Asthma In Children

What is asthma?

• Asthma is a long-term condition of inflammation (irritation, redness, and swelling) in the airways of the lungs. The airways are small tubes where air passes through to go in and out of your child's lungs. When your child's airways are inflamed, they may react more easily to things that irritate them. When this happens, your child's airways constrict (become narrow) and less air flows to his lungs. Because children's airways are smaller than those in adults, it takes less constriction and swelling to block air flow. When your child has asthma, he may have asthma attacks (episodes of asthma). These are times when your child's symptoms are worse than usual.
  
  
• During an asthma attack, the muscles around your child's airways tighten and constrict. His airways become more swollen, causing them to make more mucus. The increased swelling, tightening, and extra mucus narrow the airways even more, making it harder to breathe. A very bad asthma attack is known as an asthma exacerbation. With these attacks, your child's symptoms last longer and are more serious. Many children have asthma and increasing numbers of new children are diagnosed with it every year. There is no cure for asthma but it can be controlled. Having your child's asthma treated will relieve his symptoms and let him lead an active life.

What are the types of asthma?

Asthma can range from mild (not serious) to severe (very bad). Your child's caregivers determine the type of asthma your child has by looking at several things. These include when and how often your child has asthma attacks and how long they last. They also look at the effect your child's symptoms have on his activities. If your child has asthma, he will have one of the following types of asthma:

• Intermittent: Your child may have symptoms that come and go. He may have coughing, wheezing, and trouble breathing two days a week or less. He may have these symptoms at night twice a month or less. His asthma attacks may last minutes to hours, and symptoms may be mild, moderate, or severe. In between attacks, your child may have no symptoms and is able to breathe easily.
  
  
• Mild persistent: Your child's symptoms may come more than twice a week but not for two days in a row. He may have these symptoms at night, 2 to 4 times a month or less often than that. His asthma attacks may last for minutes or hours. Your child's symptoms may be bad enough and come often to slow him down in doing his usual activities.
  
  
• Moderate persistent: Your child may have symptoms every day. He may have symptoms at night more than once a week but not nightly. His asthma attacks may last for hours or days. These symptoms may be bad enough to prevent him from doing any activity.
  
  
• Severe persistent: Your child may have daytime and nighttime symptoms that do not go away for almost the whole day. His symptoms may last for many days and may get worse over time. His symptoms limit his ability to do physical activities such as playing. There are times when your child may need to be taken to the hospital for treatment.

What causes asthma?

• The exact cause of asthma is not clear. In children, asthma often comes with the child having allergic-type problems. These include problems tolerating certain foods, having skin reactions, and getting allergy-related nose and eye irritations. Caregivers think that your child may have been born with genes that are linked with getting asthma. Genes are little pieces of information that tell the body what to do or make. Having these genes may make him more likely to get the condition. Asthma can happen early in your child's life when something sets it off. Asthma may start when your child is exposed to an allergen (thing that causes allergy) or respiratory infection. Asthma may also be triggered by breathing in a lung irritant, such as cigarette smoke.
  
  
• Asthma comes with inflammatory responses that happen both right away and later on. Certain cells, called mast cells, found in the airways lead to these responses. Mast cells release chemicals that cause the airways to swell and the muscles around them to tighten. Leukotrienes are a type of very powerful chemical that are released by cells in the lungs during asthma attacks. These chemicals cause the signs and symptoms of asthma. Chemicals called cytokines are released later on. These chemicals cause chronic (long-lasting) inflammation in the small airways. Chronic inflammation leads to permanent damage in your child's small airways, making it harder for him to breathe.

What may increase my child's risk of having asthma?

• Environment: This includes staying in closed and crowded places where the flow of air is not so good. Poor air flow may lead to build up of dirt, dust, chemicals, and smoke. Your child may breathe in more of these things.
  
  
• Family history: Asthma can be passed by parents to their children. Your child's risk of having asthma increases if a parent or other family member has asthma or atopy. Atopy is a condition in which a person easily gets allergies from different things. These conditions damage your child's airways and lungs and lead to having an asthma attack.
  
  
• Medical problems: Having lung infections, sinusitis, and atopy. These conditions damage your child's airways and lungs, and make them react easily to things. Conditions, such as gastroesophageal reflux disease (GERD), may also damage your child's airways and increase his risk for asthma. GERD is a condition where stomach acid goes up (wrong way) and may reach your child's airways.

What may trigger an asthma attack or make it worse?

Certain things may irritate your child's airways and cause them to overreact. Things that may cause your child to have an asthma attack may be different for other children. Any of the following may trigger an asthma attack in your child or make it worse:

• Activities: These include having too much stressful activity, or having too many things to do at home or school. An asthma attack may happen after a heavy physical activity, such as playing sports or doing exercise. It may happen when your child shows strong emotions, such as fear, anger, or hard crying or laughing.
  
  
• Allergens: Allergens include pollens, molds, cockroach droppings, and dust mites. These also include dander (flakes of dead skin) from animals and pets, such as cats and dogs. Certain foods, such as eggs and sea foods, may also cause allergies.
  
  
• Changes in temperature or humidity: Humidity is the amount of moisture present in the air. Very cold or very hot weather, high or low humidity, or wind can make your child's asthma worse.
  
  
• Irritants: These are things that hurt or bother your child's airways and lungs. Irritants include air pollution, chemical fumes, strong odors (scents or smells), and dusts. Smoke from tobacco, or wood-burning stoves or fireplaces can also irritate your child's lungs.
  
  
• Medical problems: An asthma attack may be triggered by infections, such as a cold, the flu, or lung or sinus infections. If your young child gets this type of infection, he can have a bad asthma attack. It may also be caused by GERD, or by nose or sinus irritation caused by allergies.
  
  
• Medicines: These include non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, and certain heart medicines.

What are the signs and symptoms of asthma?

Most children with asthma will have signs of it by the time they are five years old. Your child's symptoms may come and go, and may change between better or worse as he grows older. How often your child has asthma attacks may depend on the season and certain times of the year. Your child may have any of the following:

• Coughing: This is a frequent sign of asthma. It is often worse at night or early in the morning.
  
  
• Signs of allergies: A red, runny and clogged nose, and itchy and teary eyes. Your child may also have dry, red, itchy or flaking skin.
  
  
• Trouble breathing: Your child's chest may feel tight and he may have a hard time breathing. He may be taking hard, fast, and deep breaths. Your child may be hunching his shoulders to force air in and out of his lungs. His chest may look puffed up because his lungs cannot fully empty when he breathes out.
  
  
• Trouble doing certain activities: Asthma attacks slow down your child during sports, school trips, or exercise. He can get very tired easily with just a little physical activity. He may need to slow down or stop to catch his breath often. Your child may also have trouble playing wind or brass musical instruments. He may not be able to study well, or to keep up with his friends or classmates.
  
  
• Trouble sleeping: Coughing and breathing problems may cause your child to have a hard time falling asleep. He may wake up during the night or early in the morning because of coughing. This can make him feel very tired and sleepy the next day.
  
  
• Wheezing: This is a high-pitched whistling or squeaky sound that is heard when your child breathes.

What are the early warning signs of an asthma attack?

Your child may have warning signs before an asthma attack happens. Warning signs are signs and symptoms that your child feels when his asthma is getting worse. These warning signs are not the same for every child. Your child's own warning signs may even be different from time to time. You and your child should learn what his usual warning signs are. By learning his warning signs, your child can take his medicines, or get help right away. Doing this may help prevent serious asthma attacks. Warning signs of an asthma attack may be one or more of the following:

• Breathing faster than normal.
  
  
• Coughing.
  
  
• Fast heartbeat.
  
  
• Fussy, irritable, or feeling more tired and sleepy than usual.
  
  
• Pain or tight feeling in the chest.
  
  
• Shortness of breath (cannot catch his breath), causing trouble doing an activity or speaking in long sentences.

How is asthma diagnosed?

Your child's caregiver will ask about your child’s health and details of his symptoms. He may ask what your child’s symptoms are, which activities cause them, and how bad and often they occur. He may ask if your child has been in the hospital for asthma treatment. He may also ask about your child's and family's medical conditions, such as allergies or lung infections. Tell your child’s caregiver what medicine or other treatments have been used for your child’s symptoms. Your child’s caregiver will do a physical exam to check for conditions that may be causing his symptoms. Your child may also need one or more of the following tests:

• Allergy testing: These tests help find out the things to which your child is allergic. These tests will help you and your child know what things to avoid. Your child's caregiver will put drops of different liquids on your child's skin. These liquids contain things that often cause allergies in people. These may include pollens, foods, and certain chemicals. He will use a needle to prick the skin under these drops and then wipe the drops off. If the skin where the drop was gets red and swells, this may mean that your child is allergic to that food or substance. Ask your child's caregiver for more information about other types of allergy tests.
  
  
• Blood tests: Your child may need blood tests to check for infections or other medical problems. These may help show other possible causes for your child's asthma, or if another condition is making it worse.
  
  
• Bronchoprovocation testing: This test measures how much air your child can breathe out as fast as he can. This is measured twice and is done first before he breathes in a chemical. Your child is then asked to breathe in a chemical which can give him a mild asthma attack. After 10 minutes, your child's caregiver will measure how much air he breathes out. If the amount of air he breathes out decreases, it is likely that your child has asthma.
  
  
• Chest x-ray: This is a picture of your child's lungs and heart. A chest x-ray may be used to check your child's heart, lungs, and chest wall. It can help caregivers diagnose your child's symptoms, or suggest or monitor treatment for medical conditions.
  
  
• Peak flow testing: This test measures your child's peak expiratory flow (PEF) using a peak flow meter (small tube-shaped device). PEF is the air your child blows out of his mouth. It shows how fast he can move air out of his lungs, which is usually decreased during an asthma attack. Your child may be given this test when he is old enough to follow instructions for it. This test can usually be given to children older than five years of age. It is important that your child uses his peak flow meter correctly to get accurate measurements. Ask your child's caregiver how to correctly use a peak flow meter and read PEF results.
  
  
• Pulmonary function tests: These tests, also called PFTs, help your child's caregiver learn how well your child's lungs work. PFTs may also help your child's caregiver choose the best treatment for him. Your child may be given these tests when he is old enough to follow instructions for them. During the tests, your child will breathe into a mouthpiece connected to a machine. The machine measures how much air he breathes in and out over a certain period of time. This helps your child's caregiver to see how well your child's lungs are moving and working.

How is asthma treated?

Your child's caregiver will work with you and your child to make a written action plan for him. This plan contains your child's treatment instructions, including what medicines to take and when.

• Medicines: Your child may be given pretreatment (preventive), rescue (quick-relief), or controller medicines for his asthma. Ask caregivers for information about the medicines your child needs. He may need one or more of the following:
  
  
  • Short-acting bronchodilators: Short-acting bronchodilators may be given to your child to help open his airways. These medicines start to work right away and are used to relieve sudden, severe symptoms, such as trouble breathing. These medicines may be called relievers or rescue inhalers.
    
    
  • Long-acting bronchodilators: Long-acting bronchodilators may be called controllers. This medicine helps open the airways over time, and is used to decrease and prevent breathing problems. Long-acting bronchodilators should not be used to treat your child for sudden, severe symptoms, such as trouble breathing.
    
    
  • Leukotriene inhibitors: These medicines can decrease the swelling in your child’s lungs. They may stop your child from having more wheezing or shortness of breath. They may also prevent your child’s attacks from lasting for long periods.
    
    
  • Mast cell stabilizers: Mast cells are found in the smaller tubes in your child’s lungs. They are in charge of releasing some chemicals that can cause your child’s airways to narrow. This kind of medicine may help prevent your child’s lungs from having more swelling.
    
    
  • Corticosteroids: These medicines help decrease swelling and open your child's air passages so he can breathe easier. They can be inhaled (breathed in) or taken by mouth (swallowed). Your child may need higher doses of corticosteroids if he has very bad asthma attacks. Give this medicine as ordered by your child's caregiver. Stopping this medicine without the caregiver's OK may cause a bad response.
  
  

What are inhalers?

Inhalers are devices that give your child’s medicine in a mist form that he can breathe into his lungs. Your child's caregiver will help choose the best type of inhaler for your child . Ask your child’s caregiver for more information about inhalers and how to use one correctly. Your child may need to use one or more of the following types of inhalers:

• Metered dose inhaler: This is a small, often tube-shaped, device that holds liquid asthma medicine. To use it, your child should hold the open end inside his mouth. The liquid medicine comes out as a mist when he presses a switch. Your child breathes in this mist through his mouth, and it goes to his airways and lungs. Your child may use a spacer with this inhaler. A spacer is a large tube which holds the mist inside it before your child breathes it in. This helps your child get the right amount of medicine. Ask your child's caregiver for more information about how to use a metered dose inhaler.
  
  
• Nebulizer: This inhaler changes liquid asthma medicine into a mist. A long tube goes from the machine to a small round chamber (container) that holds liquid asthma medicine. The liquid turns into a mist once the machine is turned on. Your child breathes in this mist through an opening on the chamber.
  
  
• Dry powder inhaler: This is a small tube or disc shaped device which contains powder asthma medicine. Your child should hold the open end of it inside his mouth. When he presses a switch, the powder is released inside. With this type of inhaler, your child must breathe in hard to suck in the powder. The powder goes through his airways and reaches his lungs. Ask your child's caregiver for more information about how to use a dry powder inhaler.

How can I help control my child's asthma or help him prevent asthma attacks?

• Avoid asthma triggers. Your child needs to stay away from things that trigger an asthma attack or make his symptoms worse.
  
  
  • Foods: Do not let your child eat foods to which he is allergic. Tell other people with whom he may eat or share meals about his food allergies.
    
    
  • Smoking: Never smoke cigarettes or tobacco products around your child or let others smoke around him. Do not let your adolescent-aged (teenager) child smoke cigarettes.
    
    
  • Remove triggers in your child's living areas: You child's caregiver may recommend taking things out of your child's bedroom and other areas of your home. These are things that could hold allergens or other asthma triggers. This may include removing carpeting, fabric-covered furniture, drapes, and stuffed animals.
    
    
    • Bedding: Keeping your child's bedding free of allergens and irritants may help improve his asthma. You may need to use special covers for your child's mattresses and pillows. These covers do not let dust mites pass through or live inside the pillow or mattress. Wash your child's bedding at least once a week in very hot water (at least 130 degrees).
      
      
    • Cleaning: You may want to clean your floors and carpets with a vacuum that traps dust and allergens. Try not to use harsh cleaning products in your home that give off irritating fumes.
      
      
    • Pets: Keep pets, such as cats and dogs, out of your child's bedroom and outside if possible. Cat dander is a bad asthma trigger for many children.
      
      
    • Pests: If you have cockroaches or other insect or rodent pests in your home, get rid of them right away. Clean the floors and other surfaces in your home often to remove dead pest parts and droppings.
      
      
    • Reduce triggers in the air: Keep windows closed during the seasons when pollen and molds are at the highest, such as spring. Make sure air flows freely through all the rooms in your house. Use air conditioning to control the temperature and humidity in your house. Keep your child away from wood burning stoves and fireplaces, and from chemical fumes (gas vapors) and dust. You may want to use special filters on your furnace to help clean the air inside your house.
  
  
• Follow the written action plan for your child and teach him about it. An action plan is the plan made by your child's caregiver for controlling your child's asthma. Keep a copy of this action plan with you and with your child at all times. Meet with your child's school nurses, teachers, coaches, and give them a copy of your child's action plan. Make a kit with a copy of the action plan and the medicines your child would need in case of an asthma attack.
  
  
• Help your child use his medicines exactly as ordered by his caregiver. If your child is given controller medicines, make sure he uses them as ordered by his caregiver. Your child should carry his rescue inhaler with him at all times.
  
  
• Protect your child from getting respiratory infections. Keep your child away from people with colds and the flu. He may also need vaccines to help protect his body from infection. Ask your child's caregiver if your child should get shots to help prevent the flu and pneumonia.

What information should be included in my child's asthma action plan?

An action plan is the plan made by your child's caregiver for controlling your child's asthma. Keep a copy of this action plan with you and with your child at all times. Meet with your child's school nurses, teachers, coaches, and give them a copy of your child's action plan. Make a kit with a copy of the action plan and the medicines your child would need in case of an asthma attack. The plan should include the following:

• Early warning signs and symptoms: These are the early signs your child often shows when his asthma is starting to get worse. These may include a drop in your child's peak flow meter reading. Other signs, such as chest tightness, coughing, shortness of breath, and wheezing may also be included.
  
  
• Asthma triggers: The plan should include a list of triggers that may cause your child's asthma attack. This can help you and your child know which triggers to avoid.
  
  
• Medicines and dosage amount to give: The medicine information should include a list of all the medicines your child takes regularly to control his asthma. It should also include a list of rescue (quick-relief) medicines to give if your child has an asthma attack. It should also include instructions on how and when to use each medicine. Help your child use his medicines exactly as ordered by his caregiver.
  
  
• Treatment instructions for worsening symptom: These should explain what your child's symptoms may be and how to know if his asthma is getting worse. It should tell you how to increase his medicines if his asthma symptoms get worse. It should also tell you when you should call 911 or seek immediate care for your child.
  
  
• Emergency contact telephone numbers: These include the telephone numbers for you and your family members. This should also include numbers for your child's caregiver, an ambulance service, and the nearest hospital.
  
  
• When to follow up with your child's caregiver: Information about when to follow up with your child's caregiver should be easy to find. If you are not sure or this information is missing, ask your child's caregivers.

When should I call my child's caregiver?

Call your caregiver if:

• Your child is coughing more than the usual, wheezing, and has trouble breathing.
  
  
• Your child's medicines do not relieve his symptoms like they used to.
  
  
• Your child's symptoms slow him down or stop him from doing certain activities.
  
  
• You and your child have questions or concerns about your child's condition or medicines.

When should I seek immediate care?

Seek immediate care or call 911 if:

• Your child is having a bad asthma attack and cannot catch his breathe even after taking his rescue medicine.
  
  
• Your child has trouble thinking or loses consciousness.
  
  
• Your child has very bad pain in his chest.
  
  
• Your child's lips or fingernails turn gray or blue.

Where can I find support and more information?

Having asthma can be hard for your child and your family. Learning more about your child's condition can help control his asthma. You and your child may want to join a support group with other people who have asthma. If your child has moderate or severe asthma, he may want to attend an American Lung Association asthma summer camp. Contact the following for more information:

• American Academy of Allergy, Asthma, and Immunology
  555 E. Wells St, Suite 1100
  Milwaukee , WI 53202-3823
  Phone: 1- 800 - 822-2762
  Web Address: http://www.aaaai.org
  

• National Asthma Education and Prevention Program
  National Heart, Lung and Blood Institute
  National Asthma Education and Prevention Program
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/about/naepp/
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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