By Dr Dave Ong
Asthma is a chronic inflammatory disorder of the airways, which causes the airways to be very sensitive and prone to constriction. It is one of the most common chronic illnesses in children and can affect as many as 20% of children.
Learn more about the causes and triggers of childhood asthma.
It is unclear why there is an increasing number of children with asthma. Many suggest that, with a cleaner environment, the general population’s immunity is being shifted towards being more allergic. Some also suggest that children are having increasing exposure to cigarette smoke and dust, thus contributing to development of sensitive airways.
During an asthma attack, the sensitive airways, upon exposure to triggers such as a common cold, smoke and dust mites, will become more inflammed, resulting in airway constriction and production of more mucus, leading to further airway narrowing. This narrowing of airways results in wheezing, coughing, chest tightness and breathing difficulties for the patient. Although the airway inflamation is worsened during an asthma attack, it is often ongoing at baseline when the child has no symptoms. Thus, asthma is a chronic condition which requires proper treatment and monitoring, and not just a one-off problem.
Please note that asthma is not the only cause of wheezing or chronic cough, thus a careful evaluation by your child’s paediatrician is necessary to make a correct diagnosis.
Some possible triggers include:
It is unusual to diagnose asthma in infants (less than 1 year of age) as other more serious diagnoses (e.g. congenital airway abnormalities, heart defects) need to be properly excluded first. However, in older children, asthma can be more easily picked up by your child’s paediatrician based on your child’s medical history and physical examination.
Your child’s paediatrician will need to explore in detail the symptoms of your child, such as chest tightness, wheezing, cough and shortness of breath. If these symptoms are recurring and tend to occur in the late night/early morning or after exercise, and are relieved by bronchodilators (such as Salbutamol/Ventolin), then it is very likely that your child has asthma. The risk factors for asthma will also be important, such as a family history of asthma or allergies, and a personal history of allergic conditions such as eczema (sensitive skin) and allergic rhinitis (sensitive nose)
Your child’s paediatrician will need to examine your child’s respiratory and cardiovascular system, 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. An asthma action plan by your child’s paediatrician will be important in teaching you and your child how and when to use the asthma medications, and what to do in emergencies. There should also be environmental modifications such as avoidance of smoke and house dust mites.
There are two main groups of asthma medicine, relievers and controllers/preventers.
Relievers work quickly to open up airways during an asthma attack, thus allowing your child to reverse his/her breathing difficulties or bad cough. They are to be used only for short periods 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).
Controllers/preventers are slower acting medicines which control the chronic airway inflammation, making them less sensitive to triggers, thus targeting the underlying disease process in asthma. These medicines MUST be used every single day (regardless of whether the child is having symptoms or an attack or not) if prescribed by the doctor and should only be stopped or reduced when advised by the doctor. The period of treatment can range from many months to years, depending on your child’s response. 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 or 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 symptomatic relief from them).
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. 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.
Your child’s asthma medications can be administered with a space chamber device (with or without a mask, depending on your child’s age and ability to cooperate) or a nebulizer machine. Your child’s paediatrician will be able to advise on the suitability of each option, depending on the situation.
|Proper Metered-Dose Inhaler/Spacer Technique|
Source: Edward A. Bell, PharmD, BCPS
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.
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.
Your child’s asthma would be considered well controlled if, with or without medications, your child:
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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