Asthma in children

What is asthma?

Asthma is a chronic (long-term) condition that causes difficulty in breathing. The small airway passages in the lungs become narrowed temporarily. This narrowing happens as a result of inflammation and swelling of the airway passages. Asthma can be mild or severe. An episode can last from minutes to hours or even days.

Using an inhaler and spacer to deliver asthma medicines to the airways can help reduce your child's asthma symptoms.

What are the symptoms of asthma in children?

Your child might have asthma if they have trouble breathing, cough or make a wheezy sound when they breathe. They may appear distressed, or tell your that they are having trouble breathing.

A severe asthma attack is very upsetting because your child will feel that they are unable to get enough air.

Symptoms of asthma in children include:

• coughing (especially at night) — this might be your child's only sign
• wheezing and shortness of breath
• chest tightness — this is when you child's breathing feels 'tight'
• lethargy (having low or no energy) or lack of interest in physical activity

Get urgent medical attention if your child has any of the following symptoms:

• difficulty breathing — you will see rapid breaths, inward movement of the chest wall while your child breaths in, and grunting while they breathe out
• inability to speak
• bluish lips — this is a sign that not enough oxygen is reaching their body
• tightness in the chest
• constant coughing or wheezing that does not respond to prescribed medicines

What causes asthma?

The cause of asthma is often not known. There may be a family history of asthma, or your child may have other medical conditions often associated with asthma such as eczema, hay fever or allergies.

Asthma can be triggered by many things. The most common trigger for an acute episode (a sudden 'asthma attack') is a viral infection such as a cold. Asthma can also be triggered by an allergic reaction to a common substance in the air, such as dust, house dust mites, pollen, animal dander (dead skin and fur) or cigarette smoke.

Other triggers for asthma include:

• exercise
• cold air
• certain medicines
• changes in the air environment (such as thunderstorms and bushfire smoke)

Asthma attacks can sometimes be prevented by avoiding triggers. Triggers differ between individuals. Some triggers can be avoided, but you will need to plan how to reduce the effect of others.

When should I see my doctor?

You should see your doctor if your child experiences symptoms of asthma.

Your doctor can assess whether your child has asthma and can help you develop a plan for treating asthma attacks when they occur.

How is asthma diagnosed?

Asthma in children is often diagnosed based on your child's medical history and a physical exam. If your doctor suspects that your child has asthma, they may start your child on a treatment trial. This means that they will give your child medicines used to treat asthma and see if the treatment is effective. If the medicines work, this means that your child most likely has asthma.

Asthma can also be diagnosed in older children using spirometry. Spirometry is a type of lung function test. It measures the amount of air you breathe in and out of your lungs. It also measures how hard and fast you can breathe out.

How is asthma treated?

A key part of managing your child's asthma is working with their doctor to develop an individualised, written asthma action plan for them.

The plan helps you, and others who care for you child, to recognise:

• what triggers your child's asthma
• when and how to take medicine
• what to do if symptoms get worse

The 2 main types of medicines that are prescribed for children with asthma are known as 'relievers' and 'preventers'. Children with more severe asthma may also require 'controllers'.

Relievers help to relieve the symptoms of asthma by opening up the airways and making it easier to breathe. The most commonly used reliever is salbutamol (one brand is Ventolin, but there are others). During an asthma episode, your child may initially need their reliever every 2 to 4 hours. Once your child's asthma has improved, they may need their reliever 3 or 4 times a day.

Preventers help prevent episodes of asthma. Not all children with asthma need preventers. Your child may need preventers if their attacks are severe or often. Preventer medicines need to be taken every day, even when your child is feeling well. Some preventer medicines are taken as inhalers (breathed in through the lungs), while others are taken orally (for example, swallowed as a tablet).

Learning how to use preventers and spacers effectively can help your child manage their asthma.

When asthma symptoms can't be prevented with preventers alone, controller medicines can be added. Examples of controllers include salmeterol and formoterol. Controllers and preventers are often combined into one inhaler.

During an asthma attack, your doctor may also prescribe an oral corticosteroid medicine called prednisolone. This helps to reduce the swelling and inflammation of the airways.

It is also important to understand what may be causing your child's asthma, so you can reduce or remove triggers in the home.

Ask your doctor about aids and tips to help you care for your child at home. It's a good idea to ask about:

• when and how to use medicines
• how to use devices, such as inhalers and spacers, to give your child their medicine effectively

It can also help to keep a diary to record when an asthma medicine is given and when symptoms appear. This can help your doctor know if changes to medicines or doses are needed.

Learn as much about asthma as you can. For more information, call the Asthma Australia Information Line on 1800 278 462 to talk to a trained health professional.

Managing an acute asthma attack

If your child has asthma, you need an emergency action plan, even if their symptoms are usually mild.

If your child has a severe asthma attack:

1. Stay calm and sit your child down.
2. Give your child 4 separate puffs of the reliever inhaler. For each puff of medicine, your child should take 4 deep breaths before you give the next puff.
3. Wait 4 minutes. If there is little or no improvement, repeat step 2 above.

While waiting for the ambulance to arrive, give your child puffs from the inhaler through the spacer as described above. Wait 4 minutes and do it again. Repeat this until the ambulance arrives.

Can asthma be prevented?

Asthma attacks can sometimes be prevented by avoiding certain triggers. For example, if you know that dust mites or animal dander are triggers for your child's asthma, removing these from your home can help prevent attacks. Unfortunately, many other triggers like viral illness or pollen are harder to avoid.

Complications of asthma

Children with asthma can have severe asthma attacks, and sometimes they need to go to the emergency department or even stay in hospital for treatment. It is important to manage asthma well to help prevent frequent and severe attacks.

Should my child with asthma play sport?

Yes. Having asthma is not a reason for children to avoid exercise. It is important that children who have asthma continue to exercise to help them stay fit and healthy. You can help your child manage their asthma while playing sport. Your child's asthma management plan will help with this.

Resources and support

• Asthma Australia has information on symptoms and triggers, as well as asthma education courses and advice for asthma first aid and action plans. Call the Asthma Australia Information Line on 1800 278 462 to talk to a trained health professional.
• The Royal Children's Hospital provides a useful kids asthma fact sheet, available in different languages.
• Log on to the Asthma Buddy app to help keep track of your child's symptoms and get the latest information on asthma.
• Watch National Asthma Council's how-to videos to learn how to use inhalers and nasal sprays correctly.
• Use National Asthma Council's My Asthma Guide for practical strategies to help you understand and manage your child's asthma.