Childhood Asthma

Young children can develop asthma, which is a condition that makes their lungs and airways easily irritated. When exposed to things like pollen, or a cold or other respiratory illness, their airways can swell and become inflamed. This inflammation causes symptoms like coughing, wheezing, and shortness of breath. These symptoms can make it hard for kids to play, exercise, go to school, or even sleep well.

In some cases, untreated asthma can lead to serious asthma attacks, requiring a trip to the hospital. Asthma in kids is similar to asthma in adults, but young children face special challenges. Asthma is a common reason why kids miss school, need emergency room care, or even need to be hospitalized.

Unfortunately, there's no cure for childhood asthma, and symptoms can continue into adulthood. However, with proper medical care and treatment, parents and doctors can work together to manage the symptoms and help prevent lung damage, especially as the child grows. This management involves controlling the triggers and using medication as directed by the doctor. By doing so, children with asthma can lead healthy and active lives.

Kids with asthma often have these common symptoms:

• Wheezing: A whistling sound when they exhale. This is a key sign.
• Shortness of breath: They might feel like they can't get enough air.
• Chest tightness or congestion: Their chest might feel full or tight.
• Frequent coughing: Coughing can be a constant problem, but it's often worse:
  • When they're sick with a virus.
  • At night while sleeping.
  • When they're playing or exercising.
  • In cold weather.

Asthma can also cause these issues:

• Trouble sleeping: Coughing, wheezing, or shortness of breath can make it hard to get a good night's rest.
• Cold or flu flare-ups: Asthma symptoms might become more noticeable when a child catches a cold or the flu.
• Slower recovery from respiratory infections: If your child gets a chest infection, asthma can make it take longer to get better.
• Difficulty with activities: Asthma can make it hard for kids to play or exercise as much as they'd like.
• Tiredness: Lack of sleep from breathing problems can lead to feeling tired all the time.

Important Note: Asthma symptoms in children can be different for each child and can change over time. Some kids might only have one or two noticeable symptoms, like a persistent cough or chest congestion.

It's not always easy to know if a child's symptoms are due to asthma. Other illnesses, like infections of the airways (bronchitis), can have similar symptoms like wheezing. If you're concerned about your child's symptoms, it's important to talk to their doctor. A doctor can help determine the cause and recommend the best treatment.

If you think your child might have asthma, take them to a doctor. Early treatment can help control asthma symptoms and possibly prevent asthma attacks.

Schedule a visit with your child's doctor if you notice any of these signs:

• Persistent coughing: This could be a constant cough, a cough that comes and goes, or a cough that seems to happen only during or after exercise.
• Wheezing or whistling sounds: These sounds are often heard when your child breathes out.
• Shortness of breath or fast breathing: Your child might be having trouble catching their breath, or breathing very quickly.
• Complaints of chest tightness: Your child might say their chest feels tight or uncomfortable.
• Frequent episodes of bronchitis or pneumonia: If your child gets these infections repeatedly, it could be a sign of asthma.

Children with asthma sometimes describe their symptoms in different ways. They might say things like, "My chest feels weird," or "I'm always coughing." It's important to listen carefully for coughs, even if your child isn't awake when they cough. Things like crying, laughing, yelling, or stressful situations can also trigger coughing or wheezing in children with asthma.

If your child is diagnosed with asthma, working with their doctor to create an asthma action plan is very helpful. This plan will outline how to monitor their symptoms and what steps to take if they have an asthma attack. This plan will also help other caregivers understand how to respond to asthma symptoms.

Understanding Childhood Asthma

Scientists don't fully know why some children develop asthma. However, several factors seem to play a role. One important factor is a family history of allergies. If allergies run in the family, a child might be more likely to develop asthma. Having a parent with asthma also increases the risk. Early childhood airway infections can also contribute.

Another important factor is a child's environment. Exposure to things like cigarette smoke or other air pollution can increase the chances of asthma. This is because these environmental factors can irritate the lungs.

Asthma happens when the body's immune system becomes overly sensitive. This means that the lungs and airways become inflamed and produce extra mucus when exposed to certain triggers. This inflammation makes it hard to breathe. Importantly, the reaction to a trigger can take time to develop, sometimes hours or even days after exposure. This makes it tough to pinpoint the exact cause.

Many things can act as triggers for an asthma attack. These triggers differ from child to child. Some common triggers include:

• Viral infections: Common colds, flu, and other viruses can irritate the airways.
• Air pollutants: Smoke (including cigarette smoke), dust, and other pollutants in the air can be triggers.
• Allergies: Allergens like dust mites, pet dander, pollen, and mold can cause allergic reactions, which can lead to asthma symptoms.
• Physical activity: For some children, intense exercise can trigger an asthma attack.
• Weather changes: Sudden changes in temperature, especially exposure to cold air, can sometimes trigger asthma.

Sometimes, asthma symptoms appear without any obvious trigger. This can make diagnosis and management more challenging.

Things that could make your child more likely to get asthma:

• Smoke: Breathing in smoke, even before a baby is born, can increase the risk of asthma. This includes cigarette smoke, but also smoke from other sources like fires.

• Allergies: If your child has had allergic reactions in the past, like skin rashes, food allergies, or hay fever (also called allergic rhinitis), they might be more prone to asthma. An allergic reaction is when the body's immune system overreacts to something harmless.

• Family history: If other family members have asthma or allergies, your child's risk is higher. This is because genes can play a role in developing these conditions.

• Air pollution: Living in a place with a lot of pollution in the air can increase the risk of asthma. This pollution can irritate the lungs and make them more vulnerable to asthma attacks.

• Weight: Being overweight or obese can also increase the risk of asthma. This is likely because extra weight can put extra stress on the respiratory system.

• Respiratory problems: If your child has ongoing issues with their nose, like a runny or stuffy nose, inflamed sinuses, or pneumonia, it might make them more susceptible to asthma. These conditions can affect the airways and make them more sensitive.

• Acid reflux: Gastroesophageal reflux disease (GERD) is when stomach acid comes back up into the food pipe. This can irritate the airways and increase the likelihood of asthma.

• Sex: Boys are slightly more likely to develop asthma than girls.

• Race and ethnicity: Studies show that Black and Puerto Rican children may have a higher risk of asthma compared to other groups. It's important to remember that these are just factors that can increase the risk. Many people with these factors never develop asthma.

It's crucial to remember that these are just possible risk factors. A child can have any or all of these factors and still not develop asthma. If you have any concerns, it's always best to talk to your doctor.

Asthma can lead to several problems. One major issue is having severe asthma attacks. These attacks can be so bad that you need quick medical help, like going to the emergency room or even the hospital.

Asthma can also cause your lungs to get weaker over time, which is a permanent change. This means your lungs might not work as well as they should.

Asthma can also affect your schoolwork. You might miss school days because of your asthma symptoms, and this can make it hard to keep up with your studies.

Asthma can also make it hard to get a good night's sleep, leading to tiredness and fatigue. This lack of sleep can make you feel run down.

Finally, asthma can make it difficult to do things you enjoy, like playing sports or just having fun. It can limit your activities and make it hard to participate in things you like to do.

Preventing asthma attacks in children involves careful planning and avoiding things that can trigger symptoms.

Avoid Asthma Triggers: The best way to keep asthma under control is to limit contact with things that make it worse. These are called "triggers." This could mean keeping the home clean to reduce dust mites and pet dander, or avoiding places with known allergens like pollen or mold. Knowing what your child's specific triggers are is crucial.

No Smoking Around Your Child: Smoking, whether it's cigarettes, cigars, or vaping, releases harmful chemicals that can trigger asthma attacks. Even secondhand smoke is a big problem, especially for young children. Keep your home and car smoke-free.

Encourage Physical Activity: Exercise is good for overall health, and it's also beneficial for children with asthma when their asthma is well-managed. Talk to your child's doctor about appropriate activity levels. This way, you can make sure exercise doesn't trigger an attack.

Regular Check-ups: It's important to take your child to the doctor regularly for asthma check-ups. Don't wait until an attack happens. If your child needs to use their quick-relief inhaler more often, or if you notice other signs of worsening asthma, schedule an appointment right away.

Asthma Changes Over Time: Asthma can change over time, so regular check-ups are essential to adjust treatment plans as needed. Your doctor can help you find the best plan for your child's specific needs.

Healthy Weight: Being overweight or obese can worsen asthma symptoms and increase the risk of other health problems. A healthy diet and regular exercise are important for managing asthma and overall health.

Control Heartburn: Heartburn, also known as acid reflux, can sometimes trigger or worsen asthma. If your child has frequent heartburn, talk to their doctor. They might recommend over-the-counter or prescription medications to help control the heartburn.

Diagnosing Asthma in Children: A Look at the Process

Diagnosing asthma in children can be tricky because many other conditions have similar symptoms. A doctor will carefully consider your child's symptoms, how often they occur, and their medical history. They might also need to rule out other possible causes.

Many childhood illnesses can mimic asthma symptoms. Sometimes, these conditions even happen together. This means the doctor needs to figure out if the symptoms are due to asthma, another condition, or a combination of both.

Conditions that can cause asthma-like symptoms in children include:

• Rhinitis (runny nose): Inflammation of the nasal passages.
• Sinusitis (sinus infections): Infections in the sinuses.
• Acid reflux (GERD): Stomach acid flowing back into the esophagus.
• Airway problems: Issues with the tubes in the lungs.
• Dysfunctional breathing patterns: Problems with how the child breathes.
• Respiratory infections (like bronchiolitis and RSV): Infections of the lungs and airways.

To figure out if it's asthma, the doctor might use these tests:

Lung Function Tests (Spirometry): Doctors use the same tests for children as they do for adults. Spirometry measures how much air a child can breathe out and how quickly. The doctor might test the child at rest, after exercise, and after taking asthma medication. This helps determine how well the lungs are working.

Bronchoprovocation: This test also uses spirometry. It looks at how the lungs react to things that might trigger asthma, like exercise or cold air.

Important Note: These tests aren't reliable for children under 5 years old. For younger children, the doctor relies more on the information you provide about their symptoms and how often they occur. Sometimes, a diagnosis can take months or even years to confirm.

Exhaled Nitric Oxide Test: If the lung function tests aren't conclusive, the doctor might measure the level of nitric oxide in the child's breath. This can help determine if steroid medications might be helpful in managing the asthma.

Allergy Skin Testing: If the doctor suspects allergies are triggering the asthma, they might recommend allergy skin tests. These tests involve pricking the skin with small amounts of common allergens (like pet dander, mold, or dust mites) to see if the child has an allergic reaction.

In summary, diagnosing asthma in children requires careful consideration of symptoms, medical history, and potentially several tests. The process can sometimes take time, but it's important to work with your child's doctor to find the right diagnosis and treatment plan.

Managing Asthma in Children

Asthma treatment focuses on controlling symptoms to ensure a child can:

• Have minimal or no symptoms.
• Have few or no asthma attacks.
• Have no limitations on activities or exercise.
• Use quick-relief inhalers rarely.
• Experience few or no side effects from medication.

Treating asthma involves preventing attacks and managing them when they happen. The best treatment depends on several factors:

• The child's age.
• The severity of symptoms.
• What triggers the asthma.
• What treatments seem to work best.

Mild Asthma in Young Children (Under 3):

For children under 3 with mild asthma, a "wait-and-see" approach might be used initially. Doctors often want to observe the child's condition before prescribing medications because the long-term effects of asthma medication in very young children aren't fully understood. However, if a young child experiences frequent or severe wheezing, a doctor might prescribe medication to help control symptoms.

Long-Term Control Medications:

These medications reduce inflammation in the airways, which is the root cause of asthma symptoms. They usually need to be taken daily.

• Inhaled Corticosteroids: These are commonly used and are inhaled directly into the lungs. Examples include fluticasone (Flovent), budesonide (Pulmicort), mometasone (Asmanex), ciclesonide (Alvesco), and beclomethasone (Qvar). These medications may take a few days to several weeks to reach their full effectiveness. While there's a potential for slightly reduced growth in children, the benefits of good asthma control usually outweigh this risk.

• Combination Inhalers: These contain an inhaled corticosteroid and a long-acting beta agonist (LABA). LABAs help open the airways. Examples include Advair, Symbicort, Breo Ellipta, and Dulera. LABAs, when used alone, have been linked to serious asthma attacks, so they should always be used with a corticosteroid in a combination inhaler. These combination inhalers are typically used only when other treatments aren't enough to control asthma.

• Leukotriene Modifiers: These oral medications help prevent asthma symptoms for up to 24 hours. Examples include montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo).

• Theophylline: This is a daily pill that relaxes the muscles around the airways, making breathing easier. It's often used alongside inhaled corticosteroids. Blood tests are needed to monitor theophylline levels.

• Immunomodulatory Agents: These medications are used for severe asthma, especially in children over 12. Specific examples include mepolizumab (Nucala), dupilumab (Dupixent), benralizumab (Fasenra) and omalizumab (Xolair). Omalizumab is used for children age 6 and older with moderate to severe allergic asthma.

Quick-Relief (Rescue) Medications:

These medications quickly open up swollen airways during an asthma attack or before exercise, if recommended by a doctor. They are used as needed.

• Short-acting Beta Agonists: These inhaled bronchodilators, such as albuterol (ProAir, Ventolin), work within minutes, easing symptoms for several hours.
• Oral and Intravenous Corticosteroids: These powerful medications are used for severe asthma attacks, but are generally only used short-term due to potential side effects.

Other Treatments for Asthma Triggers:

If allergies trigger or worsen asthma, allergy treatments can be helpful.

• Allergy Medications: These include antihistamines (oral or nasal sprays), decongestants, and corticosteroid nasal sprays.
• Allergy Shots (Immunotherapy): These gradually reduce the body's reaction to specific allergens.

Using Inhalers:

Different inhaler types are used depending on the child's age:

• Older children and teens: Can use pressurized metered-dose inhalers or inhalers that deliver a fine powder.
• Infants and toddlers: May need a face mask attached to a metered-dose inhaler or a nebulizer.
• Babies: A nebulizer, which turns liquid medicine into a mist, is used.

Asthma Action Plans:

A written asthma action plan, developed with a doctor, is crucial for managing asthma, especially in severe cases. This plan helps:

• Recognize when treatment needs adjustment.
• Monitor treatment effectiveness.
• Identify asthma attack signs and know what to do.
• Know when to seek medical help.

Monitoring and Adjustment:

Symptoms and triggers can change over time. Regular monitoring of symptoms and adjustments to medication, as directed by a doctor, are essential. If asthma is well-controlled, doses may be lowered or medications stopped (step-down treatment). If asthma is not well-controlled, doses may be increased or medications changed (step-up treatment). A peak flow meter can be used to track lung function in older children and teens. The action plan may categorize asthma into zones (green, yellow, red) based on peak flow and symptoms to help track progress. Tracking how many puffs of quick-relief inhalers are used each week can also help determine if adjustments are needed.