Pediatric Asthma

Asthma is a long-term (chronic) lung disease that causes your child's airways to become sensitive to certain things (triggers). Several things happen to the airways when a child is exposed to triggers:

• The lining around the airways swells.
• The muscles around the airways tighten.
• The airways make more thick mucus than normal.

All of these things will cause the airways to narrow. This makes it hard for air to go in and out of your child’s lungs and causes asthma symptoms.

According to the latest information available from the American Lung Association, the Centers for Disease Control and Prevention (CDC) and the National Institute of Allergy and Infectious Diseases (NIAID):

• Approximately 20.3 million people in the United States have been diagnosed with asthma, with at least 6 million of them children under the age of 18
• Asthma is the leading, serious, chronic illness among children in the United States
• Asthma accounts for 14 million absences from school each year
• Asthma is the third-ranking cause of childhood hospitalizations under the age of 15

Experts don't know the exact cause of asthma. They think it's partly passed down through families. But it can also be caused by many other things, such as the environment, infections and chemicals.

A child is more likely to get asthma if they:

• Have family members with asthma.
• Have environmental allergies, food allergies, or eczema.
• Are around tobacco smoke.
• Are around air pollution.
• Have another health problem, such as sinus problems or being overweight.

Symptoms can be different in each child. Children with asthma have times when they have few, if any, symptoms. They also have times when symptoms flare up. Symptoms may include:

• Cough that is either constant or comes and goes.
• Wheezing or whistling sound that is heard while your child breathes.
• Trouble breathing or shortness of breath while your child is active.
• Chest tightness.
• Tiredness.
• Cough at night.
• Noisy breathing.

The symptoms of asthma can look like other health conditions. Have your child see their health care provider for a diagnosis.

To diagnose asthma, your child’s health care provider will ask about your child's symptoms, possible triggers, family history and health history. They may recommend these tests:

• Spirometry: This test checks lung function. It uses a device called a spirometer. This test is most often done in children who are age six or older.     
• Peak flow monitoring (PFM): A peak-flow meter is used to measure the amount of air a child can blow out of the lungs. This test can be done at home. It's often helpful for day-to-day checking of asthma symptoms.
• Chest X-rays: This test uses energy beams to make images of internal tissues, bones, and organs on film.
• Allergy tests: Allergy tests can show if your child has specific allergies that may be causing asthma or making it worse.

The majority of children with asthma have allergies. Even exposure to low-grade allergens (those that do not cause significant allergic reactions) may increase the severity of a child's asthma. In addition, allergies may play a role in undiagnosed asthma cases. Other triggers of childhood asthma may include:

• Upper respiratory infections (i.e., colds)
• Inhaled irritants, such as secondhand smoke
• Certain weather conditions, such as cold air
• Physical expressions of emotion, such as crying, laughing or yelling

However, with proper management of the asthma, such as avoiding triggers, taking prescribed medications, monitoring for warning signs, and knowing what to do during an asthma attack, a child with asthma can conduct a healthy and active lifestyle.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Your child’s health care provider may refer your child to a pulmonologist. This is a doctor with special training to treat lung conditions. Your child may also be referred to an asthma and allergy specialist. This doctor has special training in treating both asthma and allergies. Your child’s treatment is based on how bad the symptoms are and how well they are controlled. Treatment includes finding triggers and ways to stay away from them. It will also include medicines.

Asthma medicines include:

• Bronchodilators. These medicines help open the narrowed airways. They may ease coughing, wheezing, shortness of breath or trouble breathing.
• Anti-inflammatory medicines (inhaled or oral steroids). These medicines help ease the inflammation in the airways.
• Anti-leukotrienes. These help decrease the narrowing of the airways. These are often given by mouth.
• Allergy immunotherapy. This can decrease allergies to environmental triggers, such as dust, pollen, or animal allergies that can set off asthma flares in some people.
• Biologic medicines. These are injected medicines used for certain types of severe asthma. They are available for children ages six and older.

Asthma medicines can be given in different ways. They may be given as a pill, inhaler, nebulizer or injection. Your child's health care team can help you know how to use the inhaler or nebulizer correctly.

Some asthma medicines, such as a rescue inhaler, work quickly to relieve asthma symptoms. Other medicines help with long-term asthma control and shouldn't be used in an emergency. Make sure you know which medicines are for quick relief. Ask your child's provider any questions you have about your child's medicines and when to use them.

Asthma that is not well controlled may cause:

• Severe asthma attacks. These can lead to a stay in the hospital or even death.
• Lasting damage to the airways.
• Increased time in the hospital or the emergency department.
• Missed school or other activities.
• Reduced quality of life.
• Emotional stress for your child and your family.

Asthma can’t be completely prevented. There are steps you can take to reduce the chance of your child having asthma. They include:

• Not being around secondhand smoke.
• Staying away from air pollution.

In most children, asthma flare-ups can be prevented by:

• Staying away from known triggers.
• Carefully managing symptoms.
• Taking medicines as directed.

You can help manage your child’s asthma by:

• Finding out your child’s triggers and keeping them away from those triggers.
• Not letting people smoke in your car, home, or anywhere near your child.
• Not letting your child smoke or use e-cigarettes.
• Giving your child medicine as directed to prevent symptoms.
• Keeping your child up-to-date on vaccines as directed by their health care provider.
• Creating and keeping an Asthma Action Plan.
  • The Asthma Action Plan has information on your child’s medicines. It also says what to do when symptoms occur, and what to do in an emergency.
  • Your child's provider can help you fill it out and update it as needed at each office visit.
  • You can share it with family, babysitters and school officials.
• Closely watching asthma symptoms to know when they are getting worse.
• Knowing what to do when asthma gets worse.
• Keeping scheduled follow-up appointments.
• Letting school officials or child care providers know about your child's asthma and their Asthma Action Plan.

Work with your child’s provider to find the best way to take care of your child’s asthma. There are guidelines for children from newborn to age 4, ages 5 to 11, and ages 12 and older. Your child should wear a medical alert bracelet or necklace so help can be provided in an emergency.

The more information a person with asthma has, the better the asthma can be controlled.

Call your child’s health care provide if your child’s symptoms are not well controlled. For example, your child is waking at night with symptoms or is having trouble with daily activities. Or your child needs their rescue medicine more often. Also talk to your provider if your child shows any signs of emotional distress, such as sadness, anger, or isolation, and refuses to talk to you. These emotions may be related to coping with the asthma symptoms. Bring your Asthma Action Plan to appointments so it can be updated if treatment plans or medicines change.

Call your child’s provider or get medical help right away if your child has severe symptoms. These severe symptoms can include:

• Trouble breathing.
• Trouble sleeping.
• Trouble walking.
• Trouble talking.
• Trouble doing usual activities, such as getting dressed, playing or getting ready for school.
• Coughing that won’t go away.
• Wheezing when breathing in and out.
• Wheezing that gets worse after medicine should be working (most quick-relief medicines work within 15 minutes).
• Feeling faint, dizzy or weak.

Call 911

Call 911 right away if your child has any of these:

• Symptoms or conditions as directed by your Asthma Action Plan
• Lips or nails are turning blue
• Nostrils flare each time they inhale
• Can't talk or walk at a normal pace
• Rapid breathing (30 or more breaths per minute)
• The skin between your child's ribs or under their neck sinks in when they breathe