Children and Asthma

Asthma is the most common chronic illness among children. In the United States, millions of people have this lung disease, and an estimated one-third of them are children. During childhood, as many as one in 10 children may have some “asthmatic” or airway event that causes narrowing of the airways and makes breathing difficult. By adulthood, the rate drops to about one in 20 people. As the rate of obesity in children (and adults) increases, the incidence of asthma may increase. Children with asthma often also have eczema and allergies to pollen or foods. 

When the airway of a child with asthma is exposed to an irritant or an allergen, it has two reactions: a hyperreactive response and an inflammatory response. The hyperreactive response occurs first. The smooth muscles that surround the airway tighten or constrict, narrowing the airway and making it difficult for air to pass in and out of the lungs. (The airway of a child who does not have asthma also has a hyperreactive response, but that reaction stops because the child is able to get rid of the irritant.) The inflammatory response follows the hyperreactive response. In this response, the immune system causes the airway to swell and secrete mucus, further restricting the flow of air. These responses cause coughing, wheezing and difficulty breathing.

The severity of asthma attacks is unpredictable. For some children, asthma occasionally causes mild symptoms; other children with asthma struggle every day to breathe. Sometimes asthma symptoms improve during adolescence; for some children, however, symptoms worsen as they grow up.

The allergens that can trigger an asthma attack include ragweed pollen, animal dander, molds, and dust mite and cockroach waste products. An asthma attack can also be triggered by viral or sinus infections, exercise, reflux disease, medication, food and emotional anxiety. Irritants that aggravate the nose and airway of children with asthma include air pollutants such as cigarette smoke, wood smoke and chemicals; strong odors such as perfumes, household cleaners, cooking fumes, paints and varnishes; and changing weather conditions such as fluctuations in temperature and humidity.

Some children wheeze from respiratory infections, but this does not mean they have asthma. Determining whether a child has a respiratory infection or asthma requires the care of an experienced health care provider. Research also shows that asthma, allergies and eczema tend to run in families, which makes some children predisposed to the condition.

Symptoms

These are symptoms of an asthma attack:

• Wheezing

• Rapid breathing

• Shortness of breath

• Coughing

• Tightness in the chest

• Rapid heart rate

• Sweating

After an asthma attack the cough, mucus production and inflammation can continue for days or weeks.

An asthma attack can be life-threatening. If a child has any of the following symptoms, he or she needs immediate medical attention:

• Shallow breathing

• Skin turns blue

• Skin and muscles around the ribs looks as if it is being sucked in when the child breathes

• Child loses consciousness

What to Do

It is important to avoid triggers such as house dust mites and molds. Don't smoke at home and don't allow anyone else to do so. If a child receives appropriate medication, encourage aerobic activities, because they can improve airway function. To maintain optimal airway function, children should continue to follow their asthma treatment plan as instructed, even if they have no symptoms. You should call your child's provider at once if the child's asthma symptoms, including wheezing and shortness of breath, worsen.

Use Medicine Effectively

Youngsters with asthma who are diagnosed and treated as soon as possible can avoid lung and psychological complications. Although asthma is a chronic illness, with an appropriate, individualized treatment plan, it does not have to become a debilitating disease. Maintaining control of asthma symptoms is the most important factor. With proper management of their condition, most children with asthma can maintain normal lung function and participate in athletics and other normal activities. 

Treatment can reverse or even prevent asthma symptoms. A child's health care provider may perform lung function studies to determine the severity of the asthma and whether it can be reversed. After the evaluation, the provider will create a specific treatment plan that may include medication and peak flow monitoring. Peak flow devices measure a child's peak or optimal air flow and provide the exact degree of airway obstruction. Knowing the peak flow rate is important because sometimes children are unaware that their airways are gradually tightening. Peak flow rates allow them to measure their air flow against a baseline.

Asthma severity is classified as mild intermittent, mild, moderate or severe persistent. The treatment plan is based on the child’s asthma severity. A treatment plan usually includes avoiding triggers, monitoring of breathing with a peak flow meter when necessary, and taking medications. There are several safe, effective medications that help to control a child's asthma symptoms and the disease long term. The amount, frequency and duration of asthma medications depend on the child's condition. Asthma medications include anti-inflammatory drugs such as corticosteroids or leukotrienes to stop or prevent the development of inflammation in the airway of the lungs. Bronchodilators are used as "rescue" medications to open a child's airway and relieve the feeling of tightness in the chest, wheezing and breathlessness.

Self-Care Steps for Asthma

It is essential to assess the severity of a child's condition when symptoms of asthma occur. If your child has mild wheezing or shortness of breath, monitor him or her closely. Follow these steps:

• Have the child rest quietly until the wheezing eases.

• Use a peak flow meter to measure your child's lung function and assess the degree of airway obstruction. If the flow is 70 to 90 percent of the child's personal best, offer reassurance that the symptoms are mild.

• Use a bronchodilator inhaler to open the child's airways.