Asthma

Asthma is the most common chronic disease of childhood. Twelve percent of children in the U.S. (under age 18) have been diagnosed with asthma. Asthma is a very serious disease. Asthma cannot be cured (but it can be controlled). When asthma is kept under good control children can and should be active, living normal lives.

What is asthma?

Asthma is a respiratory disease that affects the airways (breathing tubes that carry air in and out of the lungs). The lining inside the airway walls is inflamed and swollen. The inflammation of the airway walls is continuous, or chronic. Even when a child is having no asthma symptoms, there is almost always some inflammation (swelling) in the airways.

During an asthma “flare” (episode of breathing problems) the following changes occur:

  • Increased swelling and inflammation of the airway lining
  • Muscles tighten around the airways (called bronchospasm)
  • More mucus is produced (which can clog airways)

All of these things cause the airway to narrow. This causes breathing problems: it is very hard to move air in and out of a narrowed airway.

Common Symptoms

For children less than 3 years old:

Symptoms can be difficult to recognize in very young children. Some symptoms that may be associated with asthma include:

  • Cough, that takes a long time to go away after a cold
  • Bad cough with cold, coughing “spells” that waken child at night
  • Prolonged coughing after a cold, often worse at night
  • Wheezing, coughing, or trouble breathing with exercise
  • Infants may have trouble feeding and grunt during sucking
  • Infants may have a rattly cough and rapid breathing
  • Child may say their chest “hurts” or “feels funny”
  • Child may slow or stop playing to “catch their breath”

For children 3—18 years old:

  • Coughing (often worse at night, or early in the morning)
  • Wheezing (whistling or squeaking sound with breathing)
  • Chest tightness (like something squeezing the chest)
  • Difficulty breathing (may feel like can’t get enough in and out of chest)

Other signs that may indicate asthma can include:

  • Bad cough, wheezing with colds, or other respiratory illnesses
  • Waking at night with a cough (often around 2:00 or 3:00 a.m.)
  • Coughing with laughing, crying, or other strong emotions
  • Coughing when first getting up in the morning
  • Coughing, wheezing with exercise, brisk activity (especially in cold weather

Sometimes chronic cough may be the only symptom of asthma in a child

Family and child history

Children under 3 years old with asthma–like symptoms present a challenge. Some of these children with cough and breathing problems may have long term asthma, while others may not. Children “more likely” to have long term asthma can benefit from medicines to decrease the inflammation in their airways. Research has shown certain situations that strongly predict that the child will have long term asthma. Any young child or infant with most or all of these things will likely benefit from anti-inflammatory medicine:
  • Three or more episodes of wheezing in the past year, that lasted more than 1 day
  • Severe cough & wheezing episodes less than 6 weeks apart that required treatment
  • Child needs medicine for wheezing/ cough more than 2 times per week
  • Parent of the child has asthma
  • Child has eczema (atopic dermatitis)
  • Child has allergic rhinitis (hay fever)
  • Child has wheezing when they do not have a cold

Asthma symptoms can vary.

Many people have been taught that someone with asthma has “big” breathing problems nearly all the time. This is not true!

Asthma symptoms can change a lot.

Some children may have no asthma symptoms for long time periods, then they may have a serious asthma “flare”. Other children may have symptoms daily, weekly, or several times a month. Symptoms can vary from one asthma “flare” to another. Some flares may be serious, even life threatening, while others may be more mild.

Call the doctor right away when asthma begins to cause problems. Early treatment can help prevent a serious, life threatening asthma episode.

What cause (“triggers”) asthma problems in children?

Colds, and other respiratory viruses are one of the main things that cause asthma “flares” in children. Other things that may trigger asthma problems include:

Allergens

  • Pollens
  • Molds (indoor and outdoor)
  • Animal dander
  • House dust mites

Irritants

  • Cigarette smoke (no one should smoke in the house or car)
  • Air Pollution
  • Cold air and weather changes
  • Strong odors (from painting, cooking, cleaning products)
  • Scented products
  • Strong emotional expressions (laughing or crying hard)
  • Avoidance of things that trigger asthma problems will help keep asthma under better control.

Medicines

Usually two kinds of medicines are needed to treat asthma. These medicines have been shown to be very safe and effective for children.

Albuterol (quick relief or “rescue” medicine)

This medicine works quickly and is used “as needed” for breathing problems. This medicine provides temporary relief of breathing problems by relaxing tight muscles around the breathing tubes. Albuterol is the medicine used the most (Proventil® and Ventolin® are “brand names” of albuterol).

Long term control (maintenance) medicine:

  • Treats the inflammation of the airways
  • Helps control asthma and prevent problems
  • Must be taken every day (to keep the inflammation under control)

Asthma Control

The goal of asthma therapy is to achieve good control of the asthma. When asthma is under good control, the child should have minimal or no problems breathing. Signs of good asthma control include:

  • No coughing
  • No breathing difficulty (wheezing, chest tightness)
  • No waking at night with breathing problems
  • Normal activity levels (including play, sports, other activities)
  • No missed school days because of asthma problems
  • No acute “flares” requiring an urgent office visit, or emergency room visit

Asthma Action Plan

Every child with asthma needs a written asthma action plan. This management plan tells which medicines to take when the child is doing well. In addition it outlines how to increase medicines when problems start, and when to call the pediatrician. Using this plan as soon as problems start can help prevent the asthma flare from getting out of control. An asthma action plan can be made during an office visit for asthma.

Frequently asked questions...

  1. Is asthma contagious?
    No, asthma is not contagious. No one can “catch” asthma from another person, though it does run in families.
  2. Are asthma medicines addictive?
    No, medicines used to treat asthma are not addictive. Asthma medicines are extremely important to keep asthma under control, and keep lungs as healthy as possible.
  3. Do asthma medicines lose their effect when taken for a long time?
    No, the medicines will not become less effective over time. Once asthma is under control, the medicines should be reduced to the smallest amount that maintains control.
  4. Does my child need to use a chamber /spacer with inhalers ?
    YES, the chamber helps the medicine go into the lungs. If a chamber is not used, a lot of the medicine sticks in the back of the throat, and does not go into the lungs.
  5. Are inhaled steroids dangerous?
    The inhaled steroids for asthma are safe and effective. (These steroids are NOT the same drug as the unsafe steroids some athletes use to build muscle)
  6. What can I do if exercise causes asthma symptoms?

Talk to your pediatrician about how to prevent asthma symptoms with exercise. Usually the child will need to take some albuterol before exercise. If asthma is under control, children should be able to exercise and participate in all activities.

How to use and Inhaler without a mask

  1. Always stand to use your inhaler
  2. Remove cap and shake the inhaler
  3. Attach inhaler to spacer (aerochamber)
  4. Breathe out all the way
  5. Place lips tightly around mouthpiece of spacer (aerochamber)
  6. Press down on inhaler (once) to release medication, then start to breathe in slowly
  7. Breathe in slowly (over about 3-5 seconds) and as deeply as possible (“Harmonica noise” indicates that you are breathing in too fast)
  8. Hold your breath 10 seconds to let the medicine reach deeply into lungs
  9. Breathe out slowly
  10. Repeat above for next inhalation (be sure to SHAKE inhaler with each “puff”)
  11. RINSE mouth with water after using Flovent (also, after Advair diskus use)

How to use an Inhaler with a mask

  1. Remove cap and shake the inhaler
  2. Attach inhaler to spacer (aerochamber with mask)
  3. Place mask over child’s mouth and nose
  4. Press down on inhaler to release medication, and hold mask securely over child’s nose and mouth (may need a helper)
  5. Keep mask in place until child has taken about 6 breaths
  6. You may repeat another dose of medicine immediately
  7. Be sure to SHAKE inhaler before each “puff”
  8. Rinse mouth (or take drink of water) after using Flovent