What is asthma in children?

Asthma makes it hard for your child to breathe. During an asthma attack, the airways swell and narrow. Severe asthma attacks can be life-threatening, but you can usually prevent them. Controlling asthma and treating symptoms before they get bad can help your child avoid bad attacks. You may also avoid future trips to the doctor.

Your child may have symptoms every day, just now and then, or somewhere in between. Sometimes your child's symptoms may suddenly get worse (or flare up) and cause an asthma attack. Over time, your child's breathing problems may get more severe. Or your child may have symptoms more often.

Your child may have a hard time breathing only at certain times. This may be during allergy season, when your child gets a cold, or while exercising. Or your child may have breathing problems a lot of the time. The things that make your child's asthma or breathing worse are called triggers.

At times, the inflammation from asthma causes your child's airways to narrow and produce mucus. This causes asthma symptoms such as shortness of breath.

Even mild asthma may cause long-term changes to your child's airways and lungs. It may speed up and make worse the natural decrease in lung function that occurs as we age. Asthma can make lung and airway infections like bronchitis and pneumonia worse.

Loss of lung function in asthma appears to start early in childhood. Asthma also may increase the risk of a partial collapse of lung tissue (atelectasis) or a collapsed lung (pneumothorax).

Treatment can help your child feel and breathe better and help keep your child's lungs healthy. Many children with asthma play sports, and most live healthy, active lives.

When your child has asthma, your child may:

• Wheeze. This is a loud or soft whistling noise when breathing in and out. It happens when the airways of the lungs narrow.
• Cough a lot. This is the only symptom for some children.
• Feel tightness in the chest.
• Feel short of breath. Your child may have rapid, shallow breathing or trouble breathing.
• Have trouble sleeping because of coughing and wheezing.
• Get tired quickly during exercise.

If your child has only one or two of these symptoms, it doesn't always mean that your child has asthma. The more of these symptoms your child has, the more likely it is that your child has asthma.

Symptoms of asthma can be mild or severe. Your child may have symptoms every day, just now and then, or somewhere in between.

Your child might have symptoms right after being exposed to things like pollen or cigarette smoke. This is known as an early phase response. It's also possible that your child's symptoms will start hours after exposure. This is known as a late phase response. It can make it harder to know what things are causing your child's symptoms.

Many children have symptoms that get worse at night. In all people, lung function changes throughout the day and night. In children with asthma, this often is very noticeable, especially at night. In these children, a nighttime cough and shortness of breath occur often. In general, waking at night because of shortness of breath or a cough is a sign that asthma needs more treatment. Getting treatment can help your child avoid an asthma attack.

Asthma is treated with medicine to help your child breathe easier, along with self-care. Other treatments, like counseling, may also be used.

It's very important to treat your child's asthma, even if your child feels good most of the time. That's because mild asthma may also cause changes to the airways that speed up and make worse the natural decrease in lung function that occurs as we age.

Babies and small children need early treatment for asthma symptoms to prevent severe breathing problems. They may have more serious problems than adults because their bronchial tubes are smaller.

By following your child's treatment plan, you can help your child meet these goals:

• Increase lung function by treating the inflammation in the lungs.
• Reduce how often your child has asthma attacks, how long they last, and how bad they get.
• Treat the attacks as they occur.
• Have a full life by preventing and managing symptoms. This means being able to take part in all daily activities, including school, exercise, and recreation.
• Sleep through the night undisturbed by asthma symptoms.

Medicines

Most medicines for asthma are inhaled. These types of medicines go straight to your child's airways, where the problem is.

The main medicines used to treat asthma include:

Controller medicines.

These medicines prevent asthma attacks, help stop problems before they happen, and reduce inflammation in your child’s lungs. These things help control your child’s asthma.

Inhaled corticosteroids are the preferred controller medicines. The controller inhaler may also include a long-acting medicine that relaxes the airways to help your child breathe. Your child takes them every day.

Quick-relief medicines.

These medicines are used when symptoms can't be prevented and need to be treated fast. Talk to your doctor if your child needs their quick-relief medicine more than 2 days a week within a month.

They help relax the airways and allow your child to breathe easier. Albuterol is a quick-relief medicine that is often used. In some cases, a certain type of controller inhaler is used as a quick-relief medicine. Ask your child's doctor what to use for quick relief.

Oral or injected corticosteroids.

These medicines are often used to treat asthma attacks.

Other medicines may be given in some cases.

Your child needs to have regular checkups to keep asthma under control and to ensure the right treatment. How often your child needs checkups depends on how well the asthma is controlled.

Self-care

Treatment also includes things you can help your child do to manage asthma, like avoiding things that might trigger symptoms and following an asthma action plan.

Other treatments

Other treatments may be used to treat asthma. They include:

Counseling.

In addition to taking medicines, counseling may be helpful for children who have asthma. Therapy can help to improve anxiety triggers and learn how to manage stress.

Complementary medicine.

Complementary medicine is a term used for a wide variety of health care practices that may be used along with standard medical treatment.

While most mind and body practices such as breathing exercises and yoga seem to be safe when used in the right way, be sure to check with your child's doctor first. Talk about any complementary health practice that you would like your child to try or that your child is already using. Your doctor can help you manage your child's health better if they have the whole picture about your child's health.

Immunotherapy.

If your child has asthma symptoms that are triggered by allergens, the doctor may recommend immunotherapy. For this treatment, your child gets shots that have a small amount of certain allergens in them. Your child's body "gets used to" the allergen, so your child reacts less to it over time. This kind of treatment may help prevent or reduce some allergy symptoms.

Allergy shots have been shown to reduce asthma symptoms and the need for medicines in some people. But allergy shots don't work equally well for all allergens. These shots should not be given when asthma is not well-controlled.

To find out if your child has asthma, your doctor will do a physical exam and ask about your child's symptoms. The doctor may also have your child do breathing (lung function) tests. These tests find out how well your child's lungs work.

Diagnosing asthma in babies and toddlers is often very hard. Symptoms may be the same as those of other diseases, such as infection with respiratory syncytial virus (RSV) or inflammation of the lungs (pneumonia), sinuses (sinusitis), and small airways (bronchiolitis). If you have a very young child, a test such as spirometry isn't practical. So the diagnosis is made based on your report of symptoms.

Breathing (lung function) tests

In an older child, lung function tests can help the doctor diagnose asthma, see how bad it is, and check for problems. The tests include:

Spirometry.

Doctors use this test to diagnose and keep track of asthma in children age 5 and older. It measures how quickly your child can move air in and out of the lungs and how much air is moved. Spirometry is not used with babies and small children. In those cases, the doctor usually will listen for wheezing and will ask how often the child wheezes or coughs.

Peak expiratory flow.

This test shows how much air your child can quickly breathe out using the greatest effort. Testing of daytime changes in your child's peak flow may be done over 1 to 2 weeks. This test may help when your child has symptoms now and then but the spirometry test results are normal.

An exercise or inhalation challenge.

This test measures how well your child can breathe in and out after exercise or after taking a medicine. It may be used if the spirometry test results have been normal or near normal but asthma is still suspected. An inhalation challenge also may be done using a specific irritant or allergen.

Tests for other diseases

Asthma can be hard to diagnose because the symptoms vary widely from child to child and within each child over time. And asthma-like symptoms can also be caused by other conditions, such as the flu or other viral lung infections. So your doctor may want to do other tests.

Tests that may be done to find out if diseases other than asthma are causing your child's symptoms include:

A chest X-ray.

This may be used to look for signs of other lung diseases.

A sweat test.

This measures the amount of salt in sweat. This test may be used to see if cystic fibrosis is causing symptoms.

Bronchoscopy.

This test can be done to examine the airways for problems such as tumors or foreign objects, which can create symptoms that mimic those of asthma. This test uses a long, thin, lighted tube to look at your child's airways.

Other tests may be done to see if your child has health problems such as sinusitis, nasal polyps, or gastroesophageal reflux disease.

If your doctor thinks your child's symptoms may be caused by allergies, the doctor may order allergy tests.

Health professionals who can diagnose and treat asthma include:

• Pediatricians.
• Family medicine physicians.
• Nurse practitioners.
• Physician assistants.
• Internists.

Your child may need to see a specialist (an allergist or pulmonologist) if your child:

• Has moderate persistent to severe persistent asthma.
• Has other health conditions that make it hard to treat asthma.
• Is not meeting the goals of treatment after several months of therapy.
• Has had a severe asthma attack.
• Needs skin testing for allergies.

There are things you can help your child do to manage asthma.

Taking asthma medicines as prescribed.

Make sure that your child:

• Takes controller medicine to treat inflammation every day, not just when your child has symptoms.
• Uses quick-relief medicine during an asthma attack.
• Learns how to use inhalers the right way. Ask your doctor or pharmacist for help.

Finding ways to avoid triggers.

Help your child to:

• Avoid triggers like cigarette smoke, air pollution, dust mites, pollen, pet dander, cockroaches, and cold, dry air.
• Avoid infections such as COVID-19, colds, and the flu. Remind your child to wash their hands often. Make sure your child gets the flu vaccine and stays up to date on their COVID-19 vaccines.

Following an asthma action plan.

This is a written plan that will help your child manage asthma every day and know what to do during an asthma attack. If your child doesn't have an action plan, work with your doctor to make one.

Your child may be more likely to have asthma if:

Someone in your family has asthma.

Asthma may run in families (be inherited). If this is the case in your family, your child may be more likely than other children to get long-lasting (chronic) inflammation in the airways.

Your child or someone in your family has an allergy, including food allergies.

Children who have an allergy are more likely than other children to get asthma, though not every child with allergies gets asthma. And not every child with asthma has allergies.

Most children with asthma have allergic rhinitis, atopic dermatitis, or both. Having atopic dermatitis as a child may also increase the risk of a person having more severe and persistent asthma as an adult.

Your child had respiratory syncytial virus (RSV) and wheezing at a young age.

Early infection with respiratory syncytial virus that causes a lower respiratory infection increases a child's risk for wheezing. Young children who wheeze have a greater risk for asthma than children who do not wheeze.

Your child’s airways overreact.

Children who inherit a tendency of the airways (bronchial tubes) to overreact often get asthma.

Other risk factors

Other things that may put your child at risk for asthma include:

Secondhand cigarette smoke.

Children who are around secondhand cigarette smoke are at increased risk for getting asthma. If children already have asthma, secondhand smoke makes their symptoms worse.

Cigarette smoking.

Children who smoke are more likely to get asthma when they become teenagers.

Cigarette smoking during pregnancy.

Women who smoke during pregnancy increase the risk of wheezing in their babies. Babies whose mothers smoked during pregnancy also have worse lung function than babies whose mothers did not smoke.

Obesity.

There is a link between obesity in children and asthma. But the reason for the link is unclear. Also, symptoms caused by obesity are sometimes thought to be asthma symptoms.

Exposure to allergens.

Being exposed to allergens such as dust mites, cockroaches, and pet dander may increase a child’s risk for asthma.

Environment.

Environmental factors, such as pollution or dust, may play a role in the development of asthma. Exposure to these things may cause children's immune systems to develop in a way that makes it more likely they will develop allergies or asthma.

Educating yourself and your family about asthma is essential for you and your child to have control of the disease. If you understand asthma, you will have an easier time following the different aspects of treatment, such as avoiding substances that cause symptoms (triggers) and knowing what to do during an asthma attack.

Educate yourself or your child about:

Asthma.

Learn all that you can from your doctor about asthma, such as the long-term effects of not treating asthma and the best ways for you or your child to manage the disease.

Medicines.

Learn all that you can about how each of your medicines or your child's medicines helps to treat asthma. Find out about side effects that may occur and what to do if side effects become bothersome.

Part of education is effectively communicating what you don't understand and what you are concerned about.

• Always ask questions when you don't understand something about the treatment.
• Discuss any fears and concerns that you or your child may have regarding treatment.
• Tell your doctor if treatment is disrupting your life; you may be able to find another way to treat your asthma with less disruption.
• Tell your doctor if treatment is not helping asthma attacks.
• Tell your doctor if you are not able to follow any aspect of your treatment.

If your child has asthma, you may want to talk with teachers and other school officials about asthma. They can help your child follow his or her treatment plans. You should have a copy of your child's asthma action plan (which tells what to do during an asthma attack) on file in the school office, with the school nurse, and with sports coaches so that school staff will know what to do if your child has an attack at school.

Asthma attacks happen due to:

• Long-term (chronic) inflammation in the tubes that carry air to the lungs (bronchial tubes). Inflammation leads to overreaction (hyperresponsiveness) of the tubes to triggers.
• Tightening of the smooth muscles in the bronchial tubes, causing the airways to get smaller. This reduces airflow in and out of the lungs.
• Extra mucus produced by the mucous glands in the bronchial tubes. This can occur in some children who have asthma and can interfere with airflow.

Anything that makes your child's asthma or breathing worse can cause an asthma attack.

It may be things that your child is allergic to, such as:

• Pollen.
• Dust or dust mites.
• Pet dander.
• Cockroaches.
• Mold.

Other things can cause an asthma attack too, such as:

• Cigarette smoke, air pollution, and chemicals.
• A cold, the flu, or another type of upper respiratory infection.
• Exercise. Many children with asthma have symptoms when they exercise.
• Dry, cold air.
• Medicines, such as nonsteroidal anti-inflammatory drugs.
• Changes in hormones, such as during the start of a girl's menstrual blood flow at puberty.

Asthma is a challenging condition. It can affect all areas of your child's life.

• Many children who have asthma miss school days. When this happens, have your child call a friend to ask about the work that was missed. Doing this both helps your child keep up with schoolwork and gives some of the social contact that school provides.
• Children may doubt their ability to do sports or be in the band. But if your child uses the medicines and keeps asthma symptoms under control, they will likely be able to do these activities.
• Children may be embarrassed about taking medicine at school. It may help if your child can take the medicine at home or is allowed to keep the medicine with them at school. At times, though, your child may need to go to the school nurse or office to take medicine.
• Children may feel they are different from their peers because of the need to avoid situations that trigger asthma symptoms, such as going to the homes of friends who have pets. Inviting those friends to your home can help your child interact with other children. But visitors may carry pet allergens on their clothing and other items. Be aware that your child may need to increase the use of asthma-control medicines during such visits.
• Children may be concerned about having an asthma attack at school or around friends. They may fear that they will not be able to breathe during an attack. If symptoms are controlled daily, children will have fewer, less severe asthma attacks.

If your child's asthma is causing you or your child anxiety, there are things that can help with that, like counseling or family therapy.

Asthma is a lung disease that makes it hard for your child to breathe. It causes the airways that lead to the lungs to swell and get inflamed.

Some children have breathing problems only at certain times, like during allergy season, or when they get a cold, or when they exercise. Others have breathing problems a lot of the time.

When asthma symptoms suddenly get worse (or flare up), the airways tighten and get narrower. These flare-ups are also called asthma attacks or exacerbations (say "ig-ZAS-ur-BAY-shuns").

Treatment can help your child feel and breathe better and help keep your child's lungs healthy. Many children with asthma play sports and live healthy, active lives.

Experts don't know exactly what causes asthma in children. But we do know that asthma runs in families. And it's much more common in children who have allergies.