By Dr Dave Ong
Asthma is the leading cause of chronic illness in children. It affects as many as 20% of children and can begin at any age, but most children have their first symptoms by age 5.
Learn more about the causes and triggers of childhood asthma.
No one really knows why a growing number of children are developing asthma. Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution, and second-hand smoke. Others suspect that children are not exposed to enough childhood infections and living in cleaner environments, thus causing their immune system to shift towards being more allergic-type. And still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.
Asthma attacks are usually caused by exposure to triggers, which lead to increased inflammation of the air passages. The air passages narrow and produce more mucus, leading to obstruction and difficulty in breathing for the child. Although inflammation is worse during an asthma attack, it may also be present and ongoing even when a child with asthma appears to be well without much asthma symptoms. Thus, asthma is a chronic condition which requires proper treatment and monitoring, and not just a once-off problem.
Keep in mind that not all children have the same asthma symptoms, and that these symptoms can vary from episode to episode in the same child. Also note that not all wheezing or coughing is caused by asthma, thus a careful evaluation by your child’s doctor is necessary to make a correct diagnosis.
The triggers that result in asthma attacks may differ in each child. It is important to avoid triggers as much as possible. Some possible triggers include:
Asthma is often difficult to diagnose in infants (less than 1 year of age) and requires other diagnoses (e.g. congenital airway abnormalities, heart defects) to be excluded properly first. However, in older children, the disease can often be diagnosed based on your child’s medical history and physical examination.
Your child’s doctor will be interested in any history of breathing problems your child may have had, as well as a family history of asthma, allergies, allergic rhinitis, eczema, or other lung disease. It is important that you describe your child’s symptoms — cough, wheezing, shortness of breath, chest pain or tightness — in detail, including when and how often these symptoms have been occurring.
During the physical examination, the doctor will examine your child’s heart and lungs, and assess other aspects of his well-being such as growth, development and nutritional status.
The goals of asthma treatment are to control all asthma symptoms, prevent asthma attacks and allow your child to lead a healthy and normal life. Based on your child’s history and the severity of asthma, your child’s doctor will develop a care plan, called an “asthma action plan.” The asthma action plan describes when and how your child should use asthma medications, what to do when asthma gets worse, and when to seek emergency care for your child. Make sure you understand this plan and ask your child’s doctor any questions you may have. Your child’s asthma action plan is important to successfully controlling his or her asthma. Keep it handy to remind you of your child’s daily asthma management plan, as well as to guide you when your child develops asthma symptoms. In addition to following your child’s asthma action plan, you want to make sure exposure to asthma triggers is avoided as much as possible, especially passive/active smoking and house dust mites.
There are two main groups of asthma medicine, relievers and controllers/preventers.
Medicines that work rapidly to open up the narrowed air passages during an asthma attack. They provide quick relief of asthma symptoms and enable your child to breathe better. They are used for short periods only when needed, such as during asthma attacks or when the asthma is uncontrolled and causing significant symptoms affecting sleep or play. It is incorrect and unsafe to rely completely on regular usage of these relievers, and patients often get confused about its role as a reliever (thinking that it is the cure for their asthma).
Medicines that work gradually to control the chronic inflammation in the air passages, making them less hyper-responsive (sensitive) to triggers, thus targeting the underlying disease process in asthma. These medicines MUST be used daily (regardless of whether the child is having symptoms/attacks or not) if prescribed by the doctor and should only be stopped/reduced when advised by the doctor. The period of treatment for each child prescribed with controllers/preventer medicines can range from many months to years, depending on the response and control of your child’s asthma. It is incorrect and unsafe to stop the controllers/preventers on your own because it may result worsening of the asthma control, causing more frequent and severe attacks/symptoms. Patients also often get confused about its role as a controller/preventer (thinking that they do not work, because they do not get immediate symptom relief from it).
All children with asthma will be prescribed with a reliever medicine for use during asthma attacks or when the asthma symptoms are not controlled. Many children whose asthma is not well controlled may need to use a controller/preventer medicine daily. The doctor will be able to assess and advise if your child needs to use a controller/preventer medicine daily. It is of paramount importance to be strictly compliant with the controller/preventer prescribed.
During acute asthma attacks, there are other medications that are commonly prescribed, including a short course (3-5 days) of oral steroids to help reduce the severe airway inflammation during attacks. These must be completed according to the prescription. A short course of oral steroids does not cause long-term side effects and does not need to be tailed down. Your child’s usual controllers/preventers does not help during acute asthma attacks – its role is more for achieving longer-term control.
You will probably give your child asthma medications using a spacer device (with or without a mask, depending on the child’s age and ability to cooperate) or a home nebulizer (also known as a breathing machine). The nebulizer delivers asthma medications by changing them from a liquid to a mist. Your child gets the medicine by breathing it in through a facemask. Your child may be able to use a metered dose inhaler (MDI) with a spacer. A spacer is a chamber that attaches to the MDI and holds the burst of medication. Talk with your child’s doctor to see if an MDI with spacer is right for your child.
|Proper Metered-Dose Inhaler/Spacer Technique|
Source: Edward A. Bell, PharmD, BCPS
If your child is showing symptoms of an asthma attack:
Children with asthma often have symptoms at school, so it is very important to get the school involved in caring for your child’s asthma. This is true even if your child has only a mild case of asthma or if he or she does not need to take asthma medicines while at school. Most schools have several children with asthma, so teachers should be familiar with helping children with asthma. Still, it is important to take steps to ensure that your child gets adequate attention and that all relevant school personnel are familiar with what is needed to help your child. You can look at this in two ways: there are things you need to do to prevent your child from having an asthma attack at school, and there are things you need to do to make sure that your child gets the right treatment if an asthma attack occurs at school.
The most important thing is to talk to your child and, depending on how old he or she is, explain as much about the disease that your child will understand. Ideally, your child should also:
School officials should know about your child’s asthma, including:
Write up and a list and distribute it to every school official who may be caring for your child. If possible, you should try to arrange a meeting with the school officials and explain the triggers, severity, symptoms, and treatment of your child’s asthma. You should look at your child’s classroom and other areas where he or she goes in school to see if there are any triggers. If you identify possible triggers for your child’s asthma (dust mites and dust are common triggers in a classroom), you should work with the teacher to reduce your child’s exposure to these triggers. It is very important to provide the teacher with all of your child’s asthma medicines and the proper instructions. Remember that for some medicines, like inhalers, there is often no way to tell whether or not the inhaler still has medicine. You need to keep track of this and replace the medicines at school on a regular basis. Some of the newer inhaler devices have dose counters, and you will be able to tell when the medication needs to be refilled. Be sure to check every few months that the school is taking care of your child’s asthma and that everyone involved understands your child’s condition.
In addition to the above, the more teachers and other adults at school who know about your child’s asthma, the better. Your child could have an asthma attack while at lunch or in the hallway; these are places where the class teacher may not be present.
The school should have a clear set of instructions (your doctor can help with this) about what symptoms it should look out for, and what treatment it should give, where there is an asthma attack. The school should have a clear idea of what to do and when to call 995.
The child should avoid exercise or physical activities during and soon after an asthma attack. Many children improve, in terms of asthma control, as they get older. Once asthma is properly controlled, your child should be encouraged to take part in all usual activities. There is no need to restrict activity. With the right medication and care, children with asthma should be able to participate in sports and lead normal active lives. Many outstanding athletes have won Olympics medals despite having asthma.
You know your child’s asthma is well-controlled if, with medications, your child:
By learning about asthma and how it can be controlled, you take an important step toward managing your child’s disease. We encourage you to work closely with your child’s doctor to learn all you can about asthma, how to avoid triggers, what medications to use, and how to correctly give them. With proper care, your child can live free of asthma symptoms and maintain a normal, healthy lifestyle.
Will my child’s asthma go away or be cured?
Once a person’s airways become sensitive, they generally remain that way for life. However, about half of children experience a noticeable decrease in asthma symptoms by the time they become adolescents, therefore appearing to have “outgrown” their asthma. But, about half of these children will develop symptoms again in their 30s and/or 40s. Unfortunately, there is no way to predict whose symptoms will decrease during adolescence and whose will return later in life. Nonetheless, it is very important to manage your child’s asthma properly and achieve good control as soon as possible, as this will help your child breath better and improve his/her quality of life, and it may potentially reduce the risk of asthma persisting into adulthood (as some studies have shown).
Asthma is a common chronic illness in children, affecting as many as 20% of children.
Frequent coughing spells, breathlessness or chest tightness are symptoms of asthma; however not all wheezing or coughing is caused solely by asthma.
Asthma attacks may be triggered by a variety of factors, including the environment, viruses, weather or allergens. It is important to identify and avoid your child’s asthma triggers as much as possible.
Asthma is usually difficult to diagnose in infants below 1 year. In older children, asthma can be diagnosed through a detailed medical history, physical examination or series of tests.
Based on your child’s history and condition, your paediatrician should develop an “asthma action plan” to outline when and how your child should use medication such as relievers and controllers/preventers.
Get your child’s school involved in caring for your child’s asthma – including identifying possible triggers and informing teachers of your child’s condition.
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