Tips for Managing Asthma in Children

Asthma is the most common chronic disease of childhood, with about six million children between 3 and 17 years of age estimated to have the condition. While the number of asthma attacks in American children has been on the decline over the last 10 years, about half of children with asthma still have an asthma flare-up every year. Here’s what to know about childhood asthma, including how to avoid and manage potential triggers. 

What Is Asthma? 

Asthma is a persistent inflammatory condition in the tubes that carry air to the lungs. Those with asthma have airways that are narrow, irritated, and inflamed, even when typical asthma symptoms aren’t present. Because of this chronic smoldering inflammation, airways are oversensitive and can easily spasm or become blocked when triggered.

What Are the Symptoms of Childhood Asthma? 

While asthma symptoms vary, they often include coughing, wheezing, and difficulty breathing. If your child is experiencing these symptoms, their provider can help uncover if asthma is the culprit. Providers will ask questions about how often your child experiences illnesses, if their daily activity or sleeping is affected by symptoms, whether they cough in their sleep, and if there is a family history of asthma or other respiratory conditions. 

Signs that your child is experiencing chronic inflammation in the lungs includes wheezing with physical exertion, coughing persistently in their sleep, prolonged cough for weeks following every viral cold, and a tendency to have wheezing with allergies or upper respiratory tract illnesses. 

An “asthma attack” refers to the sudden spasm and acute tightening of all of the airways due to the immune system’s over-activation to a trigger. This tightening makes it hard to get air into the lungs, but even harder to fully exhale the air out of the lungs. This causes the child to feel their chest is “tight,” and the air that is moving whistles through the tiny swollen airways causing the characteristic wheezing sound. To compensate, a child might frequently cough short dry coughs or breathe faster and more shallowly than normal. These symptoms should be your parental trigger to give your child’s rescue medication and get your child to medical attention right away.

If your child is old enough, they may also be tested for asthma using an in-office test called spirometry to assess their lung function (typically for children ages 7 and older). For this test, your child will breathe into a device that determines whether there is an airway limitation caused by inflammation. If necessary, additional testing could include imaging tests and more complex lung function testing. Any child who has asthmatic symptoms more than twice a week should seek treatment to control inflammation of the airways.

What Are Common Asthma Triggers? 

There are several common triggers that your child can avoid in order to reduce symptoms and prevent an asthma attack. Common triggers include: 

• Viral infections: Whenever your child is sick, it can cause an asthma flare-up. Viral respiratory illnesses like the cold, RSV, and influenza can cause symptoms that are harder to manage with your child’s typical treatments, known as treatment failure. If your child needs to use rescue inhaler more often than usual during a sickness, it’s important to contact their provider. 
• Indoor allergens: There are several things in your home that can trigger a child’s asthma including dust mites, cockroaches, mice, and pet dander. To minimize triggers, wash bedding weekly with hot water, keep their environment dust-free, and use a dehumidifier when possible. If your child has a specific pet allergy, avoid the animal and keep it out of the bedroom to prevent asthma attacks. 
• Outdoor allergens: Pollen and mold are seasonal triggers, particularly in the warmer months. If your child is exposed to a known outdoor trigger, like pollen or grass, be sure to bathe them after being outside. Keep an eye on air quality reports, and keep your child indoors when possible if the air quality is poor. 
• Cold air: When it starts to get cold outside, sudden changes in temperature (such as leaving a warm house and going outdoors) can trigger a spasm and potential asthma attack. Dry air, and even air conditioners, can also dry out and irritate the lungs. If your child is having more flare-ups due to changes in the weather, their medication may need to be adjusted, and should be discussed with their provider.
• Exercise: Many kids with asthma develop wheezing and tightness in their chest during or after exercise. If your child has exercise-induced asthma flares, their provider may recommend taking albuterol via an inhaler up to a half hour before exercise.
• Secondhand cigarette smoke: Children exposed to tobacco smoke have more severe asthma, worse wheezing, and longer lasting symptoms. All children should avoid being around secondhand tobacco smoke. If you smoke, it’s important to quit for your and your household’s health.
• Stress: If your child is highly affected by stress and anxiety, their asthma may be triggered. If you’re concerned about how stress is affecting your child and contributing to their asthma, speak with their provider about mental and physical health. 

What is the Treatment for Asthma? 

There are two types of inhalers for asthma treatment, and since they act differently on the lung tissue, it’s critical to know which of your child’s inhalers should be used daily and which is only for exacerbations/attacks. 

Many people with asthma will need a daily inhaler containing a small dose of steroid. This keeps the immune system’s inflammatory status normal rather than persistently over-reactive. By calming the hyperactive immune system in this way, it’s much less likely to have an asthma attack occur quickly, even when a known trigger is encountered. This inhaler should be taken daily whether the child is well or sick. 

Albuterol is a medication that causes the muscles around the main airway to relax quickly in an acute asthma attack. It does not act upon the inflammation status of the immune system at all, and its effect lasts only about four hours. 

Inhaler treatments get to the lungs most effectively by using a spacer (a plastic tube that enables your child to inhale the medication appropriately without having to time their inhale with the release of the inhaler. 

Do Children Grow Out of Asthma? 

Most children who have asthma tend to have it for life; however, it often improves with age. The key to keeping symptoms in check is by using control medicine as prescribed, ensuring you always have medication available at the home and with the child, and knowing which inhaler treats the daily asthma vs. asthma attacks.

If your child has asthma, it’s important to follow their provider’s instructions if they are prescribed medication. It’s estimated that about half of children prescribed asthma medication don’t use it as regularly as recommended. If you have any questions about your child’s symptoms, triggers or medication, schedule an evaluation with their provider or specialist.