Asthma and kids: What parents should know – CHOC

According to the CDC, about 10 to 12% of all U.S. kids under the age of 17 years have asthma. Although it is a chronic condition, asthma can be well managed in kids with teamwork from their families, pediatricians and schools.

Here, Dr. Stanley Galant, a pediatric allergist specializing in asthma at CHOC, maps out what parents should know about asthma to keep their children healthy.

Diagnosing asthma in kids

Asthma occurs when there is an obstruction of the bronchial tubes caused by mucus in the airways, muscle spasm and swelling that cause three key symptoms: a cough, shortness of breath and wheezing.

There’s no single test for asthma, so it can be hard to diagnose the condition in a young child, says Dr. Galant, noting that symptoms are sometimes mistaken for another illness like bronchiolitis.

“One big clue to help diagnose asthma versus another condition or illness has to do with this chronic cough. A diagnosis of asthma is suggested when the cough occurs following exercise, or in the middle of the night, and responds well to a bronchodilator or medication that opens the airways and dilates the bronchial tubes,” says Dr. Galant.

Children with asthma — roughly 70 percent — have allergies, which play a big role in diagnosing and controlling the condition. They may also have eczema (a condition that causes dry, itchy skin) or a family history of asthma.

How can I tell if my child may have asthma?

Your child should be checked for asthma if he or she experiences the following symptoms:

• Chronic or persistent coughing at night.
• Coughing, wheezing or shortness of breath during or after exercise.
• Recurrent wheezing.

Asthma symptoms can be triggered by respiratory viral infections, like the common cold virus, as well as environmental factors, like second-hand smoke and allergens.

Treatments for asthma

Asthma treatment action plans

Effective treatment for asthma requires a comprehensive approach. It’s best to have a written treatment plan referred to as the asthma action plan, Dr. Galant says, which includes:

• What medications to take and when.
• A list of possible asthma triggers.
• Early symptoms of flare-ups and what to do if they happen.
• Regular checks for lung and breathing function using a peak flow meter, an easy-to-use breathing test for home use.
• Written instructions for when the child needs “rescue” medications and when to call the doctor.

With the right treatment, we want few day or night symptoms, no exercise limitation, nor hospitalizations or emergency room visits and little use of the bronchodilator (you might hear these being called rescue inhalers), says Dr. Galant.

What is the treatment like for persistent asthma?

If a child has persistent asthma, or trouble in terms of coughing and wheezing, more than twice a week during the day and more than twice a month at night, the child should have skin or blood testing for allergies. Allergy testing helps pinpoint triggers for asthma so families can make changes at home to reduce or eliminate them.

Avoiding triggers is the first key factor in managing asthma; the second is medication. Allergy shots can also be helpful in certain patients. Parents should discuss options with their child’s physician.

What medications should I have on hand for my child with asthma?

You should have your child’s controller and rescue medication on hand, says Dr. Galant.

Controller medications (long-term control medicines)

For preventative measures, those who suffer from persistent asthma should have a controller medication such as an inhaled corticosteroid or an oral medication to ease airway swelling, limit mucus and help prevent asthma symptoms. These medicines may be inhaled or swallowed as a pill or liquid. These need to be taken daily for several months as directed by your provider to be effective.

All inhaled medication in children using a meter dose inhaler will require a valved holding chamber, as well as a mask for children less than 6 years old. This is not required for dry powder inhalers.

Rescue medications

Also known as a quick-relief medicine or fast-acting medicine, these medications work right away to relieve symptoms of an asthma flare-up as it’s happening. They open the airways to relieve symptoms like wheezing, coughing and shortness of breath.

The child should have access to a reliever medication such as albuterol — both at home and school.

Refer to your asthma action plan (mentioned above) so that you know when to take controllers and quick-relief medicines — depending on how well your child is doing — as well as advice on when to seek medical help.

Get more help about making sense of asthma medications.

Avoiding asthma triggers

What are common asthma triggers?

Since asthma is often due to an allergic response, children with persistent asthma should also be tested for allergies to help identify allergens that can trigger an asthma attack, says Dr. Galant.

“There are allergen and non-allergen triggers. Children can be allergic to foods as well as indoor allergens like dust mites, cockroaches, mold spores, and pets’ dander, while outdoor allergens include seasonal tree, grass, and weed pollens. Nonallergic triggers include the common cold virus, air pollution, and environmental tobacco smoke,” he says.

Knowing a child’s allergic and nonallergic triggers can help the family make changes at home to minimize the child’s exposure to allergens and avoid asthma triggers.

What are seasonal asthma triggers that I should be aware of? How can I avoid them or treat their symptoms of them?

While seasonal allergies occur typically in the spring and fall and are difficult to avoid, it is important to avoid playing outside in the spring when pollen counts are high, such as after the grass is freshly cut, if this triggers your asthma. The influenza vaccine can reduce flu-related asthma symptoms in the fall and winter months.

Keep in mind also that the avoidance of indoor allergens by using pillow and mattress impermeable covers can reduce the effect of outdoor allergens and non-allergic triggers.

How can I help manage my child’s asthma year-round?

In the CHOC Breathmobile Asthma Clinic, we strongly emphasize the importance of taking measures to avoid potential indoor allergens such as house dust mites, cat and dog dander, cockroaches and mold, says Dr. Galant.

We also recommend avoiding non-allergic triggers such as environmental tobacco smoke and high levels of air pollution.

The appropriate use of medication also plays a major role in managing asthma. Make sure to reference your child’s asthma action plan and having their medications on hand at home.

Learn how to protect your kids with asthma from colds and the flu.

Playing sports with asthma

Can my child play sports if they have asthma?

Just because your child has asthma does not mean they can’t participate in sports or physical activities, says Dr. Galant.

In fact, exercise and physical fitness can be very important for lung development. It can improve asthma status in those who have it. During exercise, you have to take a deep breaths, which can help open your airways.

“I encourage every child to exercise. If your asthma is well controlled, you have less of a chance of a problem,” says Dr. Galant. “It’s important for the families and their providers to create a situation that allows them to participate.”

How to manage your child’s asthma during sports or exercise

Children participating in sports can take some steps to minimize or avoid asthma trouble, like:

• Warm up with short exercises such as short sprints.
• Use a rescue medicine, such as albuterol, about 15 minutes before exercising or playing sports to help prevent symptoms caused by physical activity. This will help for about two to four hours, says Dr. Galant.
• Keep rescue medication on hand if it’s needed during the sports game or exercise.
• If it’s a cold day, athletes with asthma should wear a mask to prevent the cold, dry air from getting into their lungs.

Dr. Galant notes that swimming is a great sport for children with asthma because of the moist environment. Running in dry, cold air is not as ideal.