What is childhood asthma?
Asthma is the most common serious chronic disease of childhood, affecting nearly six million children in the United States. Asthma in children is the cause of almost four million physician visits and 200,000 hospitalizations each year and is a major cause of school absenteeism.
Children with asthma will cough, wheeze and experience chest tightness and shortness of breath. Many parents do not realize that a chronic cough may be the only symptom of asthma and conversely, that a child does not have to wheeze to have asthma. Children with reactive airway disease, recurrent bronchitis or wheezy bronchitis probably have asthma in different forms. Some children with chronic cough do not have asthma and will never develop it. Your allergy and immunology specialist can help decide if your child really has asthma and what the future holds for your child.
How is childhood asthma diagnosed?
Up to 80% of children with asthma develop symptoms before age five. A child’s physician must rely heavily on parents’ observations to make a proper diagnosis in this young age group. Often the diagnosis is made by a combination of family history, presence of wheezing, and response to asthma medications. It is important to remember that many children who wheeze before the age of five do not end up with asthma. It is up to your allergy and immunology specialist to help define who really has asthma and who will outgrow their tendency to wheeze.
To make a diagnosis of asthma, your child’s physician will want to know about the following:
- Does your child cough, wheeze (a whistling sound when breathing), have chest tightness or shortness of breath?
- Do colds go right to your child’s chest and last much longer than other siblings?
- Does your child cough or wheeze with exercise, play and laughter or during temper tantrums? Can the wheeze occur any time without there being an infection?
- Is there a family history of asthma or allergies, particularly in the parents or any siblings?
- What triggers your child’s symptoms – colds, allergens (like the family pet) or exercise?
- How often are the symptoms and how bad?
- Is your child missing school?
- Is coughing or wheezing keeping you and your child up at night?
If your child is old enough (usually older than five or six), he or she may do a pulmonary function test. The results will tell the physician about how the child’s lungs actually work. This test helps not only in the diagnosis but will help the doctor follow the response to medication.
For children, asthma symptoms can interfere with many school and extracurricular activities. Parents may notice their child has less stamina during play than his or her peers, or they may notice the child trying to limit or avoid physical activities to prevent coughing or wheezing. More subtle signs of asthma, such as chest tightness, are often not identified as such by children. Sometimes they will complain that their “chest hurts” or that they cannot “catch their breath.” Often, recurrent or constant coughing spells may be the only observable symptom.
The two most common triggers of asthma in children are common colds and allergens (substances that trigger allergies). In fact, most kids with asthma are allergic and should have an allergy evaluation as part of their evaluation and care. Common allergens include dust mite, animal dander, cockroach, pollen and molds. We cannot do a lot about viral illnesses but there are ways to limit allergen exposure in the home environment if you know what you need to avoid.
How is childhood asthma treated?
The goal for managing childhood asthma is simple; help the asthmatic child grow and develop to live a normal life to the fullest potential. If asthma is waking the family at night, the child cannot play soccer or dance ballet, and he or she is missing school (and parents missing work) then the asthma is not controlled.
Every child with asthma should have a well understood asthma action plan. This tells the child and parents what medications to take when the child is feeling well, how to go up on medication when the child has increasing symptoms, the allergens to avoid and when to call the physician. This plan gives control to the patient and their parents and allows for early treatment of symptoms, before the asthma flare gets out of control.
As part of an effective asthma action plan, the child’s physician may prescribe specific asthma medications and devices. These can include a peak flow meter to measure ease of breathing, metered dose inhalers, spacers that attach to inhalers, nebulizer that deliver medication in a mist, dry powder inhalers, or oral (tablet/liquid) medications. Your allergy and immunology specialist will not only prescribe these medications and devices, but teach children and parents how to use them correctly.
Asthma medications include rescue medication or quick relievers to treat symptoms and long-term controller medicines to control the inflammation that causes asthma. Nearly all the asthma medications used to treat adults are safe and available for children. If a child has symptoms more than twice a week or wakes more than twice a month at night (referred to as the “Rule of 2’s”), he or she should be on long-term controller therapy or if already on one, the child needs more medication.
How can childhood asthma be prevented?
Mothers who smoke during pregnancy put their newborn at increased risk of wheezing during infancy. Exposing children to second hand smoke in the home has also been shown to increase the development of asthma and other chronic respiratory illnesses. Therefore, it is extremely important that infants not be exposed to tobacco smoke before or after they are born.
Respiratory infections are also a common trigger of asthma. Breast feeding for the recommended time period of at least six months strengthens a child’s immune system, which can be helpful in avoiding respiratory infections, and consequently, asthma. Early exposures to viral infections in some circumstances appears to have a beneficial effect on the long-term development of asthma, but not necessarily allergies. However, once asthma has been established in a child, it may be best to avoid early exposures to infectious disease until around school age. This also is a very controversial subject and should be discussed with your allergy and immunology specialist.
Frequently asked questions about childhood asthma
Will my child outgrow his/her asthma?
The challenge to the physician and parents who care for children with asthma is to identify which children who wheeze early in life really have asthma and who will outgrow their wheezing. Some infants and toddlers who wheeze with viral respiratory illnesses will stop wheezing as they grow and their airways get bigger. Researchers feel this is due to the fact that some children have small lungs whose airways get very narrow with any viral infections, causing wheezing. This is not really asthma and the problem resolves itself with growth of the lung airways.
If a child has atopic dermatitis (eczema), known allergies to foods or inhalants such as pollen, there is smoking in the home or if the mom has asthma, there is a greater chance that any child with wheezing will actually have asthma. In this circumstance, the asthma tendency never really goes away but will vary throughout the child’s life depending on many factors, especially allergies. Many children have asthma symptoms that improve during adolescence due to rapid lung growth, while others worsen. Often, symptoms in young children seem to resolve, but their asthma may flare up later in life. It is important to remember that once you have asthma, the tendency never really goes away.
Can asthma be cured?
Currently there is no cure for asthma. However, for most children, asthma can be controlled with appropriate management and treatment. While asthma is a chronic illness, it should not be a progressively debilitating disease. A child with asthma can have normal or near-normal lung function with appropriate management and medications.
Should my child exercise?
Parents may have the urge to restrict their asthmatic child’s physical activity to prevent wheezing. But once a child is taking proper medications, aerobic exercise needs to become part of his or her daily activities, because it improves airway function. Children must be encouraged to participate in normal activities as much as possible. It is also very possible for a child with asthma to excel in athletics. Several Olympic athletes have asthma.
Parents may have the urge to restrict their asthmatic child’s physical activity to prevent wheezing. Adolescent children can also use asthma as a way of avoiding physical education class. But once a child is taking proper medications, aerobic exercise needs to become part of every child’s daily activities, because it improves airway function and is an integral part of normal growth and development. Children must be encouraged by their parents to participate in normal activities as much as possible. Some forms of competitive athletics are better tolerated by asthmatics than others. Swimming is the most tolerated sport for the asthmatic. In contrast, sprint sports outside in cold or polluted air are the least tolerated.
How should my child be treated at school?
The child, family, physician and school personnel must work together to prevent and control asthma symptoms at school. Many children with asthma are embarrassed about their need for medication. In some cases, children may have difficulty because they are required to go to another part of the school building, such as a nurse’s office, to take their medication. School officials and parents must create a supportive environment. With the approval of physicians and parents, school-age children with asthma should be allowed to carry metered dose inhalers with them at all times and use them as appropriate. Many states have now passed laws to allow responsible children to keep their inhaler in a backpack.
To ensure optimal care at school, parents can also take the following proactive steps:
- Meet with teachers, the school nurse, coach and perhaps the principal at the beginning of the school year
- Have your child’s doctor provide a written asthma plan for school such as the Asthma School Action Plan. You can find this on the Patients & Consumers resources page of the AAAAI Web site, aaaai.org
- Encourage local educational programs to improve education for schools about asthma
For children with asthma to function normally, school personnel, families and health care providers must effectively communicate and work together to encourage asthmatic children to fully participate in physical activities. This team effort will help create a positive, healthy and safe environment for the child both in and out of school, and ensure the best asthma care possible.
- American Academy of Allergy, Asthma & Immunology http://www.aaaai.org/patients.stm
- American College of Allergy Asthma & Immunology http://acaai.org/public
- Allergy & Asthma Foundation of America http://www.aafa.org
- Kids Health http://www.kidshealth.org
- MedicAlert Supplies https://www.medicalert.org
- American Lung Association http://www.lungusa.org
- Center for Disease Control and Prevention http://www.cdc.gov/nceh/airpollution
- Environmental Protection Agency http://www.epa.gov/iaq