Asthma in children
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Asthma is a common condition that causes coughing, wheezing, tightness of the chest and breathlessness. About two-thirds of all children who develop asthma will grow out of it, but left untreated asthma can cause permanent damage to the airways. Very rarely, a severe asthma attack can be fatal.
About one in 10 children has asthma and it´s the most common long-term medical condition.
Asthma is a condition where the airways become irritated and inflamed. As a result, they:
- become narrower
- produce extra mucus
This makes it more difficult for air to flow into and out of the lungs and causes the symptoms of asthma.
The symptoms of asthma may be mild, moderate or severe. They may include:
- shortness of breath
- tightness in the chest
These symptoms tend to be variable and may stop and start. They are usually worse at night.
The exact cause of asthma is not fully understood at present. Sometimes, the symptoms flare up for no obvious reason, but you may notice certain triggers that set off your child´s asthma attack or make their symptoms worse. These triggers irritate the airways in your child´s lungs and can include:
- infections such as colds and flu
- irritants such as dust, cigarette smoke, fumes and chemicals
- allergies to pollen, medicines, animals, house dust mites or certain foods
- exercise - especially in cold, dry air
- emotions - laughing or crying very hard can trigger symptoms, as can stress
Factors thought to increase a child's risk of developing asthma include those listed below.
- Asthma often runs in families and children can inherit the tendency to get inflamed airways. Children can also inherit the tendency to have allergies (this is called atopy), which increases the risk of developing asthma.
- Boys are more likely than girls to get asthma as a child.
- If you smoke when pregnant, your baby is more likely to get asthma. Children with parents who smoke around them are also more likely to get asthma.
If you think your child has asthma, contact your GP for advice. He or she will ask about your child's symptoms and if you have noticed any factors that trigger the symptoms. Your GP will also do a physical examination, and may ask you about your child´s medical history.
Your GP may also do one or more of the tests listed below.
- Depending on the age of your child, your GP may use a device called a peak flow meter to help diagnose asthma. A peak flow meter measures how much, and how fast, air can be expelled from your child´s lungs. This device can also be used to monitor whether a treatment is effective.
- A spirometry test can also measure how well your child's lungs are functioning but provides more detailed information than a peak flow meter.
- Other tests such as a chest X-ray may be done to make sure no other breathing problems are present.
- An allergy skin test may be done to find out whether your child is allergic to certain substances.
In children under five, diagnosis may be made if your child responds to asthma treatments.
Asthma cant be cured. Treatments aim to reduce the frequency, severity and length of asthma attacks. A lot of different factors are involved in asthma, so each treatment plan will be individual, combining medicines and asthma management in the way that works best for your child.
Inhalers (sometimes called "puffers") contain a gas that propels the correct dose of medication either when the top is pressed down or on inhalation (some older children may have dry powder inhalers). This is inhaled into the airways. Inhalers need to be used correctly to work properly so ask your GP for advice.
There are two basic categories of inhaler medicines that are used for asthma:
- relievers - to treat symptoms
- preventers - to help prevent symptoms
Your child should use a reliever when asthma symptoms occur. They can be short-acting or long-acting, and are usually a blue or green colour.
Short-acting relievers (known as bronchodilators) contain medicines such as salbutamol (eg Ventolin) and terbutaline (Bricanyl) that work to widen the airways and quickly ease the symptoms.
If your child´s asthma is not well controlled using a regular steroid and occasional use of a short-acting reliever, a long-acting reliever can be added to their treatment. Long-acting relievers contain medicines such as salmeterol (Serevent) or formoterol (eg Oxis).
If your child is given a preventer it should be used every day - even if he or she does not have symptoms. Preventers help to keep symptoms from occurring, and are usually a brown, orange or red colour.
Preventers usually contain a steroid medicine, such as beclometasone (eg Asmabec) or fluticasone (eg Flixotide) that work to reduce the inflammation of the airways.
Side-effects are rare at normal doses (although they can sometimes cause a sore mouth or throat). It can take up to six weeks for the full effect of preventer medicines to build up, but once they do, your child may not need the reliever inhaler at all.
If your child uses an inhaler, he or she may also be given a spacer. Spacers are devices which can help your child to use their inhaler correctly. A spacer is a long tube which clips on to the inhaler. Your child breathes in and out of a mouthpiece at the other end of the tube.It is easier to use because it allows your child to activate the inhaler and then inhale in two separate steps. Children as young as three can learn to use an inhaler with a spacer, and for babies and very young children a face mask can be attached. Using a spacer also reduces the risk of getting a sore throat from using a steroid inhaler.
Severe attacks of asthma are sometimes treated with a course of steroid tablets, such as prednisolone. If your child takes a course of steroids for less than a week, he or she is less likely to have side-effects than if they are taken for longer.
Several other medicines are available as tablets and inhalers, if the standard treatments are not suitable for your child, either because of side-effects or if asthma is still not adequately controlled. These include tablets of montelukast (Singulair), zafirlukast (Accolate), or theophylline (eg Slo-Phyllin).
If your child has poorly controlled asthma, your GP will refer him or her to a specialist in children´s asthma.
In the event of an asthma attack you should:
- give your child his/her reliever treatment immediately, preferably with a spacer
- sit your child down (do not lie them down) and try to relax them
- wait five to 10 minutes - if the symptoms do not go away, you should call your GP or an ambulance but continue giving your child their reliever, preferably with a spacer, every few minutes until help arrives
If you go to hospital, take details of your child´s treatments with you.
Visit your GP after your child is discharged from hospital so you can review their treatment.
Nebulisers make a mist of water and asthma medicine that is breathed in. They can deliver more of the medicine to exactly where its needed than conventional inhalers can.
Nebulisers are often used in hospital, or by the emergency services in the event of a severe attack.
Medicines are only part of the treatment for asthma. Asthma also needs to be managed by dealing with the things that make it worse. Identifying and avoiding the things that trigger your child´s asthma are an essential part of their overall treatment plan.
Keeping a diary to record anything that triggers your child´s asthma can help you to discover a pattern. Frequent occurrence of the following may help identify the trigger.
- Low readings on your child's peak flow meter.
- Disturbed sleep because of coughing or wheezing.
- Missed school or social activities.
The older your child, the more he or she will be able to understand and participate in his/her own asthma management. With good preventative measures and appropriate treatment, most children with asthma lead completely normal lives.
1. My child has just been diagnosed with non-wheezy asthma, what is it?
Non-wheezy asthma is when you have asthma without any wheezing - instead you have a dry cough. This type of asthma can affect both children and adults.
One of the most recognisable symptoms of asthma is wheezing. However, it is possible to have asthma without any wheezing - instead your main symptom is a dry cough. This type of asthma is also called atypical asthma, hidden asthma, cough-variant asthma and cough-type asthma. It's common in families that have a history of allergies, and, although it can affect anyone at any age, it's the most common cause of longterm coughing in children.
The cough is dry and repetitive, and your child can have it during the day and when he or she is in bed at night. You may find that it gets worse if he or she has a cold, when he or she is exercising or breathing in cold air. If your child has any of these symptoms, it's important to see your GP to get a diagnosis and treatment.
Treatment for non-wheezy asthma is the same as for regular asthma. Your child will be prescribed a short-acting beta2 agonist inhaler (reliever) such as salbutamol (eg Ventolin), and/or an inhaled steroid medicine (preventer) such as beclometasone (eg Asmabec).
If you have any questions or concerns about non-wheezy asthma, talk to your GP.
2. Can passive smoking cause asthma in children?
Yes, there is evidence to show that passive smoking can cause asthma and other respiratory symptoms in children.
Passive smoking is when you breathe in other people's second-hand smoke. Passive smoking is potentially harmful to everyone, but especially to children. When children are growing, their lungs are still developing and can be particularly sensitive to pollutants in the air. Babies can also be affected by smoking when they are still in the womb.
It's been found that exposure to tobacco smoke in the home can increase the risk of your child developing asthma and can cause asthma attacks. In children who already have asthma, it can make their symptoms much worse.
All children, whether they have asthma or not, should be kept out of smoky atmospheres. If you have children or are pregnant and smoke, you should consider quitting. Your GP will be able to give you support and advice on how to stop smoking.
If you aren't ready to quit, try not to smoke around your children. Smoke outside rather than indoors. Cigarette smoke can linger for several hours in a room after you have stopped, so your children will continue to be exposed until it has completely disappeared. If you are going to be spending long periods of time with your family (for example, when you are on holiday) try using nicotine replacement gum instead of smoking.
If you have any questions or concerns about passive smoking and asthma, talk to your GP.
3. Can children grow out of their asthma?
Yes, some children who have asthma will have fewer symptoms as they get older and may become symptom-free by the time they are adults.
Asthma affects one in 10 children in Hong Kong. Symptoms can start at any age, but most commonly start at around the age of five. As they get older, most children will experience fewer asthma symptoms, and over half the children who have mild, infrequent symptoms will grow out of the condition altogether.
For children who have asthma symptoms on a regular basis or have chronic asthma, the chances of their condition disappearing when they are older are far less likely. This risk is further increased if your child:
- started getting asthma at an early age and has needed frequent hospital treatment because of his or her symptoms
- has ongoing eczema
- has chronic lung disease
- starts smoking at a young age
If you have any questions or concerns about your child's asthma, talk to your GP.
4. I've heard that breastfeeding helps to prevent asthma in children, is this true?
Yes, research has shown that breastfeeding your baby can help reduce his or her risk of developing asthma.
Breastfeeding your baby has many long-term health benefits. It has been found that breastfeeding can help prevent many health conditions, including ear infections, stomach upsets, eczema and asthma.
Research into the effects of breastfeeding on asthma found that breastfed babies, without a family history of asthma, where less likely to develop asthma than those who were fed on formula milk. For babies with a family history of asthma, the results were less clear
It's recommended that all babies are breastfed for the first six months of their life without any water, other fluids or solid foods. After this time, they can be introduced to solid foods and fluids as well as continuing with breast milk. Breastfeeding should be carried on for a minimum of two years.
If you have any questions or concerns about asthma and breastfeeding, talk to your GP.
- Asthma UK
0800 121 6244
- British Lung Foundation
08458 50 50 20
- Health and Safety Executive (HSE)
0845 345 0055
- Go Smokefree
0800 022 4332
- National Childbirth Trust
0300 33 00 771 (breastfeeding line)
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