Asthma In Children

What Is Asthma in Children?

Asthma is a condition that affects the air passages in the lungs. These air passages are made up of thousands of tiny tubes that bring the air in and out of the lungs.

It’s a two-step problem:

  • When a child has asthma, the air passages are inflamed, which means they are red and swollen.
  • The inflammation of the air passages makes the air passages extra sensitive to a number of different things that can bring on asthma symptoms.

The things that can bring on asthma symptoms are often called “triggers,” since they can trigger an attack. When the child is exposed a trigger, the oversensitive air passages react. They become narrower, swollen and more inflamed. This obstructs the air flow through the lungs, making it difficult for the child to breathe.

Why Do Some Children Get Asthma?

We don’t know why. But we do know that some children are born with the tendency to develop asthma. Asthma is likely to run in families, though some children get it even if no close relatives are asthmatic. It seems that children who have allergies at a young age may be at greater risk of developing asthma.

Will Asthma Go Away?

Asthma is a chronic condition. This means that while it often looks like it goes away for a while, the inflammation of the air passages remains present all the time, though sometimes so slight that it is not noticed.

As long as the air passages are inflamed, asthma can flare up any time. But asthma often gets better in the teenage years, and in mild cases, may disappear completely. It may come back again in some adults – especially if they smoke, or something else irritates their lungs.

Although asthma cannot be cured, symptoms can often be prevented or minimized with good management. Success is most likely if you and your child:

  • Understand what asthma is
  • Make efforts to avoid known triggers when possible
  • Learn how to manage asthma symptoms effectively

Facts About Asthma In Children

  • Asthma is common. As many as 5 million youngsters in the U.S. are known to have it, and it goes undiagnosed in many more.
  • This means that millions of parents are involved in their child’s asthma care.
  • Although asthma cannot be cured, with proper treatment it can be effectively controlled, allowing your child to enjoy a trouble-free and fully active life. Indeed, up to 10% of America’s best athletes have asthma!
  • But if asthma is not adequately controlled, it’s hard for children to lead a normal life. They may often be unable to join in some sports and play, may miss a lot of school, and there may be many visits to the emergency department.
  • Parents need to become a partner in their child’s treatment.


What Are The Symptoms Of Asthma?

Asthma symptoms occur as the child’s lungs react to something to which they are sensitive. Inside the lung:

  • The many tiny muscles surrounding the air passages tighten, making them narrower than usual.
  • The air passages become swollen and more inflamed.
  • The swollen air passages produce more mucus, further clogging the already narrow tubes.

This results in the symptoms of asthma:

  • Shortness of breath as the child strains to get air into the lungs.
  • A wheezing, whistling sound, as the air goes through the narrowed airways.
  • Tightness in the chest, sometimes with pain.
  • Coughing to get rid of mucus.
  • A feeling that the throat is clogged.

What Brings On Asthma Symptoms?

A number of “triggers” can bring on an asthma episode. These can vary from child to child. They include:

Respiratory Infections

Respiratory-tract infections, such as the common cold and flu, can make asthma worse.

How To Information

Preventing attacks:

  • If your child has a cold, flu, and other trouble breathing, see the doctor. Antibiotics don’t work against colds, but medication to open up the air passages will help.
  • Encourage your child to wash hands often. This can help reduce transmission of the cold viruses.
  • Consider flu shots for both the child and the family every year.

Exercise And Sports

Many asthmatic children suffer from asthma episodes brought on by exercise and sports.

Symptoms may begin after several minutes of exercise or after the exercise is over. They may last for a few minutes to an hour and usually get better by just stopping the exercise, but they can continue even with resting. These symptoms may limit play and interfere with performance.

The severity of the asthma episode will depend on how intense and for how long the child exercised.

The symptoms are not caused by the physical effort itself, but by the loss of heat and moisture from the air passages that occurs when dry, cold air is inhaled rapidly.

How To Information

Preventing attacks:

  • Work out a plan with your doctor. This may mean taking medication to prevent symptoms before exercising or playing sport.
  • Appropriate warm-up is important in reducing symptoms and can be very important for competitive athletes.
  • If asthma symptoms occur during sports, the child should take a short rest and then if possible continue. Medication may need to be taken when symptoms occur.

Need To Know

The importance of exercise for children with asthma

Almost all asthmatic children can play the sports they most enjoy if a good treatment plan has been worked out. Swimming is particularly encouraged by many physicians.

Even though exercise may cause symptoms, you should encourage your child to exercise and participate in sports. This is likely to help your child develop physically as well as gain self-confidence.

As many as 10% of all Olympic athletes are asthmatic.


Weather may affect asthmatic children in different ways. Some children wheeze more on damp days, some on dry days, and others only when the weather is very cold.

How To Informtion

Preventing attacks:

  • It is important to recognize if there is a relationship between the weather and your child’s asthma, so that you’ll be ready to deal with any symptoms, should they occur.
  • On particularly cold days, keeping the mouth and nose covered by a bulky scarf may be useful.
  • In very cold weather, if the child is wheezy, it’s preferable not to play outside.
  • There is no point moving to a different climate. Asthma is quite common in all parts of the country.

Irritants And Pollutants

There are many chemicals and pollutants that irritate air passages and can trigger an asthma attack:

  • Anything with a strong smell such as aerosol sprays, perfumes, deodorizers, household cleaners, paints and varnishes.
  • Smoke, especially tobacco smoke.
  • Some types of air pollution (for example, car exhaust smoke).
  • At school, fumes from science labs.

How To Information

Preventing attacks:

  • Keep strong-smelling cleaning fluids out of your house, or keep the child out of areas where household cleaners and other substances with strong odors are being used.
  • Make sure no one smokes in the house (even smoke on people’s clothes can sometimes trigger attacks).
  • Avoid smoke from barbecues, fireplaces, etc.
  • When pollution is bad, use air conditioning, if you have it.
  • Rooms where hobbies are performed that produce strong smells should be aired thoroughly and often.

Certain Medications And Food

Aspirin can occasionally trigger an attack in some children. But children should never be given aspirin because of the risk of a rare but potentially fatal condition called Reye’s syndrome.

Rarely, certain foods, especially sulfite preservatives, may trigger an asthma episode.


If someone has an allergy, it means they react to substances that are normally quite harmless. These substances, or “allergens,” can either be inhaled or ingested. At first, reactions may be very minor, barely noticeable. But repeated exposure gradually increases sensitivity.

Most asthmatic children are allergic. They may be allergic to many different things. And the more severe the allergy, the more severe the asthma. If the levels of allergen (anything that brings on an allergic attack) in the home or environment are high, asthma is also likely to be more severe.

In an allergic reaction, certain body cells release various chemicals. In an asthma attack brought on by an allergen, these chemicals irritate the inflamed air passages and cause the reactions that make the airways narrow and breathing difficult.

The following allergens are known to bring on asthma attacks:

  • House dust mites – These are tiny microscopic insects that live in dust. They are commonly found in mattresses, pillows, bedding, carpets, and upholstered furniture. They are a common source of allergies and are especially common in warm, damp climates.

    Prevention: Dust mites cannot be entirely avoided. But you should aim to lessen the child’s exposure to them, particularly in the bedroom:

    • Put plastic zippered covers on mattresses and pillows.
    • In the child’s bedroom, move out anything that collects dust (including the carpet if possible) and avoid upholstered furniture and clutter.
    • Keep as few stuffed animals as possible and wash them in hot water weekly (they can be put in a pillowcase that is closed with a clothespin).
    • Wash all bedding each week in hot water (at least 135 F).
    • Linoleum, tile, and hardwood floors are best for minimizing both dust and dust mites.
    • Vacuum when the child is out of the area. Vacuuming will not get rid of mites, and in fact spreads them up into the air for several minutes before they settle again. Use a vacuum cleaner with a HEPA air filter (which stands for “high efficiency particle arresting”).
    • Keep humidity in the child’s environment low, around 35% (never over 50%), because high humidity encourages dust mite growth.
    • Air conditioners are recommended. If possible, add special filters to help trap allergens (HEPA air filter).
    • Curtains should be laundered often; it is better to avoid heavy curtains.
  • Mold – Mold is the greenish material that grows in damp places. Mold releases microscopic particles called spores for their reproduction. These spores can float through open windows into the house, especially on cool nights in the spring and fall. Asthma attacks may also be triggered by the type of mold that grows in the house.

    Prevention: Ways to reduce exposure to molds include:

    • If possible, use air conditioning and filtration to reduce humidity. This will help control mold.
    • Avoiding indoor mold spores requires regular ventilation of the kitchen, bathroom, basement, and other damp areas of the house.
    • Clean out mold from damp places in the house, and clear out moldy objects from closets. Use a spray cleaner with a fungicide in it.
    • Keep bedroom windows closed to keep out mold and pollen spores.
    • Keep drainage from rainwater away from the house, so as to decrease humidity in the basement.
    • If you use a humidifier, clean it often. Otherwise mold can grow inside it.
  • Pollen – Pollen is made up of microscopic particles released by plants for their reproduction. Pollen is more a cause of hay fever than asthma, but there are some children with asthma who clearly have problems with ragweed and other typical plant pollens. You should note whether your child’s asthma is worse when the grass is being mowed or when the pollen count is high.

    Prevention: Ways to reduce exposure to pollen include:

    • Pay attention to the pollen count in your area, and keep the windows shut whenever necessary.
    • Air conditioning and filtration systems can be very helpful in minimizing pollen and in keeping the humidity down. But check with your doctor before purchasing expensive equipment.
    • On days of high mold and pollen counts, have the child take a shower and wash his or her hair before bedtime (to get the pollen and mold out). Also, leave outdoor clothes out of the bedroom.
    • Change pillowcases every two to three days.
  • Pets – Many children are allergic to a substance in the saliva and on the skin of furry animals. This substance will get on the dog’s or cat’s coat, and when it dries, it can float through the air. It can still be found on the walls of a house even months after a pet has left.

    Hamsters, mice, and rats can produce the same problem. In some children, feathers also set off an allergic reaction.

    Animal allergens are such a potent stimulator of asthma that it is safe to assume that frequent asthma symptoms in a child living with a furry pet are caused by the pet.

    Prevention: Ways to deal with pet allergy include:

    • The best way is to find the pet another home.
    • If this is out of the question, the pet should be kept outdoors as much as possible and never allowed into the child’s bedroom.
    • Deciding what to do about a pet is not easy, but if its presence really worsens the child’s condition, making the hard decision is the right thing to do.
  • Cockroaches – The dried-up body parts of dead cockroaches are a very potent stimulator of asthma.

    Prevention: Regular cockroach control is essential to good control of asthma.


Stress does not cause asthma, but when a child is stressed out, it can make the asthma worse. If the child is afraid of asthma attacks, this fear can also make the attacks worse.

Prevention: Dealing with fear about asthma should be part of a program of preventing and managing attacks that is worked out between you, your child, and your doctor. If your child seems stressed out, talk to your doctor.

Certain Health Problems

Certain health problems, such as sinusitis and heartburn, can make asthma worse.

  • Sinusitis – The sinuses are hollow parts of the facial bones that can become infected. Children with sinusitis may have a post-nasal drip that irritates the airways, making the asthma hard to control.

    Prevention: Work with the doctor on treating the sinusitis. If the doctor prescribes antibiotics, make sure the child takes them all.

  • Heartburn (gastroesophageal reflux) – Even in young children, the contents of the stomach may occasionally flow back towards the throat, and this can make asthma worse.

    Prevention: The doctor may suggest:

    • Avoiding foods that seem to cause heartburn
    • Raising the head of the child’s bed, to avoid heartburn at night
    • Medication

Working With The Doctor

It is very important to work closely with the doctor in getting control of the asthma. If you ever feel that the treatment is not going well, don’t be embarrassed to say so.

The doctor will:

  • Give you advice about avoiding the things that cause attacks.
  • Prescribe medication to control inflammation.
  • Prescribe “rescue” medication to treat attacks.
  • Help you work out a plan for using medication.
  • Help you work out a plan so your child can exercise without being limited.
  • Tell you what to do in emergencies.

Helping Your Child Manage Asthma

Parents should make sure that the child plays an important part in managing his or her own asthma.

For example:

  • Small children (even 6- and 7-year olds) should know the names of the their medications, and how the medicine helps.
  • All children over the age of 4 or 5 should know what triggers their attacks, so they can avoid those triggers.
  • All children over the age of 4 or 5 should understand what their symptoms mean. They should know when they need to take their medication if an attack is coming.
  • Older children should be responsible for taking their medicine at the right time.

Need To Know

It is important that your child develop self-confidence about his or her ability to manage asthma and learn to communicate to parents and others when asthma symptoms are occurring.

Working Out A Plan

To successfully help manage your child’s asthma you, your child and the doctor should work out a written plan of action:

  • Identify the triggers responsible for your child’s asthma. Know how to avoid them.
  • Know what medication needs to be taken, even when there are no symptoms.
  • Know how to recognize the earliest warning signs of an asthma episode and what to do about it.
  • Know how to use a peak flow meter to predict when an asthma attack may occur.
  • To determine how well the medication is working.
  • Know what to do in emergencies.
  • Know when to contact your doctor.
  • Find out about asthma support groups and summer asthma camp (see Additional Sources Of Information).

Both you and your child should become familiar with this plan.

Asthma in Children: The Peak Flow Meter

The peak flow meter is an important device that can give you valuable information about your child’s air passages – whether air is passing through freely, or whether they are partially blocked.

The meter measures how fast the child is able to breathe into it. This measurement is known as the “peak flow.”

Most children over the age of five can learn to use the meter, though with young children it’s important to make sure they are doing it correctly.

Monitoring Your Child’s Peak Flow

You should learn to use the peak flow meter as a tool for managing your child’s asthma and for predicting attacks.

This involves taking regular peak flow measurements and comparing them against your child’s best peak flow rates. This is the highest peak flow number a child can produce in the doctors office, when perfectly well, after inhaling medication to open the airways.

Together with your doctor you will decide on a plan of action if the peak flow reading falls significantly.

Why Peak Flow Numbers Are So Useful

By regularly measuring your child’s peak flow you can:

  • Predict when an attack may occur, by detecting a drop in peak flow hours or even a day or two before obvious symptoms appear.
  • Know how well your child is responding to medication.
  • Know whether your child’s asthma is under control.

When To Use The Peak Flow Meter

The doctor will tell you how often the child should use the meter, and will show you and the child how to use it.

  • If the asthma is quite severe, the doctor may want the child to use the meter daily, at the time of day when the asthma is usually worst.
  • If the asthma is quite mild, the doctor may suggest using the meter only when the child is wheezing, or feels an attack may be coming on.

It is also useful to measure peak flow when the child is starting on a new medicine, because it will show clearly how well the medication is working.

How To Information

How To Use A Peak Flow Meter

Your child should:

  • Have an empty mouth – no gum or food.
  • Stand up.
  • Set the meter at “zero.”
  • Hold the meter correctly, so fingers don’t get in the way.
  • Take a really deep breath, with the chest puffed up as far as it can go.
  • Close lips around the mouthpiece, with the tongue out of the way.
  • Blow as hard and fast as possible – as if blowing out candles on a cake. The arrow will move until it points to a number on the scale. This is the peak flow number.
  • Blow into the meter three times, and write down the best number.

Parents should:

  • Watch. The child’s chest should puff out – the cheeks should not.
  • Listen. There should not be a whistling noise from the meter.
  • Check the numbers on the scale and keep a record. This is best recorded on a calendar.
  • Keep your child’s peak flow meter clean. Wash the plastic body in warm water at least once a week.

Children can get readings that are too low by not taking a deep enough breath or by not blowing hard enough when blowing out. They can also get readings that are artificially high, by spitting into the meter or putting their hand in the wrong place on the meter. Parents may need to watch closely to make sure the child is doing it right.

Interpreting Peak Flow Numbers

Here’s how you and your child can use a peak flow reading to help decide the severity of his or her immediate condition.

The peak flow reading will fall into one of three zone based on accepted medical standards:

  • The Safety or Green Zone – This includes readings higher than 80% of the child’s best peak flow rate. This indicates there is no problem and suggests that current treatment is working.
  • The Caution or Yellow Zone – The child is only able to achieve 50% to 80% of his or her personal best peak flow rate. A reading in the caution zone means that the asthma is worse, even if your child feels fine and looks well.

Now you need to act on the plan worked out with your doctor – give or increase a particular medication or prepare for an attack. Your plan should make clear when the doctor is to be contacted. In many cases, this is not necessary unless readings repeatedly enter the Caution Zone, or stay there even after the treatment prescribed in your plan has been given.

  • The Danger or Red Zone – The child is able to achieve only half, or less than half, of his or her personal best peak flow rate. This usually means an attack has begun.

Your plan should make clear what you need to do. This will include specific medication to be taken immediately. You should get in touch with your doctor if the medicine doesn’t stop the attack, or go immediately to the emergency room.

Medicines To Prevent Asthma Attacks

Medicines are taken daily, whether or not symptoms occur, to prevent asthma attacks. The goal of these medications is to reduce the inflammation in the air passages. They are therefore called anti-inflammatory medications.

These medicines need to be taken even when there are no obvious symptoms of asthma. They are particularly helpful in preventing asthma attacks due to allergies, exercise, cold air, and some air pollutants. By reducing the swelling and mucus production in the lung’s tiny air passages, these medications lower the risk of asthma episodes, or in more severe situations, reduce the number and severity of attacks.

Preventive medications don’t work immediately, but may take weeks or months before they are really effective. So it is very important for the child to stick with them – and to take them regularly.

  • If doses are skipped the asthma is likely to get worse.
  • If medication is taken regularly, most children can keep their asthma under control. Even though they won’t be “cured,” they should be free of symptoms most of the time.
  • Taken properly, preventative medications should make the child’s life much easier. But it is still important to avoid the triggers and irritants that bring on asthma attacks.

Medicines To Deal With Asthma Symptoms

The safest and most effective way of opening up the air passages in the lungs when an attack is about to start or has started is by using medications called bronchodilators. They are the “rescue medications.”

These medicines are taken as soon as coughing or wheezing starts. Once the symptoms end, the child may need to continue taking the medication for a few days or a week, along with any other medications they may be taking.

Bronchodilators are best taken by inhaling them so that the medication can go directly to the lungs where it is needed. They are also available as tablets.

Nice To Know

Bronchodilate means to “open up air passages” and that is exactly what these medications do. They achieve this by relaxing the tight muscles that narrow the air passages during an asthma attack. They also help clear out the mucus that clogs the airways during an attack.

Your child should see the doctor regularly while taking medications to check growth, measure lung function and discuss and determine if the dose needs to be changed.

If side effects do occur, keep track of them, and tell the doctor. Often, side effects will go away after a few days. If not, the doctor may want to change the medication, or give the same medication in a different form.

Medications To Prevent Attacks




Intal Tilade

Cromolyn Nedocromil

  • Well tolerated
  • May irritate the throat and cause child to cough when taking it. Drinking water usually helps
  • Tilade tastes bad for some children; therefore, best tried before being prescribed

Theodur Slobid Uniphyl


  • Used to be the main asthma medication; now replaced by newer drugs
  • Still is the most effective in preventing attacks during sleep
  • Blood tests needed from time to time to make sure dose is correct
  • Fever can affect the way it works (temperature over 100 degrees Fahrenheit)
  • Overdose may cause sleeplessness, nausea, vomiting, and rarely seizures and/or heart problems
  • May interact with other drugs especially erythromycin

Accolate Singulair


Montelukast Zafirlukast


  • Useful for preventing exercise-induced asthma
  • Used to prevent attacks in those with mild asthma
  • Well tolerated; headaches, dizziness and nausea may occur in some children

Medications For Dealing With An Attack (Bronchodilators)




Ventolin Proventil

Maxair Alupent

Bricanyl, Brethine





  • The child should breathe more easily within 5-10 minutes after taking the medication
  • Should be inhaled for best results
  • Well tolerated; few side effects; may cause a faster heart rate and tremors of the hands and fingers for a couple of minutes in some children


Ipratropium bromide

  • Takes longer to work but effects last longer
  • Often taken together with one of the above for severe attacks
  • Inhaled for best results
  • May cause dry mouth, increased heart rate and cough in some children
  • If gets into the eyes, the pupils may dilate temporarily (black central part of eye gets larger)


Steroids to treat asthma are quite different from the steroids that athletes take illegally to bulk up. They are the most effectiveanti-inflammatory medications available. They are used to treat severe attacks as well as to prevent attacks.

Inhaled forms (such as Beclovent, Azmacort, Vanceril, Flovent,Pulmacort, Aerobid) may be used regularly to prevent attacks. Except in high doses, they are usually well tolerated, but the child should use a spacer to avoid sores in the mouth.

For severe attacks that don’t respond to initial medications, steroids (such as Prednisone) may be taken as pills or in liquid form. It is important to take these medications for no more than several days at a time, because they can produce side effects such as vomiting, headache, dizziness or trouble sleeping.

Usually, doctors try to limit oral steroids to less than a week at a time, no more than two or three times a year.

Need To Know

With heavy use, steroids can sometimes slow a child’s growth. That’s one reason why it’s important to try avoid things that bring on an attack, so the child can get by with small doses of steroids, if any. And if the child is taking steroids, be sure he or she takes plenty of calcium for good bone development.

How to Use Asthma Medication Effectively

The medication given to prevent and treat asthma is usually inhaled, because it gets directly to the lungs, where it is needed. Depending on the child’s age, there are several different devices through which the medicine can be inhaled:

  • Through an inhaler. An inhaler is a device in which the medication is contained in a small pressurized canister that releases a pre-measured or “metered” dose. This is called a metered-dose inhaler or an MDI – sometimes also called “the puffer.”
  • Through an inhaler with a built-in spacer. A spacer is a small container attached to the inhaler. The spacer acts as a reservoir. The medication goes from the inhaler into the spacer, where it turns into a fine mist. The child then breathes the medication in from the spacer.

    Studies suggest that spacers greatly improve the effectiveness of the medication. They are recommended for younger children who are unable to use an aerosol inhaler. But some experts recommend that all children who use inhalers should use spacers as well.

  • Through a nebulizerA nebulizer is a small air compressor that turns medication into a fine mist that the child breathes in over a period of about 10 minutes. Nebulizers are used for children who are too young to use the inhalers correctly. Sometimes they are used by older children during severe attacks, when they cannot coordinate their breathing with an inhaler. The medication is delivered either through a mask or through a mouthpiece. For children over the age of 3 or 4, the mouthpiece is considered better, because more medicine can get into the lungs. It is not wasted on the child’s face.

How To Information

How To Use An Inhaler With A Spacer

  • Shake the inhaler, to mix up the medication
  • Connect the inhaler to the spacer.
  • Breathe in deeply, then breathe out.
  • Place lips firmly around the mouthpiece of the spacer.
  • Push the plunger on the inhaler once.
  • Breathe in slowly and deeply; hold breath for five to 10 seconds.
  • Repeat for each “dose” of medication.

Advantages of the spacer

The spacer helps to mix the medication with air before it is breathed in, so that:

  • It’s easier to breathe the medication deep into the lungs.
  • There is less chance of medication sticking to the mouth and throat, where it can taste bad, irritate the tissues, and get swallowed into the stomach where it may be absorbed into the blood.

Note: With inhaled steroids, children should always use a spacer to prevent soreness and yeast infections in the mouth.

How To Information

How To Use A “Dry Powder” InhalerTo load the inhaler:

  • Hold in an upright position (mouthpiece up).
  • Twist the brown grip fully to the right and then back to the left.
  • You will hear a click – it is now loaded.
  • Do not shake or blow into the inhaler after loading it.

Inhaling the medication:

  • Turn your head away from the inhaler and breathe out.
  • Place the mouthpiece between your lips and inhale deeply and forcefully. This is one dose.
  • Take the number of doses as prescribed by your doctor.
  • Rinse the mouth with water. Do not swallow.


Making The Most Of The Asthma Medication

For all asthma medications, it is very important to follow the doctor’s instructions. Here are some tips to make the most of the medication:

  • Don’t stop the medication that is used to prevent attacks.Because the benefits of preventive medications are not immediate, parents sometimes stop giving the drug regularly or even discontinue it altogether. This misunderstanding of how preventive medications work is the biggest reason for their failure.
  • Don’t increase the dose of any medicine without talking to your health care team. Only your doctor knows whether the child needs more medication, and whether it is safe to increase the dose.
  • Don’t let children use more “rescue” medicine than the doctor prescribed. They are sometimes tempted to take extra doses to help with their symptoms. This can be dangerous, because it can cover up serious symptoms.
  • Take the “rescue” medication at the earliest signs of an attack.Don’t start taking these medications too late when breathing has become difficult.
  • If there are side effects from the medication, keep track of them and tell the doctor. Often, side effects will go away on their own after a few days. If not, the doctor may want to give the child a different medication, or give the medicine in a different form.

What To Expect From Treatment

Children should be able to run and play, sleep through the night, and miss no more school than their classmates. In other words, they should lead a normal life. It is important not to accept less and to work with the doctor to achieve these results. If a plan doesn’t achieve these results, it is important to tell the doctor.

Recognizing When An Asthma Attack Is Coming

Children will learn to recognize when an attack may be coming. Here are some of the most common signs:

  • A change in breathing pattern
  • A runny, stuffy nose
  • A cough
  • Feeling or looking tired
  • An itchy, scratchy throat
  • Headache
  • Bad mood
  • Difficulty sleeping
  • Stomachache

These are the signs of a more serious attack:

  • The child has great trouble breathing. The chest sinks in, and the stomach pushes out quickly as the child strains to breathe.
  • The child can’t talk.
  • The child finds it hard to walk or to eat.
  • Lips or fingers may look blue.
  • Rescue medication doesn’t improve the child’s breathing within 15 minutes.
  • A dose of rescue medication works at first, but the asthma comes back in less than 24 hours.
  • The readings of the peak flow meter stays in the red zone after using rescue medications.

Handling An Asthma Emergency

You will have worked out a plan with your doctor and this plan should be followed:

  • Remain calm and confident.
  • Give the prescribed medication.
  • Immediate relief usually occurs after taking bronchodilator medication. This can be repeated after five to ten minutes.
  • Encourage the child to breathe slowly and deeply.
  • Loosen any tight clothing.
  • The child should sit in a comfortable position and not lie down.
  • Use the peak flow meter to make sure that the medication has been effective in returning the peak flow to the green zone.
  • Determine if any triggers that may have caused the attack are still in the environment and remove them.
  • Make a note for the doctor about the attack.

If The Attack Gets Serious

It is important to know what to do if the medication doesn’t seem to be working or the attack gets much more serious.

  • Your plan may call for you to repeat the bronchodilator medication (usually not more than twice, at 15- to 30-minute intervals), and to begin steroid medication.
  • If there has been no improvement within five minutes after beginning bronchodilator treatment, or if an attack occurs again in less than two hours, then you will need to call your doctor or go immediately to the emergency department.

Need To Information

What not to do:

  • Don’t give more rescue medication than the doctor prescribed. This can cover up symptoms and make the asthma harder to treat.
  • Don’t expect a severe attack to go away on its own. If the normal medication doesn’t work, call your doctor or go immediately to the emergency department.

If the child goes to the emergency department:

  • Bronchodilator medication will be given through a nebulizer or another breathing device.
  • Steroid medication may be given to quickly reduce the inflammation in the air passages.
  • The child may be given fluids through an IV tube placed directly into a vein, usually in the arm.
  • The asthma attack will then settle and the child quickly recovers. Sometimes the child may be admitted to the hospital for a day or two.
  • The child’s regular anti-inflammatory medication is usually increased for a short period after a severe attack to help settle the inflammation.

After The Attack

You should encourage the child to return to his normal activities.

Frequently Asked Questions: Asthma In Children

Here are some frequently asked questions related to asthma in children.

Q: My child really wants a pet. He doesn’t seem allergic to pets, and skin tests show he’s not allergic to dogs or cats. How about it?

A: In some cases, a dog or cat may seem to cause no asthma symptoms. But its presence may keep the child’s airways slightly inflamed. This will set up the child for attacks brought on by other triggers, such as a cold or a change in the weather. In these cases, people may not realize that the pet is having an effect until they (or the pet) move away, and the asthma improves.

Q: How accurate are peak flow meters?

A: When used correctly, peak flow meters are excellent tools that reflect the state of the child’s asthma – but you need to treat the device with respect. Keep it clean, use it as directed, check it frequently for damage, and it will give accurate measurements. However, remember that symptoms are just as important as numbers. In some cases, children can get a good peak flow “score” even when they are having symptoms. If that’s the case, make a note of the numbers and talk to your doctor.

Q: What are the chances that a child will outgrow asthma?

A: It depends. Asthma usually gets much better in adolescence, so a child with mild asthma might have no symptoms as a teenager, and a child with serious asthma symptoms will have fewer problems as a teenager. However, in many cases the child’s lungs may still be inflamed, as shown on lung function tests. In these cases, asthma may return in later life, usually in the 30’s or 40’s. Experts don’t know why that is. But we do know that keeping a child’s symptoms under good control should reduce the risk of problems in later life.

Q: Can inhaled steroids cause any problems with growth?

A: Inhaled steroids at low doses are well tolerated, but at higher doses they may slow a child’s growth, especially in the early school years. In most cases, the rate of growth will speed up again when the steroid dose is lowered. If your child needs significant doses of inhaled steroids, it is important to consider the following points:

  • Severe asthma itself can affect the rate of growth.
  • Without steroids, your child may not be able to live a normal life, attend school regularly, and enjoy sports and games with the other children. Indeed, he or she may spend far too much time in the hospital or rushing to the emergency department.

In other words, it’s a balancing act. Always discuss the dosage with the child’s doctor, so you know what to expect – and what the alternatives may be.

Q: What are the most important things I can do to help improve my child’s asthma?

A: Three important things you can do are:

  • Check the environment
  • Keep lines of communication open
  • Understand your child’s treatment plan

In terms of the environment, removing a “trigger” from the child’s environment can often do wonders. For example, even though a child can survive the presence of a cat by inhaling steroids to control asthma, he or she would be far better off if the cat went to another home. Generally speaking, the more “triggers” you can remove, and the less medicine your child has to take as a result, the better he or she will be.Good communication between you and your child, the child and the doctor, and you and the doctor, is essential. The three of you need to know what symptoms the child has and what brings them on – and that means talking to one other.

Q: Should we consider moving to a different climate?

A: Moving to a different climate will probably not help. Asthma is quite common in all parts of the country. Generally, families that do move to a new area find that asthma symptoms continue to occur often due to different triggers in the new environment.

Putting It All Together: Asthma In Children

Here is a summary of the important facts and information related to asthma in children.

Here is what you can do to make your child’s asthma easier to manage:

  • Keep lines of communication open between you and the doctor, you and the child, and the doctor and the child.
  • Have a written plan that says how you should manage everyday asthma, and what you should do in emergencies.
  • Be confident in your ability to carry out these instructions.
  • If you are ever confused or have questions, ask the doctor.
  • Make sure you (and your child) understand the different medications and what they do.
  • Make sure you (and your child) know how to properly use equipment such as inhalers and the peak flow meter. You should be able to help your child with these devices.
  • Help your child understand what the treatment does. Even young children should learn what triggers to avoid and what to do in emergencies.
  • As children get older, have them manage their own asthma more and more.
  • Make sure that everyone in the house knows what to do if the child has a serious attack.
  • Have clear guidelines as to when to call the doctor or go to the emergency department. This will prevent unnecessary trips to the hospital.

Most important is teaching the child to understand all aspects of his or her treatment program as soon as age and ability permit. This, of course, is a gradual process, but it should also be a daily one, particularly when attacks are frequent or severe, or when triggers are hard to avoid.

If you and your child both work closely with the health team and learn to manage asthma, you can expect your child to enjoy a trouble-free and fully active life.

More children will “outgrow” asthma and will greatly improve by the time they reach their teens. Some will experience symptoms of asthma in adulthood.

The better you and your child understand its symptoms and causes the better your chances of managing it, and the less the risk of problems later in life.

Glossary: Asthma In Children

Here are definitions of medical terms related to asthma in children.

Allergen: A foreign substance that triggers an allergic response in a susceptible person. Allergens are usually common items encountered in everyday life such as substances from insects, animals or plants (such as pollen).

Allergy: An unusual response to a small amount of a foreign substance that normally does not cause a reaction in another person.

Anti-inflammatory medications: Drugs that work by blocking inflammation. Inflammation is a chemical reaction in the body that produces swelling.

Asthma: A chronic, reversible obstruction of the airways. Allergic asthma is caused by an allergic stimulus; most common in children and adults; caused by exposure to substances such as dust mites, plants, pollens, and molds. Nonallergic asthma is caused by exposure to substances or conditions such as cold air, exercise, or respiratory infections, rather than exposure to allergens.

Asthma attack; asthma episode: The development of asthma symptoms, usually at rest, which are not immediately relieved by “rescue” or “reliever” medications; symptoms include coughing, wheezing, and shortness of breath caused by narrowing of the airways.

Bronchodilators: Medication that helps to open air passages by relaxing tight muscles that can narrow these passages.

Chest tightness: A symptom of asthma caused by over-inflation of the lungs due to the difficulty in pushing air out through obstructed air passages.

Dry powder inhaler (DPI): A portable device used to deliver dry powdered medication to the lungs; single and multi-dose models are available; no propellant is required; all models are breath-actuated and require no hand-lung coordination.

Inflammation: A tissue reaction in which increased numbers of cells invade the tissues. These cells release chemicals that cause changes such an increase in mucus production, swollen linings of airways, and constriction of the airways due to muscle spasm.

Metered-dose inhaler (MDI): A portable device used to deliver a fine aerosol mist of medication to the lungs; powered by propellant; use of the inhaler must be coordinated with the intake of breath.

Mucus: The secretion normally released by the body into the airways to coat and protect them; mucus normally traps inhaled smoke and dust particles to prevent them from reaching deeper into the lungs.

Nebulizer: A device that uses a small compressor and face mask to deliver a fine aerosol mist of drug to the lung; no hand-lung coordination required; units are bulky and not portable.

Peak flow meter: A small, portable monitoring device that measures the amount of effort to force air out of the lungs; obstructive diseases such as asthma often cause an increase in the effort to breath out, which shows as a decreased value on the peak flow meter.

“Preventer” medication: A group of asthma drugs that prevent the symptoms of asthma by controlling the production, release, or activity of inflammatory chemicals.

“Reliever” medication: A group of asthma drugs that counter, or relieve, the symptoms of asthma by causing the relaxation of airways.

Spacer device: A small tube-like device, usually made out of plastic, to which a pressurized metered-dose inhaler (MDI) is attached; depression of the MDI canister delivers a dose to the spacer which holds it long enough for the medication mist to turn into a very fine cloud of vapor that is inhaled when a breath is taken.

Trigger: An irritating substance or condition to which a person reacts when they are exposed.

Wheeze: A symptom of asthma caused by the whistling sound made when air is pushed past an obstruction or narrowed area of an airway.

Additional Sources Of Information: Asthma In Children

Here are some reliable sources that can provide more information on asthma in children.

Asthma and Allergy Foundation of America


Allergy & Asthma Network Mothers of Asthmatics (AANMA) 
Phone: 1- 800-878-4403

National Institute of Allergy and Infectious Diseases

American Lung Association 
Phone: 1-800-586-4872

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