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Asthma in children

Pediatric asthma; Asthma - pediatric; Wheezing - asthma - children

Asthma is a disease that causes the airways to swell and get narrow. It leads to wheezing, shortness of breath, chest tightness, and coughing.

Causes

Asthma is caused by swelling (inflammation) in the airways. During an asthma attack, the muscles surrounding the airways tighten. The lining of the air passages swells. As a result, less air is able to pass through.

Asthma is often seen in children. It is a leading cause of missed school days and hospital visits for children. An allergic reaction is a key part of asthma in children. Asthma and allergies often occur together.

In children who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens, or triggers.

Common asthma triggers include:

  • Animals (hair or dander)
  • Dust, mold, and pollen
  • Aspirin and other medicines
  • Changes in weather (most often cold weather)
  • Chemicals in the air or in food
  • Tobacco smoke
  • Exercise
  • Strong emotions
  • Viral infections, such as the common cold

Symptoms

Breathing problems are common. They can include:

  • Shortness of breath
  • Feeling out of breath
  • Gasping for air
  • Trouble breathing out (exhaling)
  • Breathing faster than normal

When the child is having a hard time breathing, the skin of the chest and neck may suck inward.

Other symptoms of asthma in children include:

  • Coughing that sometimes wakes the child up at night (it may be the only symptom).
  • Dark bags under the eyes.
  • Feeling tired.
  • Irritability.
  • Tightness in the chest.
  • A whistling sound made when breathing (wheezing). You may notice it more when the child breathes out.

Your child's asthma symptoms may vary. Symptoms may appear often or develop only when triggers are present. Some children are more likely to have asthma symptoms at night.

Exams and Tests

The health care provider will use a stethoscope to listen to the child's lungs. The provider may be able to hear asthma sounds. However, lung sounds are often normal when the child is not having an asthma attack.

The provider will have the child breathe into a device called a peak flow meter. Peak flow meters can tell how well the child can blow air out of the lungs. If the airways are narrow due to asthma, peak flow values drop.

You and your child will learn to measure peak flow at home.

Your child's provider may order the following tests:

Treatment

You and your child's providers should work together as a team to create and carry out an asthma action plan.

This plan will tell you how to:

  • Avoid asthma triggers
  • Monitor symptoms
  • Measure peak flow
  • Take medicines

The plan should also tell you when to call the provider. It is important to know what questions to ask your child's provider.

Children with asthma need a lot of support at school.

  • Give the school staff your asthma action plan so they know how to take care of your child's asthma.
  • Find out how to let your child take medicine during school hours. (You may need to sign a consent form.)
  • Having asthma does not mean your child cannot exercise. Coaches, gym teachers, and your child should know what to do if your child has asthma symptoms caused by exercise.

ASTHMA MEDICINES

There are two basic kinds of medicine used to treat asthma.

Long-term control drugs are taken every day to prevent asthma symptoms. Your child should take these medicines even if no symptoms are present. Some children may need more than one long-term control medicine.

Types of long-term control medicines include:

  • Inhaled steroids (these are usually the first choice of treatment)
  • Long-acting bronchodilators (these are almost always used with inhaled steroids)
  • Leukotriene inhibitors
  • Cromolyn sodium

Quick relief or rescue asthma drugs work fast to control asthma symptoms. Children take them when they are coughing, wheezing, having trouble breathing, or having an asthma attack.

Some of your child's asthma medicines can be taken using an inhaler.

  • Children who use an inhaler should use a spacer device. This helps them get the medicine into the lungs properly.
  • If your child uses the inhaler the wrong way, less medicine gets into the lungs. Have your provider show your child how to correctly use an inhaler.
  • Younger children can use a nebulizer instead of an inhaler to take their medicine. A nebulizer turns asthma medicine into a mist.

GETTING RID OF TRIGGERS

It is important to know your child's asthma triggers. Avoiding them is the first step toward helping your child feel better.

Keep pets outdoor, or at least away from the child's bedroom.

No one should smoke in a house or around a child with asthma.

  • Getting rid of tobacco smoke in the home is the single most important thing a family can do to help a child with asthma.
  • Smoking outside the house is not enough. Family members and visitors who smoke carry the smoke inside on their clothes and hair. This can trigger asthma symptoms.
  • DO NOT use indoor fireplaces.

Keep the house clean. Keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches, which can trigger asthma attacks. Cleaning products in the home should be unscented.

MONITOR YOUR CHILD'S ASTHMA

Checking peak flow is one of the best ways to control asthma. It can help you keep your child's asthma from getting worse. Asthma attacks usually DO NOT happen without warning.

Children under age 5 may not be able to use a peak flow meter well enough for it to be helpful. However, a child should start using the peak flow meter at a young age to get used to it. An adult should always watch for a child's asthma symptoms.

What's an Asthma Management Plan?

  • What should be in an asthma management plan?

     

    A. What medicines you take and when

     

    B. A list of your asthma triggers and how to avoid them

     

    C. How to tell when your asthma is getting worse

     

    D. When to call your doctor or go to the emergency room

     

    E. All of the above

    Correct Answer
    The correct answer is all of the above. An asthma management plan –also called an asthma action plan – is a written document that helps you control your asthma over the long term and in emergencies. You and your doctor can work together to create your own personal plan.
  • Everyone with asthma, including children, should have an asthma action plan.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Asthma action plans are an important tool to help people of all ages manage asthma.
  • Your child with asthma needs support at school. You can help by:

     

    A. Making sure school staff have the child's asthma action plan

     

    B. Making sure your child has a place to go to get away from asthma triggers

     

    C. Making sure the staff know and can treat asthma symptoms caused by exercise

     

    D. Making sure your child is allowed to use his or her asthma medicines at school

     

    E. Not allowing your child to play with other children

     

    F. A, B, C and D

    Correct Answer
    The correct answers are A, B, C and D. Your child's teachers, coaches, the school nurse and the school office staff are all key members of your support team. Work with them so they can help your child manage asthma symptoms.
  • The green zone on your asthma management plan means you are:

     

    A. Allergic to grass

     

    B. Doing well

     

    C. Feeling ill

    Correct Answer
    The correct answer is doing well. The green zone is your happy place when it comes to asthma. You're not coughing or wheezing, and you can do your regular activities. Your long-term control medicines are managing your asthma.
  • Your asthma has gotten worse. Your asthma action plan says you're now in:

     

    A. The yellow zone

     

    B. The black zone

     

    C. The Twilight Zone

    Correct Answer
    The correct answer is the yellow zone. Yellow-zone symptoms include coughing, wheezing, chest tightness and shortness of breath. Your asthma action plan tells you which quick-relief medicine to take and how much – and what to do if you don't go back to the green zone.
  • Which of these is a sign you're in the red zone?

     

    A. Your quick-relief medicines aren't helping.

     

    B. You have severe shortness of breath.

     

    C. After 24 hours in the yellow zone, your symptoms are the same or worse.

     

    D. All of the above

    Correct Answer
    The correct answer is all of the above. Get help right away if you are in the red zone of your asthma action plan. Take the medicines in your plan and call your doctor. Call 911 if you are still in the red zone after 15 minutes and you can't reach your doctor.
  • A big part of managing asthma is staying away from your asthma triggers.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Things that make asthma worse are called triggers. Common triggers are dust, mold, pollen, and smoke. You will need to learn how to avoid your asthma triggers. Write down your triggers and talk with your doctor if you need more ideas for coping.
  • If you think your asthma action plan isn't working, you should:

     

    A. Give it more time

     

    B. Tell your doctor right away

     

    C. Use someone else's

    Correct Answer
    The correct answer is tell your doctor right away. Asthma can be managed, but it can change over time. Your doctor may need to adjust your asthma action plan. Tracking your symptoms and using a peak flow meter can help you and your doctor address problems early.
  • To control your asthma, you can't be physically active.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Exercise can trigger asthma in some people, but that doesn't mean you should give it up. Everyone needs physical activity for good health. Talk with your doctor about how you can stay active while managing your asthma.
  • Most people with asthma can manage their symptoms by following their asthma action plans and:

     

    A. Having regular asthma checkups

     

    B. Never leaving home without a mask

     

    C. Avoiding crowds

    Correct Answer
    The correct answer is having regular asthma checkups. There is no cure for asthma. But working with your doctor can help you avoid problems, take good care of yourself, and live a full and active life.

Outlook (Prognosis)

With proper treatment, most children with asthma can live a normal life. When asthma is not well controlled, it can lead to missed school, problems playing sports, missed work for parents, and many visits to the provider's office and emergency room.

Asthma symptoms often lessen or go away completely as the child gets older. Asthma that is not well controlled can lead to lasting lung problems.

In rare cases, asthma is a life-threatening disease. Families need to work closely with their providers to develop a plan to care for a child with asthma.

When to Contact a Medical Professional

Call your child's provider if you think your child has new symptoms of asthma. If your child has been diagnosed with asthma, call the provider:

  • After an emergency room visit
  • When peak flow numbers have been getting lower
  • When symptoms get more frequent and more severe, even though your child is following the asthma action plan

If your child is having trouble breathing or having an asthma attack, get medical help right away.

Emergency symptoms include:

  • Difficulty breathing
  • Bluish color to the lips and face
  • Severe anxiety due to shortness of breath
  • Rapid pulse
  • Sweating
  • Decreased level of alertness, such as severe drowsiness or confusion

A child who is having a severe asthma attack may need to stay in the hospital and get oxygen and medicines through a vein (intravenous line or IV).

References

Dunn NA, Neff LA, Maurer DM. A stepwise approach to pediatric asthma. J Fam Pract. 2017;66(5):280-286. PMID: 28459888 www.ncbi.nlm.nih.gov/pubmed/28459888.

Jackson DJ, Lemanske RF, Guilbert TW. Management of asthma in infants and children. In: Adkinson NF, Bochner BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 53.

Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 42.

US Department of Health and Human Services; National Heart, Lung, and Blood Instutite website. Guidelines for the diagnosis and management of asthma (EPR-3). www.nhlbi.nih.gov/sites/default/files/media/docs/asthgdln_1.pdf. Updated April 2012. Accessed June 21, 2018.

  • Asthma - children

    Animation

  •  

    Asthma - children - Animation

    Did you know that asthma is one of the most common disorders affecting children, as many as 10 percent of them? Thankfully, advances in the diagnosis and treatment of asthma have dramatically improved life for these children. Asthma is caused by swelling and other signs of inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by the bronchioles, or small tubes, of the lung. Most asthma attacks are caused by triggers, such as pollen, dust mites, mold, pet dander, cockroaches, tobacco smoke, and exercise. Your child may have asthma if they experience shortness of breath, maybe gasp for air, and have trouble breathing out. When breathing gets very difficult, the skin of your child's chest and neck may suck inward. Your child may cough so hard at night he wakes from sleeping. He may have dark bags under his eyes and feel tired and irritable. Your child's doctor will listen to your child's lungs. The doctor will have your child breathe into a device called a peak flow meter. This device can tell you and your child's doctor how well the child can blow air out of his lungs. If asthma is narrowing and blocking your child's airways, his peak flow values will be low. To treat your child with asthma, you will need to work with your child's pediatrician, pulmonologist, or allergist as a team. Your child will need an action plan that outlines his asthma triggers and how to avoid them, how to monitor his symptoms, measuring peak flow, and taking medicines. You should have an emergency plan that outlines what to do when your child's asthma flares up, at home and in school. Make sure the school has a copy of your child's asthma action plan too. Your child will probably need to take two kinds of medicines, long-term control medicines and quick relief or rescue medicines. Your child will take long-term control medicines every day to prevent asthma symptoms, even when he has none. Your child will need to use quick relief medicines during an asthma attack. If your child needs to use an inhaler with his medicines, make sure the doctor shows him how to use a spacer device, to get the medicine into his lungs properly. Today, most children with properly managed asthma can lead a life unhindered by their disease. It shouldn't hold them back from even the highest levels of athletic competition. With proper education and medical management, it is possible to control this disease on a daily basis and prevent asthma attacks.

  • Normal versus asthmatic bronchiole

    Normal versus asthmatic bronchiole - illustration

    During an asthma attack smooth muscles located in the bronchioles of the lung constrict and decrease the flow of air in the airways. The amount of air flow can further be decreased by inflammation or excess mucus secretion.

    Normal versus asthmatic bronchiole

    illustration

  • Peak flow meter

    Peak flow meter - illustration

    A peak flow meter is commonly used by a person with asthma to measue the amount of air that can be expelled from the lungs. If the airways become narrow or blocked due to asthma, peak flow values will drop because the person cannot blow air out of the lungs as well. A peak flow meter can be a useful aid in monitoring a person's asthma over time and can also be used to help determine how well a patient's medications are working.

    Peak flow meter

    illustration

  • Lungs

    Lungs - illustration

    The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

    Lungs

    illustration

  • Common asthma triggers

    Common asthma triggers - illustration

    Many of the same substances that trigger allergies can also trigger asthma. Common allergens include pollen, dust mites, mold and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Asthma symptoms can be substantially reduced by avoiding exposure to known allergens and respiratory irritants.

    Common asthma triggers

    illustration

  • Asthma - children

    Animation

  •  

    Asthma - children - Animation

    Did you know that asthma is one of the most common disorders affecting children, as many as 10 percent of them? Thankfully, advances in the diagnosis and treatment of asthma have dramatically improved life for these children. Asthma is caused by swelling and other signs of inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by the bronchioles, or small tubes, of the lung. Most asthma attacks are caused by triggers, such as pollen, dust mites, mold, pet dander, cockroaches, tobacco smoke, and exercise. Your child may have asthma if they experience shortness of breath, maybe gasp for air, and have trouble breathing out. When breathing gets very difficult, the skin of your child's chest and neck may suck inward. Your child may cough so hard at night he wakes from sleeping. He may have dark bags under his eyes and feel tired and irritable. Your child's doctor will listen to your child's lungs. The doctor will have your child breathe into a device called a peak flow meter. This device can tell you and your child's doctor how well the child can blow air out of his lungs. If asthma is narrowing and blocking your child's airways, his peak flow values will be low. To treat your child with asthma, you will need to work with your child's pediatrician, pulmonologist, or allergist as a team. Your child will need an action plan that outlines his asthma triggers and how to avoid them, how to monitor his symptoms, measuring peak flow, and taking medicines. You should have an emergency plan that outlines what to do when your child's asthma flares up, at home and in school. Make sure the school has a copy of your child's asthma action plan too. Your child will probably need to take two kinds of medicines, long-term control medicines and quick relief or rescue medicines. Your child will take long-term control medicines every day to prevent asthma symptoms, even when he has none. Your child will need to use quick relief medicines during an asthma attack. If your child needs to use an inhaler with his medicines, make sure the doctor shows him how to use a spacer device, to get the medicine into his lungs properly. Today, most children with properly managed asthma can lead a life unhindered by their disease. It shouldn't hold them back from even the highest levels of athletic competition. With proper education and medical management, it is possible to control this disease on a daily basis and prevent asthma attacks.

  • Normal versus asthmatic bronchiole

    Normal versus asthmatic bronchiole - illustration

    During an asthma attack smooth muscles located in the bronchioles of the lung constrict and decrease the flow of air in the airways. The amount of air flow can further be decreased by inflammation or excess mucus secretion.

    Normal versus asthmatic bronchiole

    illustration

  • Peak flow meter

    Peak flow meter - illustration

    A peak flow meter is commonly used by a person with asthma to measue the amount of air that can be expelled from the lungs. If the airways become narrow or blocked due to asthma, peak flow values will drop because the person cannot blow air out of the lungs as well. A peak flow meter can be a useful aid in monitoring a person's asthma over time and can also be used to help determine how well a patient's medications are working.

    Peak flow meter

    illustration

  • Lungs

    Lungs - illustration

    The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

    Lungs

    illustration

  • Common asthma triggers

    Common asthma triggers - illustration

    Many of the same substances that trigger allergies can also trigger asthma. Common allergens include pollen, dust mites, mold and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Asthma symptoms can be substantially reduced by avoiding exposure to known allergens and respiratory irritants.

    Common asthma triggers

    illustration

A Closer Look

 

Talking to your MD

 

Self Care

 

 

Review Date: 5/20/2018

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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