What is childhood asthma?
In childhood asthma, the lungs and airways become easily inflamed when exposed to certain triggers, such as inhaling airborne pollen or catching a cold or another respiratory infection. Childhood asthma can cause bothersome daily symptoms that interfere with play, sports, school and sleep. In some children, unmanaged asthma can cause dangerous asthma attacks.
Childhood asthma isn’t a different disease from asthma in adults, but children do face unique challenges. Asthma in children is a leading cause of emergency department visits, hospitalizations and missed school days. Unfortunately, childhood asthma can’t be cured, and symptoms may continue into adulthood. But with the right treatment, you and your child can keep symptoms under control and prevent damage to growing lungs.
How common is childhood asthma?
Asthma is the leading cause of chronic illness in children. Asthma can begin at any age (even in the very elderly), but most children have their first symptoms by age 5. Please discuss with your doctor for further information.
What are the symptoms of childhood asthma?
The common symptoms of childhood asthma are:
- Frequent, intermittent coughing
- A whistling or wheezing sound when exhaling
- Shortness of breath
- Chest congestion or tightness
- Chest pain, particularly in younger children
- Trouble sleeping caused by shortness of breath, coughing or wheezing
- Bouts of coughing or wheezing that get worse with a respiratory infection, such as a cold or the flu
- Delayed recovery or bronchitis after a respiratory infection
- Trouble breathing that may limit play or exercise
- Fatigue, which can be caused by poor sleep
The first signs of asthma in young children may be recurrent wheezing triggered by a respiratory virus. As children grow older, asthma associated with respiratory allergies is more common.
Asthma signs and symptoms vary from child to child, and may get worse or better over time. Your child may have only one sign or symptom, such as a lingering cough or chest congestion.
It may be difficult to tell whether your child’s symptoms are caused by asthma or something else. Periodic or long-lasting wheezing and other asthma-like symptoms may be caused by infectious bronchitis or another respiratory problem.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
You should contact your doctor if your child have any of the following:
- Coughing that’s constant, intermittent or seems to be linked to physical activity
- Wheezing or whistling sounds when your child exhales
- Shortness of breath or rapid breathing
- Complaints of chest tightness
- Repeated episodes of suspected bronchitis or pneumonia
What causes childhood asthma?
The underlying causes of childhood asthma aren’t fully understood. Developing an overly sensitive immune system generally plays a role. Some factors thought to be involved include:
- Inherited traits
- Some types of airway infections at a very young age
- Exposure to environmental factors, such as cigarette smoke or other air pollution
Increased immune system sensitivity causes the lungs and airways to swell and produce mucus when exposed to certain triggers. Reaction to a trigger may be delayed, making it more difficult to identify the trigger. These triggers vary from child to child and can include:
- Viral infections such as the common cold
- Exposure to air pollutants, such as tobacco smoke
- Allergies to dust mites, pet dander, pollen or mold
- Physical activity
- Weather changes or cold air
Sometimes, asthma symptoms occur with no apparent triggers.
What increases my risk for childhood asthma?
There are many risk factors for childhood asthma, such as:
- Nasal allergies (hay fever) or eczema (allergic skin rash)
- A family history of asthma or allergies
- Frequent respiratory infections
- Low birth weight
- Exposure to tobacco smoke before or after birth
- Black or Puerto-Rican ethnicity
- Being raised in a low-income environment
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is childhood asthma diagnosed?
Asthma can be hard to diagnose. Your child’s doctor will consider the nature and frequency of symptoms and may use tests to rule out other conditions and to identify the most likely cause of his or her symptoms.
A number of childhood conditions can have symptoms similar to those caused by asthma. To make things more complicated, these conditions also commonly co-occur with asthma. So your child’s doctor will have to determine whether your child’s symptoms are caused by asthma, a condition other than asthma, or both asthma and another condition.
Some conditions that can cause asthma-like symptoms include:
- Acid reflux or gastroesophageal reflux disease (GERD)
- Airway abnormalities
- Vocal cord dysfunction
- Respiratory tract infections such as bronchiolitis and respiratory syncytial virus (RSV)
The doctor will ask for a detailed description of your child’s symptoms and health. Your child may also need medical tests.
In children 5 years of age and older, doctors diagnose asthma with the same tests used to identify the disease in adults. Lung function tests (spirometry) measure how quickly and how much air your child can exhale. Your child may have lung function tests at rest, after exercising and after taking asthma medication.
In younger children, diagnosis can be difficult because lung function tests aren’t accurate before 5 years of age. Your doctor will rely on detailed information you and your child provide about symptoms. Sometimes a diagnosis can’t be made until later, after months or even years of observing symptoms.
If you suspect your child has asthma, it’s important to see a doctor as soon as possible. Early diagnosis and proper treatment can prevent disruptions from daily activities such as sleep, play, sports and school. It may also prevent dangerous or life-threatening asthma attacks.
For children younger than age 3 who have symptoms of asthma, the doctor may use a wait-and-see approach. This is because the long-term effects of asthma medication on infants and young children aren’t clear. If an infant or toddler has frequent or severe wheezing episodes, a medication may be prescribed to see if it improves symptoms.
Allergy tests for allergic asthma
If your child seems to have asthma that’s triggered by allergies, the doctor may want to do allergy skin testing. During a skin test, the skin is pricked with extracts of common allergy-causing substances, such as animal dander, mold or dust mites, and observed for signs of an allergic reaction.
Children with skin conditions or who are taking antihistamines may benefit from allergy blood tests, rather than allergy skin tests.
How is childhood asthma treated?
The goal of asthma treatment is to keep symptoms under control all of the time. Well-controlled asthma means that your child has:
- Minimal or no symptoms
- Few or no asthma flare-ups
- No limitations on physical activities or exercise
- Minimal use of quick-relief (rescue) inhalers, such as albuterol
- Few or no side effects from medications
Treating asthma involves both preventing symptoms and treating an asthma attack in progress. The right medication for your child depends on a number of things, including his or her age, symptoms, asthma triggers and what seems to work best to keep his or her asthma under control.
Long-term control medications
Preventive, long-term control medications reduce the inflammation in your child’s airways that leads to symptoms. In most cases, these medications need to be taken every day.
Types of long-term control medications include:
- Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), ciclesonide (Alvesco), beclomethasone (Qvar) and others. Your child may need to use these medications for several days to weeks before they reach their maximum benefit.
Long-term use of these medications has been associated with slightly slowed growth in children, but the effect is minor. In most cases, the benefits of good asthma control outweigh the risks of any possible side effects.
- Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). They help prevent asthma symptoms for up to 24 hours.
In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away if your child has any unusual reaction.
- Combination inhalers. These medications contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include fluticasone and salmeterol (Advair Diskus, Advair HFA), budesonide and formoterol (Symbicort), fluticasone and vilanterol (Breo), and mometasone and formoterol (Dulera).
In some situations, long-acting beta agonists have been linked to severe asthma attacks. For this reason, LABA medications should always be given to a child with an inhaler that also contains a corticosteroid. These combination inhalers should be used only for asthma that’s not well-controlled by other medications.
- This is a daily pill that helps keep the airways open. Theophylline (Elixophyllin, Theo-24, Uniphyl, others) relaxes the muscles around the airways to make breathing easier. It’s not used as often now as in past years.
Quick-relief medications quickly open swollen airways that are limiting breathing. Also called rescue medications, quick-relief medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your child’s doctor recommends it.
Types of quick-relief medications include:
- Short-acting beta agonists. These inhaled bronchodilator (brong-koh-DIE-lay-tur) medications can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA). These medications act within minutes, and effects last several hours.
- Ipratropium (Atrovent HFA). Your doctor might prescribe this inhaled medication for immediate relief of your child’s symptoms. Like other bronchodilators, it relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it’s sometimes used to treat asthma attacks.
- Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. They can cause serious side effects when used long term, so they’re only used to treat severe asthma symptoms on a short-term basis.
- Immunomodulatory agents. Mepolizumab (Nucala) may be appropriate for children with severe eosinophilic asthma.
Treatment for allergy-induced asthma
If your child’s asthma is triggered or worsened by allergies, your child may benefit from allergy treatment as well. Allergy treatments include:
- Omalizumab (Xolair). This medication is specifically for people who have allergies and severe asthma. It reduces the immune system’s reaction to allergy-causing substances, such as pollen, dust mites and pet dander. Xolair is delivered by injection every two to four weeks.
- Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.
- Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your child’s immune system reaction to specific allergens.
Don’t rely only on quick-relief medications
Long-term asthma control medications such as inhaled corticosteroids are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely your child will have an asthma attack.
If your child does have an asthma flare-up, a quick-relief (rescue) inhaler can ease symptoms right away. But if long-term control medications are working properly, your child shouldn’t need to use a quick-relief inhaler very often.
Keep a record of how many puffs your child uses each week. If he or she frequently needs to use a quick-relief inhaler, take your child to see the doctor. You probably need to adjust his or her long-term control medication.
Inhaled medication devices
Inhaled short- and long-term control medications are used by inhaling a measured dose of medication.
Older children and teens may use a small, hand-held device called a pressurized metered dose inhaler or an inhaler that releases a fine powder.
Infants and toddlers need to use a face mask attached to a metered dose inhaler or a nebulizer to get the correct amount of medication.
Babies need to a use a device called a nebulizer, a machine that turns liquid medication into fine droplets. Your baby wears a face mask and breathes normally while the nebulizer delivers the correct dose of medication.
Asthma action plan
Work with your child’s doctor to create a written asthma action plan. This can be an important part of treatment, especially if your child has severe asthma. An asthma action plan can help you and your child:
- Recognize when you need to adjust long-term control medications
- Keep tabs on how well treatment is working
- Identify the signs of an asthma attack and know what to do when one occurs
- Know when to call a doctor or seek emergency help
Children who have enough coordination and understanding may use a hand-held device to measure how well they can breathe (peak flow meter). A written asthma action plan can help you and your child remember what to do when peak flow measurements reach a certain level.
The action plan may use peak flow measurements and symptoms to categorize your child’s asthma into zones, such as the green zone, yellow zone and red zone. These zones correspond to well-controlled symptoms, somewhat-controlled symptoms and poorly controlled symptoms. This makes tracking your child’s asthma easier.
Your child’s symptoms and triggers are likely to change over time. You’ll need to carefully observe symptoms and work with the doctor to adjust medications as needed.
If your child’s symptoms are completely controlled for a period of time, your child’s doctor may recommend lowering doses or stopping asthma medications (stepping down treatment). If your child’s asthma isn’t as well-controlled, the doctor may want to increase, change or add medications (stepping up treatment).
While some alternative remedies are used for asthma, in most cases more research is needed to see how well they work and to measure the extent of possible side effects. Alternative treatments that may help with asthma include:
- Breathing techniques. These include structured breathing programs, such as the Buteyko breathing technique, the Papworth method and yoga breathing exercises (pranayama).
- This technique has roots in traditional Chinese medicine. It involves placing very thin needles at strategic points on your child’s body. Acupuncture requires holding still for up to a few minutes, which can be hard for young children. It’s safe and generally painless.
- Relaxation techniques. Techniques such as meditation, biofeedback, hypnosis and progressive muscle relaxation may help with asthma by reducing tension and stress.
- Homeopathy aims to stimulate the body’s self-healing response by using very small doses of substances that cause symptoms. In the case of asthma, homeopathic remedies are made from substances that trigger an asthmatic reaction, such as pollen or weeds. There’s still not enough evidence to determine whether homeopathy helps treat asthma caused by allergies.
- Herbal remedies and supplements. A few herbal remedies have shown some evidence that they may help in treating asthma, including beta-carotene, black seed, fish oil and magnesium. However, further studies need to be made to confirm their benefit.
Herbs and supplements can have side effects and some may interact with other medications your child is taking. Talk to your child’s doctor before trying any herbs or supplements.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage childhood asthma?
The following lifestyles and home remedies might help you cope with childhood asthma:
- Maintain low humidity at home. If you live in a damp climate, talk to your child’s doctor about using a device to keep the air drier (dehumidifier).
- Keep indoor air clean. Have a heating and air conditioning professional check your air conditioning system every year. Change the filters in your furnace and air conditioner according to the manufacturer’s instructions. Also consider installing a small-particle filter in your ventilation system.
- Reduce pet dander. If your child is allergic to dander, it’s best to avoid pets with fur or feathers. Regularly bathing or grooming your pets also may reduce the amount of dander in your surroundings.
- Use your air conditioner. Air conditioning helps reduce the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers indoor humidity and can reduce your child’s exposure to dust mites. If you don’t have air conditioning, try to keep your windows closed during pollen season.
- Keep dust to a minimum. Reduce dust that may aggravate nighttime symptoms by replacing certain items in your bedroom. For example, encase pillows, mattresses and box springs in dust-proof covers. Consider removing carpeting and installing hard flooring, particularly in your child’s bedroom. Use washable curtains and blinds.
- Clean regularly. Clean your home at least once a week to remove dust and allergens.
- Reduce your child’s exposure to cold air. If your child’s asthma is worsened by cold, dry air, wearing a face mask outside can help.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Childhood asthma. http://www.mayoclinic.org/diseases-conditions/childhood-asthma/home/ovc-20193095. Accessed September 20, 2017.
Asthma in Children and Infants. http://www.webmd.com/asthma/children-asthma#1. Accessed September 20, 2017.
Review Date: September 20, 2017 | Last Modified: September 20, 2017