include:


Coughing
A whistling or wheezing sound when exhaling
Shortness of breath
Chest congestion or tightness


Other signs and symptoms of asthma in children include:


Trouble sleeping caused by shortness of breath, coughing or wheezing
Bouts of coughing or wheezing that get worse with a respiratory infection such as a cold or the flu
Delayed recovery or bronchitis after a respiratory infection
Fatigue or trouble breathing during active play or exercise — signs of exercise-induced asthma


Asthma signs and symptoms vary from child to child, and may get worse or better over time. While wheezing is most commonly associated with asthma, not all children with asthma wheeze. Your child may have only one sign or symptom, such as a lingering cough or chest congestion.


Sometimes it's difficult to tell whether your child's symptoms are caused by asthma. Wheezing episodes and other asthma-like symptoms may be caused by infectious bronchitis or other respiratory problem.


When to see a doctor

Take your child to see the doctor as soon as possible if you suspect he or she may have asthma. Early treatment will not only help control disruptive asthma flare-ups, it may also improve breathing every day.
Make an appointment if you notice:


Coughing that's constant, intermittent or associated with physical activity
Wheezing or whistling sounds when your child exhales
Shortness of breath or rapid breathing that may or may not be associated with exercise
Complaints of chest tightness
Repeated episodes of suspected bronchitis or pneumonia


Pay attention to cues from a child who says, "My chest feels funny" or "I'm always coughing." Asthma can be worse at night, so listen for coughing during sleep or coughing that wakes your child in the night. Crying, laughing, yelling, or strong emotional reactions and stress also may trigger coughing or wheezing. If your child is diagnosed with asthma, creating an asthma action plan can help you monitor symptoms and be ready if an asthma attack does occur.


When to seek emergency treatment

Even if your child hasn't been diagnosed with asthma, seek medical attention immediately if he or she has any trouble breathing. Although episodes of asthma vary in severity, asthma attacks can start with coughing, which progresses to wheezing and rapid breathing.


In severe cases, you may see your child's chest and sides pulling inward as he or she struggles to breathe. Your child may have an increased heartbeat, sweating and chest pain. Seek emergency care if your child is:


Breathing so hard that he or she has to stop in midsentence to catch his or her breath
Using abdominal muscles to breathe
Widening the nostrils when breathing in
Trying so hard to breathe that the abdomen is sucked under the ribs when he or she breathes in



Causes
In children with asthma, an overly sensitive immune system makes airways become inflamed and swollen when exposed to triggers such as smoke or allergens. Sometimes, asthma symptoms occur with no apparent triggers. When asthma flares up, airway muscles constrict, the lining of the airways swell, and thick mucus fills the bronchial tubes, leading to asthma symptoms.


Asthma triggers differ from child to child and include:


Viral infections such as the common cold
Allergens such as dust mites, pet dander, pollen or mold
Tobacco smoke or other environmental pollutants
Exercise
Weather changes or cold air


Conditions linked to asthma include:


A chronic runny or stuffy nose (rhinitis)
Inflamed sinuses (sinusitis)
Heartburn (gastroesophageal reflux disease)



Risk factors
It isn't clear why some children get asthma and others don't, but it's probably due to a combination of genetic (inherited) and environmental factors. Children with a family history of asthma are at greater risk of developing the disease. Other environmental factors that may increase your child's chances of developing asthma include:


Exposure to tobacco smoke
Previous allergic reactions, including skin reactions, food allergies or allergic rhinitis (hay fever)
Living in a large urban area with increased exposure to air pollution
A family history of asthma, allergic rhinitis, hives or eczema
Low birth weight
Obesity



Complications


Asthma may cause a number of complications, including:


Severe asthma attacks that require emergency room visits or even hospitalization
Permanent narrowing of the bronchial tubes (airway remodeling)
Side effects from long-term use of some medications used to stabilize severe asthma (oral corticosteroids)
Slightly slowed growth in children caused by long-term use of inhaled corticosteroids



Preparing for your appointment
A big part of diagnosing childhood asthma depends on accurately reporting your child's symptoms. Be prepared to talk to the doctor about:


Exactly what symptoms your child has
Whether symptoms occur at certain times of day
Whether symptoms get worse or improve at certain times of the year
What, if any, triggers seem to set off asthma flare-ups
Whether your child has allergies, and whether he or she has a family history of allergies or asthma



Tests and diagnosis
Asthma is a very individual condition. Your child's doctor will consider the nature and frequency of symptoms along with results from tests to rule out other diseases before diagnosing asthma.
First, the doctor will ask for a detailed description of your child's symptoms and ask about your family history of asthma or allergic diseases such as eczema, hives or allergic rhinitis (hay fever).
In children 6 years of age and older, doctors diagnose asthma with the same tests used to identify the disease in adults. Lung function tests (spirometry) measure how quickly and how much air your child can exhale. Your child may have pulmonary function tests at rest, after exercising and after taking asthma medication. Allergy tests also may be part of the evaluation.


In younger children, diagnosis can be difficult because lung function tests aren't accurate before 6 years of age. Some children also simply outgrow asthma-like symptoms over time. Your doctor will rely on detailed information about symptom type and frequency when considering an asthma diagnosis in a young child. Sometimes a diagnosis is not made until later, after months or years of observing symptoms.


If you suspect your child has asthma, it's important to start the testing process early. Early diagnosis and proper treatment can prevent disruptions from daily activities such as sleep, play, sports and school. It may also prevent dangerous or even life-threatening asthma attacks.


For children younger than age 3 who have symptoms of asthma, many times doctors will use a "wait-and-see" approach. This is because the long-term effects of asthma medication on infants and young children aren't clear. If an infant or toddler has frequent or severe wheezing episodes, a course of medication may be prescribed to see if the wheezing improves symptoms.



Treatments and drugs
The goal of asthma treatment is to get the asthma under control.
Well-controlled asthma means that your child has:


Minimal or no symptoms
Few or no asthma flare-ups
No limitations on physical activities or exercise
Minimal use of fast-acting "rescue" inhalers
Few or no side effects from medications


Treating asthma involves both preventing asthma symptoms and treating an asthma attack in progress. Preventive medications reduce the inflammation in your child's airways that can lead to symptoms. Quick-relief (rescue) medications quickly open airways that are swollen and limiting breathing.


While quick-relief medications work quickly, they can't keep your child's symptoms from coming back. If your child has frequent or severe symptoms, he or she will need to take a long-term control medication as well. Your child's symptoms and triggers are likely to change over time. You and your child will need to carefully monitor asthma symptoms and work with your doctor to adjust medications as needed.


Long-term control medications

These preventive anti-inflammatory medications are generally taken every day on a long-term basis to control persistent asthma. In some cases, these medications are taken seasonally if asthma symptoms get worse at certain times of the year. These medications include:


Inhaled corticosteroids, used to treat persistent asthma. These medications reduce chronic inflammation in the airways and reduce the need for other medications. Examples include fluticasone (Flovent), budesonide (Pulmicort), mometasone (Asmanex), triamcinolone (Azmacort), flunisolide (Aerobid) and beclomethasone (Qvar). Continuous inhaled corticosteroids have been associated with slightly slowed growth in children, but research has shown that the effect is minor. In most cases, the benefits of good asthma control outweigh the risks of possible side effects.


Combination inhalers, which contain inhaled corticosteroids plus a long-acting bronchodilator. Advair combines the corticosteroid fluticasone and the bronchodilator salmeterol. Symbicort contains the corticosteroid budesonide plus the bronchodilator formoterol.


Leukotriene modifiers, which include montelukast (Singulair) and zafirlukast (Accolate) and zileuton (Zyflo).


Cromolyn, which may help prevent mild to moderate asthma attacks. Cromolyn needs to be taken two to four times a day and is usually taken along with an inhaled corticosteroid.


Theophylline, a daily pill that opens the airways (bronchodilator). It relaxes the muscles around the airways to make breathing easier.


Quick-relief (rescue) medications

These medications — called short-acting bronchodilators — provide immediate relief of asthma attack signs and symptoms such as coughing, wheezing, chest tightness or shortness of breath. These inhaled medications are delivered using a small, hand-held device called a metered dose inhaler. Albuterol is the most commonly used short-acting bronchodilator. Others include pirbuterol and levalbuterol. These bronchodilators begin working within minutes and last four to six hours.


Allergy-desensitization shots (immunotherapy) Immunotherapy may help if your child has allergic asthma that can't be controlled by avoiding triggers. With immunotherapy, your child will probably need injections once a week for a few months, then once a month for a period of three to five years. Your child's allergic reactions will gradually diminish, lessening the immune system response that triggers asthma symptoms.


Inhaled medication devices

Inhaled short- and long-term control medications are used by inhaling a measured dose of medication.


Older children and teens may use a small, hand-held device called a pressurized metered dose inhaler or an inhaler that releases a fine powder.


Infants and toddlers need to use a face mask attached to a metered dose inhaler or a nebulizer to get the correct amount of medication.


Babies need to a use a device called a nebulizer, a machine that turns liquid medication into fine droplets. Your baby wears a face mask and breathes normally while the nebulizer delivers the correct dose of medication.


HFA inhalers: A recent change

The chlorofluorocarbon (CFC) propellant in quick-relief asthma inhalers has been replaced with a propellant called hydrofluoroalkane (HFA). Unlike CFC inhalers, HFA inhalers don't harm the environment. The spray from the new inhalers may taste different. Although the spray from an HFA inhaler may not seem as strong, your child is still getting the full dose of medication.



Prevention
Careful planning and steering clear of asthma triggers are the best ways to prevent asthma attacks.
Avoid triggers. As much as possible, avoid the allergens and irritants that your child's doctor has identified as asthma triggers.
Ban smoking around your child. Exposure to tobacco smoke during infancy is a strong risk factor for childhood asthma, as well as a common trigger of asthma attacks.


Encourage your child to be active. As long as your child's asthma is well controlled, regular physical activity can condition the lungs to work more efficiently.


Have a plan. Work with your child's doctor to develop an asthma action plan, and make sure all of your child's caregivers — child care providers, teachers, coaches, and the parents of your child's friends — have a copy. Some plans use a peak flow meter that can detect decreases in lung function before your child feels any symptoms, giving you important information on how to treat your child's asthma from day to day.