Asthma - 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.
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.
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.
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.
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.
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.
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 your 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 your 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.
Wheezing can be a normal healthy response to an unhealthy environment. Or, wheezing can be a sign of asthma. I'm Dr. Alan Greene and I want to talk with you for a moment about how to tell the difference, what causes wheezing anyway, and when is it healthy and when is it not. Well to understand that, first let's all take a deep breath together (inhales). When you breathe in, the air comes through your nose or mouth, through the big windpipe and breaks into 2 big bronchi, one into each lung. And from there they break into a whole bunch of little, smaller bronchioles. It's almost like a tree's branches branching out. And those bronchioles are where the wheezing happens. Let's look at a bronchiole. Here's one of those small airways. Now if you happen to walk into a cloud of something that's toxic, your body is going to respond instantly to try to protect you. The first thing that will happen is the muscles around the bronchioles will tighten, will constrict down almost like a boa constrictor, and you get the tight airways. If that toxic cloud is still there, to protect your delicate tissues deep in your lungs, swelling of the lining will happen. Inflammatory stuff to help protect you from those toxins. And if it's still there, still irritating, mucus will begin to be secreted to be able again to capture and protect you from those toxins. That's wheezing. Asthma happens when your airways are hyper-responsive. When they're twitchy. When they're hyper-alert and they respond to something that's not truly dangerous. The problem with that is when your bronchioles are constricted and swollen and has mucus in them, that narrow little opening is hard to breathe through. You have to work to breathe, especially to breath out. And that hard breathing through a narrow passageway is what creates the sound we know as wheezing.
Exams and Tests
Your health care provider will use a stethoscope to listen to your child's lungs. The provider may be able to hear asthma sounds. However, lung sounds are often normal when your child is not having an asthma attack.
The provider will have your 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:
- Allergy testing on the skin, or a blood test to see if your child is allergic to certain substances
- Chest x-ray
- Lung function 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 may 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 medicines 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 medicines 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 outdoors, 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.
If you have a chronic lung disease, like asthma or COPD, a metered-dose inhaler is often your main type of therapy. An inhaler is a small, hand-held device that delivers medicine in the form of a spray that you breathe in. Using an inhaler may seem easy, but many people don't use them the right way. You need to know how to use your inhaler correctly for the medicine to get to your lungs and work effectively. A spacer device will help. The spacer connects to the inhaler mouthpiece, and the medicine goes into the spacer tube first. This allows you to breathe in the medicine more easily. Using a spacer wastes a lot less medicine than spraying the medicine directly into your mouth. It also makes it less important to get the exact timing for activating the inhaler while taking in a breath. These are instructions for using an inhaler with a spacer. First off, if you have not used the inhaler in a while, you may need to prime it. See the instructions that came with your inhaler for when and how to do this. Take the caps off the inhaler and spacer. Look inside each mouthpiece to make sure there is nothing in it. Shake the inhaler 10 to 15 times to mix the medicine with the propellant. Attach the inhaler mouthpiece to the open end of the spacer and hold it upright. Stand or sit upright. Breathe out all the way to empty your lungs. Place the spacer mouthpiece in your mouth so that it fits just past your teeth and above your tongue. Close your lips around the spacer so that you form a tight seal. Tilt your head back slightly. As you slowly begin to breathe in through your mouth, press down once on the top of the inhaler. Keep breathing in slowly, as deeply as you can. Your spacer may have a whistle that sounds if you breathe in too fast. Take the spacer out of your mouth. Hold your breath for 5 to 10 seconds. This lets the medicine reach deep into your lungs. Breathe out slowly through your mouth. If you need a second puff, wait about 1 minute before you take your next puff. Put the caps back on the inhaler and spacer. After using your inhaler, gargle and rinse your mouth with water. Do not swallow the water. This helps reduce side effects from your medicine. To keep your inhaler and spacer operating correctly, you need to keep them clean. Follow the manufacturer's instructions for when and how often to clean your inhaler and spacer. Using your inhaler with a spacer the right way ensures you get the medicine you need. It's a good idea to bring your inhaler and spacer to your medical appointments. That way your health care provider can make sure you are using them correctly.
If you have a chronic lung disease, like asthma or COPD, a metered-dose inhaler is often your main type of therapy. An inhaler is a small, hand-held device that delivers medicine in the form of a spray that you breathe in. Using an inhaler may seem easy, but many people don't use them the right way. You need to know how to use your inhaler correctly for the medicine to get to your lungs and work effectively. In general, using the inhaler without a spacer requires more coordination in order to ensure that medicine reaches your lungs. So, when possible, it's best to use a spacer. These are instructions for using an inhaler without a spacer. First off, if you have not used the inhaler in a while, you may need to prime it. See the instructions that came with your inhaler for when and how to do this. Take the cap off the mouthpiece, and look inside the mouthpiece to make sure there is nothing in it. Shake the inhaler 10 to 15 times to mix the medicine with the propellant. Hold the inhaler upright. Stand or sit upright. Breathe out all the way to empty your lungs. Place the mouthpiece in your mouth so that it fits just past your teeth and above your tongue. Close your lips around the inhaler so that you form a tight seal. Tilt your head back slightly. As you slowly begin to breathe in through your mouth, press down once on the top of the inhaler. Keep breathing in slowly, as deeply as you can. Take the inhaler out of your mouth. Hold your breath for 5 to 10 seconds. This lets the medicine reach deep into your lungs. Breathe out slowly through your mouth. If you need a second puff, wait about 1 minute before you take your next puff. Put the cap back on the inhaler and make sure it is firmly closed. After using your inhaler, gargle and rinse your mouth with water. Do not swallow the water. This helps reduce side effects from your medicine. To keep your inhaler operating correctly, follow the manufacturer's instructions for when and how often to clean your inhaler. Using your inhaler the right way ensures you get the medicine you need. It's a good idea to bring your inhaler to your medical appointments. That way your health care provider can make sure you are using it correctly.
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
Contact 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
Jackson DJ, Lemanske RF, Bacharier LB. Management of asthma in infants and children. In: Burks AW, Holgate ST, O'Hehir RE, et al, eds. Middleton's Allergy: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 50.
Liu AH, Spahn JD, Sicherer SH. Childhood asthma. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 169.
Lugogo N, Que LG, Carr TF, Kraft M. Asthma: diagnosis and management. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 62.
National Heart, Lung, and Blood Institute website. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group.
Version Info
Last reviewed on: 4/25/2023
Reviewed by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
