Childhood Asthma

Childhood asthma has become more widespread in recent decades. As the most common chronic illness in children, childhood asthma causes more missed school and places more limits on activity than any other disease. Childhood asthma and adult asthma have the same underlying cause — continuous inflammation of the airways leading to the lungs. This inflammation makes the airways overly sensitive and prone to tightening and constricting when irritated. Fortunately, childhood asthma is treatable. With the right medications and action plan, a child with asthma can enjoy normal activities with few disruptions.

Signs and symptoms

The most common signs and symptoms of childhood asthma are:

Coughing
Wheezing
Shortness of breath
Chest congestion
Chest tightness

Additional signs and symptoms of asthma in infants include:

Rattly cough
Recurrent bronchitis with croup, bronchiolitis or pneumonia

While wheezing is most commonly associated with asthma, not all children with asthma wheeze. Likewise, not all children who have wheezing episodes have asthma. Your child may have only one sign or symptom, such as a lingering cough or chest congestion. Because symptoms of asthma can be related to other disorders and illnesses, your doctor will consider frequency of the symptoms along with other factors before making a diagnosis.

Causes

In children with asthma, the airways leading to the lungs are chronically inflamed and often swollen. This makes the airway muscles sensitive and reactive. Asthma triggers, such as smoke or allergens, can make the airway muscles tighten and constrict and may cause asthma symptoms. Triggers are different for everyone. The most common triggers include:

Irritants

Allergens

Other factors

respiratory infections

Treatment

The goal of asthma treatment is to get the asthma under control. Well-controlled asthma means that your child has:

Minimal or no symptoms
Few or no attacks
No limitations on physical activities or exercise
Minimal use of fast-acting inhalers
Few or no side effects from medications

Treating asthma involves both preventing asthma symptoms and treating an asthma attack in progress. Preventive medications reduce the inflammation in your child's airways that can lead to symptoms. "Relief" medications quickly open airways that are swollen and limiting breathing. If your child has symptoms more than twice a week before starting treatment, the doctor will probably prescribe a combination of long-term anti-inflammatory drugs and a fast-acting bronchodilator.

Anti-inflammatory drugs

The most widely used and effective anti-inflammatory medications for asthma are inhaled corticosteroids, which have a relatively low risk of side effects and reduce the need for additional medications. Inhaled corticosteroids, which are taken every day, include fluticasone (Flovent HFA), beclomethasone (Qvar), budesonide (Pulmicort Turbuhaler) and mometasone (Asmanex). Another anti-inflammatory drug (Advair), combines an inhaled corticosteroid (fluticasone) and a long-acting inhaled bronchodilator (salmeterol). Other long-term control medications are available and might be suitable for your child, such as montelukast (Singulair), zafirlukast (Accolate), theophylline and inhaled cromolyn (Intal).

Bronchodilators

Short-acting bronchodilators — often called "rescue" medications — stop the symptoms of an asthma attack in progress. The most commonly used short-acting beta-2 agonist for asthma is albuterol (Proventil HFA, Ventolin HFA). If you find your child needs to use the bronchodilator more than two times a week, adjustments may need to be made to long-term medications to maintain better control.

For children younger than age 3 who have symptoms of asthma, many times doctors will use a "wait-and-see" approach. This is because the long-term effects of asthma medication on infants and young children are unknown. If an infant or toddler has frequent or severe wheezing episodes, a course of medication may be prescribed to see if the wheezing improves symptoms. Newer delivery devices with face masks make it possible for even infants and toddlers to use metered dose inhalers. Children younger than 2 months, however, usually need to use a nebulizer to take medication for asthma. A nebulizer is a machine that turns liquid medication into fine droplets. Your baby wears a face mask and breathes normally while the nebulizer delivers the correct dosage of medication, converting it to a fine mist for your child to breathe in.

Your child's symptoms and triggers are likely to change over time, so treatment should be evaluated periodically to ensure that the asthma is controlled. The doctor may adjust dosages — up and down — over a period of time before finding the right treatment for your child.

Prevention

Careful planning and steering clear of asthma triggers are the best ways to prevent asthma attacks.

Avoid triggers. As much as possible, avoid the allergens and irritants that your child's doctor has identified as asthma triggers.
Ban smoking around your child. Exposure to tobacco smoke during infancy is a strong risk factor for childhood asthma, as well as a common trigger of asthma attacks.
Encourage your child to be active. As long as your child's asthma is well controlled, regular physical activity can condition the lungs to work more efficiently.
Have a plan. Work with your child's doctor to develop an asthma action plan, and make sure all of your child's caregivers — child care providers, teachers, coaches, and the parents of your child’s friends — have a copy.
Use a peak flow meter. This tool can detect decreases in lung function before your child feels any symptoms, giving you important information on how to treat your child's asthma from day to day.

Credit: National Institute of Health.

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