Childhood Asthma

What is Childhood Asthma?

Childhood asthma has become more prevalent over the last few decades. Approximately 1 out of every 10 children have asthma. It is the most common chronic illness in childhood.

Childhood asthma and adult asthma share many similarities.

What is Asthma?

Asthma occurs when the airways in the lungs become inflamed (swollen) and constrict (become smaller). The cells in the lungs produce extra mucus which also makes the airways smaller.  This makes breathing more difficult because there is less room for air to flow in and out.  Asthma is a chronic but treatable condition.  There is no cure but with proper treatment your child can enjoy normal activities with few disruptions.

Signs and Symptoms of Childhood Asthma

The most common symptoms or childhood asthma are coughing, wheezing (some children never wheeze), shortness of breath, chest congestion and chest tightness.  Infants may have a loose cough or have recurrent bouts of croup, bronchiolitis or pneumonia.  These symptoms can range from mild to severe and they can come and go.  In between episodes, your child may feel normal and have no difficulty breathing. For instance, children under the age of four may only wheeze when they are ill with a respiratory infection.

Triggers for Childhood Asthma

Many things in the environment can cause an asthma attack.  Every child has unique triggers for his or her asthma.  The most common triggers include:

  • Cigarette smoke
  • Viral infections in the upper or lower airways, including the common cold and sinus infections
  • Exercise
  • Perfumes and other strong smells
  • Cold air
  • Air pollution
  • Weather changes
  • Allergens, such as pollens, animal dander, molds, cockroaches and dust mites
  • Strong emotions and stress
  • Gastroesophageal reflux disease (GERD), a condition in which stomach acid backs up into the esophagus.

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Risk Factors for Asthma

Asthma is a common reason for missing school.  Before puberty, asthma is more common in females but after puberty, it is more common in males.  Children with a family history of asthma, hay fever, hives or eczema are at greater risk of developing the disease.  There are also environmental factors that play a role including:

  • Living in a large city which may increase your child’s exposure to air pollution
  • Exposure to cigarette smoke
  • Previous allergic reactions (i.e. stuffy nose or skin rash) to environmental allergens
  • Low birth weight or prematurity
  • Obesity
  • History of Gastroesophageal reflux disease (GERD)
  • History of respiratory infections in childhood, including RSV (Respiratory Syncytial Virus)


When to Seek Medical Advice for Childhood Asthma

Every day your child should be able to:

  • Run, play, jump and be active inside and outside
  • Sleep without coughing or having trouble breathing

If your child cannot play and sleep every day, it is time to seek further help.  Other red flags may include:

  • Coughing that’s constant, intermittent or worse with exercise
  • Wheezing (or whistling sound) when your child breathes out
  • Shortness of breath or fast breathing that may or may not be worse with exercise
  • Complaints of chest tightness
  • Repeated respiratory infections such as pneumonia or bronchitis

Older children may say things like “My chest feels funny” or “I’m always coughing”.  Asthma is often worse at night, so listen for coughing during sleep.  You may also notice that your child coughs and/or wheezes when he or she is crying or laughing really hard.

Seek emergency care if your child has any trouble breathing such as:

  • Breathing so hard that they can’t speak a sentence without stopping and catching their breath.
  • Chest, ribs, or belly pulling in as he or she struggles to breathe. The child’s head may be bobbing up and down as well.
  • Widening the nostrils when breathing in
  • Pale, grey color around lips

Screening and Diagnosis of Childhood Asthma

If your child is younger than 5 years old, your healthcare provider may diagnose or rule out asthma based on the symptoms that you describe.  They will ask for a detailed history of the child’s symptoms and they will want to know if there is a family history of asthma, hay fever or eczema. It is difficult to diagnose asthma in infants and toddlers.  Approximately 80% of infants and toddlers outgrow asthma-like symptoms especially if they only wheeze or cough when they are ill with a viral respiratory infection.

In children over the age of 5, doctors use the same tests that they use with adults to help determine if the child has asthma. These test include:

  • Pulmonary Function Testing (Spirometry): This breathing test measures the amount of air exhaled and how fast that air can be exhaled.  Asthmatics often have difficulty blowing out air quickly due to the inflammation in their lungs.  This test may be performed twice during your child’s visit.  The first test will measure their baseline.  Then your child may be given albuterol (which is an inhaled medication that relaxes the airways). The spirometry will be repeated and if there is a significant increase in how quickly your child can exhale, then a diagnosis of asthma may be made.
  • FeNO (Fractional Exhaled Nitric Oxide): This breathing test will help measure how much inflammation is in your child’s lungs.  Children with allergic asthma tend to have more inflammation in their lungs and if so, this measurement will be higher than normal


Treatment for childhood asthma

Children who have uncontrolled asthma may develop permanent scarring in their lungs which could lead to an inability to recover from respiratory infections as they get older. The scarring in their lungs can cause them to have daily coughing, shortness of breath and wheezing despite taking asthma medications.  Therefore, it is extremely important to get asthma under control.  Your child’s asthma is well controlled when:

  • They can run and play as hard as they want
  • They don’t miss school or activities
  • You can’t remember the last time you had to take them to the Emergency Room or an Urgent Care because they couldn’t breathe well
  • They don’t have asthma symptoms (cough, wheeze or shortness of breath) more than 2 days a week
  • They don’t need Albuterol (rescue medication) more than 2 times a week to relieve symptoms
  • They don’t wake up coughing at night more than 2 nights a month
  • They don’t go through more than 2 Albuterol inhalers every year

There are two main types of asthma medications and they are often used together:

  • Long-term-control medications: These are used on a daily basis to control symptoms and prevent future attacks
  • Quick-relief or rescue medications: Your child can use these medications as needed for rapid relief of symptoms during an asthma attack


Long-term-control medications for Childhood Asthma

These medications are taken every day.  They will help to prevent future attacks from occurring. It is very important for your child to not skip doses of these medications and keep in mind that it usually takes up to two weeks from starting these medications to recognize any relief of symptoms.

Inhaled Corticosteroids: These medications help to reduce inflammation (swelling) inside the airways.  They are the most effective medications for asthma. They are completely different from anabolic steroids, which some athletes abuse. There is a low risk of side effects with inhaled corticosteroids, although studies have shown that some children who are on a high dosage of inhaled corticosteroids may grow up to be about ½ inch shorter than they would have been otherwise.  More commonly, growth velocity can slow down but then they catch up later and achieve the same adult height as they would have without steroids. Another more common side effect is thrush (rash in mouth) which can be prevented by having your child rinse his mouth out after using their inhaled corticosteroid.  When used as directed, inhaled corticosteroids can minimize your child’s need for oral steroids, which have a higher risk of side effects.  Examples of inhaled corticosteroids include Flovent, QVAR, Arnuity, Alvesco, Asmanex, Pulmicort and Aerospan.

There are also inhaled corticosteroids that are combined with a long acting albuterol which serves the dual function of reducing inflammation and relaxing the muscles around the airways. Examples of these combination drugs include Advair, Symbicort and Dulera.

Your child’s doctor may recommend using a spacer which can help deposit the particles of the inhaled corticosteroid in the airways.

Leukotriene Modifiers: These drugs reduce the production or block the action of leukotrienes.  Leukotrienes are released by cells in your lungs during an asthma attack.  Leukotrienes cause the linings of your airways to become inflamed, which in turn leads to wheezing, shortness of breath and mucous production.  Leukotriene modifiers can be used with inhaled corticosteroids to help prevent asthma attacks.  Examples of leukotriene modifiers include Singulair (montelukast).


Quick-relief medications

These medications are often called “rescue” medications because they can quickly stop the symptoms of an asthma attack.  These medications are taken as needed when your child first begins to feel symptoms of asthma including coughing, wheezing, chest tightness and difficulty breathing.

Bronchodilators: Albuterol and Xopenex are quick relief medications that relax the muscles around the airways.  They are inhaled into the airways directly and should relieve symptoms within 15-20 minutes.  If your child has asthma symptoms that get worse with exercise, try using albuterol or Xopenex fifteen minutes prior to exercise to help prevent symptoms.


The best way to prevent asthma attacks is to identify and avoid indoor and outdoor allergens and irritants.  The following section includes strategies that may help to prevent your child from having issues with their asthma.


Smoke: Ban smoking around your child.  If you smoke, contact 1-800-QUIT-NOW for resources if you are ready to quit.  If not, never smoke in the home or in your car and wear a “smoking jacket” when you smoke outside.  Make sure this jacket covers your hair and always leave this jacket outside. Avoid using a wood burning stove and avoid campfires

Air Pollution: Have your child stay indoors when the pollution count is high

Strong Smells: Use unscented household cleaning products and protect your child from strong smells found in air fresheners, perfumes, cologne, room sprays or hair sprays

Illness: Avoid people who are sick.  Have your child get the flu vaccine every fall. Teach your child to wash their hands several times a day and practice doing this yourself.


Pollen and Outdoor Mold: Keep your windows closed during allergy season and use central air conditioning or fans when available. Mow the lawn frequently to limit the amount of pollen released. Have your child shower and change their clothes after playing outside during high-pollen season. Talk to your medical provider about medications that your child can take to relieve allergy symptoms.

Indoor Mold: Keep bathrooms and kitchens well ventilated and clean. Use a bleach solution (1 part bleach to 10 parts water) to clean mold. Reduce indoor humidity to less than 50% and fix all water leaks and remove standing water.  Have heating, ventilation and air conditioning systems cleaned and serviced regularly.

House Dust: Consider using a HEPA filter and remove drapes and blinds when possible.  Bare floors are best; if you have carpet, vacuum frequently.  Wrap your child’s mattress and box spring with allergen proof coverings and wash stuffed toys and bedding in hot water (130 degrees) weekly.  Forced air furnaces should have a dust filter installed. Replace the filters every 2 weeks during heating season.

Animals: All furry or feathered animals have the potential to cause allergic reactions. If you have pets, make sure to keep them out of your child’s bedroom and if possible, keep them outdoors.  Make sure your child washes their hands and face after playing with the pet.  Brush the pet daily and give them a bath weekly.  If your child’s asthma is not well controlled, consider relocating the pet.

Cockroach: Avoid leaving food and garbage out and use insect spray as needed.

Bottom line is to have your child skin tested to find out what allergic triggers are present.

Other Triggers

Exercise:  Some children use albuterol before activity. Discuss this therapy with your doctor before starting. If appropriate, give your child 2 puffs of Albuterol (or Xopenex) 10-15 minutes before exercise

Coping Skills for childhood asthma

It can be stressful to manage your child’s asthma.  Keep these tips in mind to make life as normal as possible:

  • Don’t limit your child’s activity out of fear of an attack. Work with your child’s doctor to help get your child’s asthma under control.
  • If your child needs to take a daily medication, make this a part of their daily routine such as eating breakfast or brushing their teeth.
  • Be calm and in control when facing asthma symptoms. Know the steps to take and communicate clearly with your child.

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