Asthma - childrenPediatric asthma; Asthma - pediatric
Asthma is a disease that causes the airways to swell and get narrow.
Asthma is caused by swelling in the airways. During an asthma attack, the muscles surrounding the airways tighten. The lining of the air passages swells. Less air is able to pass through as a result.
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.
Some things that can bring on asthma symptoms (triggers) include:
- Animals (hair or dander)
- Dust, mold, and pollen
- Aspirin and other medicines
- Cold air, such as changes in weather (most often cold weather)
- Chemicals in the air or in food
- Tobacco smoke
- Strong emotions
- Viral infections, such as the common cold
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
- 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 else 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 to listen to the child's lungs. The health care provider may be able to hear asthma sounds. However, lung sounds are often normal when the child is not having an asthma episode.
The health care 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.
Tests may include:
- Allergy testing
- Chest x-ray
- Eosinophil count (a type of white blood cell)
- Lung function tests
You and your child's doctors 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 nurse or doctor. It's important to know what questions to ask your child's doctor.
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.
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.
- Examples of quick relief medicines include Proventil, Ventolin, and Xopenex.
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 to get the medicine into the lungs properly.
- If your child uses the inhaler wrong way, less medicine gets into the lungs. Have your health care 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 what things make your child's asthma worse. These are called asthma "triggers." Avoiding them is the first step toward helping your child feeling 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 do NOT usually come on without warning.
Children under age 5 may not be able to use a peak flow meter well enough for it 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 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
Everyone with asthma, including children, should have an asthma action plan.
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
The green zone on your asthma management plan means you are:
A. Allergic to grass
B. Doing well
C. Feeling ill
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
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
A big part of managing asthma is staying away from your asthma triggers.
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
To control your asthma, you can't be physically active.
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
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 doctor'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.
Rarely, asthma can be a life-threatening disease. Families need to work closely with their health care professionals to develop a plan to care for a child with asthma.
When to Contact a Medical Professional
Call your health care provider if you think your child has new symptoms of asthma. If your child has been diagnosed with asthma, call the doctor:
- After an emergency room visit
- When peak flow numbers have been getting lower
- When symptoms are 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
- 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).
National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, Md. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publications 08-4051.
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Bush A, Saglani S. Management of severe asthma in children. Lancet. 2010 Sep 4;376(9743):814-25.
Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010 Sep;126(3):466-76.
McMahon AW, Levenson MS, McEvoy BW, Mosholder AD, Murphy D. Age and risks of FDA-approved long-acting beta-adrenergic receptor agonists. Pediatrics. 2011;128(5):e1147-1154.
Liu AH, Covar RA, Spahn JD, Leung DYM. Childhood asthma. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 138.
Normal versus asthmatic bronchiole - illustration
Normal versus asthmatic ...
Peak flow meter - illustration
Peak flow meter
Review Date: 5/10/2013
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.