Childhood asthma

Childhood asthma

From MayoClinic.com
Special to Health

Introduction

Childhood asthma has become more widespread in recent decades. As the most common chronic illness in children, childhood asthma causes more missed school and places more limits on activity than any other disease.

Childhood asthma and adult asthma have the same underlying cause — continuous inflammation of the airways leading to the lungs. This inflammation makes the airways overly sensitive and prone to tightening and constricting when irritated. Fortunately, childhood asthma is treatable. With the right medications and action plan, a child with asthma can enjoy normal activities with few disruptions.

Signs and symptoms

The most common signs and symptoms of childhood asthma are:

• Coughing
• Wheezing
• Shortness of breath
• Chest congestion
• Chest tightness

Additional signs and symptoms of asthma in infants include:

• Rattly cough
• Recurrent bronchitis with croup, bronchiolitis or pneumonia

While wheezing is most commonly associated with asthma, not all children with asthma wheeze. Likewise, not all children who have wheezing episodes have asthma. Your child may have only one sign or symptom, such as a lingering cough or chest congestion. Because symptoms of asthma can be related to other disorders and illnesses, your doctor will consider frequency of the symptoms along with other factors before making a diagnosis.

Causes

In children with asthma, the airways leading to the lungs are chronically inflamed and often swollen. This makes the airway muscles sensitive and reactive. Asthma triggers, such as smoke or allergens, can make the airway muscles tighten and constrict and may cause asthma symptoms. Triggers are different for everyone. The most common triggers include:

Irritants

• Tobacco smoke
• Exercise
• Weather changes or cold air
• Environmental pollutants

Allergens

• Dust mites
• Pet dander
• Pollen
• Mold

Other factors

• Upper respiratory infections
• Rhinitis or sinusitis
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into the esophagus

Risk factors

Both genetic and environmental factors can increase your child's chances of having asthma. Children with a family history of asthma are at greater risk of developing the disease. Other environmental factors that may increase your child's chances of developing asthma include:

• Previous allergic reactions (stuffy nose or skin rash) to environmental allergens
• Exposure to tobacco smoke
• Living in a large urban area with increased exposure to environmental air pollutants
• Family history of asthma, allergic rhinitis (hay fever), hives or eczema
• Low birth weight
• Obesity

When to seek medical advice

If you suspect your child may have asthma, it is important that your child be evaluated by a doctor as soon as possible. Make an appointment if you notice:

• Coughing that's constant, intermittent or associated with physical activity
• Wheezing or whistling sounds when your child exhales
• Shortness of breath or rapid breathing that may or may not be associated with exercise
• Complaints of chest tightness
• Repeated respiratory infections such as pneumonia or bronchitis

Pay attention to cues from an older child, who may say, "My chest feels funny" or "I'm always coughing." Asthma can be worse at night, so listen for coughing during sleep or coughing that wakes your child in the night. Coughing and wheezing may also accompany crying, laughing, yelling or strong emotional reactions and stress.

Emergency care for an asthma attack
Even if your child hasn't been diagnosed with asthma, seek medical attention immediately if he or she has any trouble breathing. Although episodes of asthma vary in severity, attacks typically start with coughing, which progresses to wheezing and rapid breathing. In the most severe cases, you can see your child's chest and sides pulling inward as he or she struggles to breathe. Increased heart rate, sweating and chest pain also may occur. A severe asthma attack is a medical emergency. Seek emergency care if your child is:

• Breathing so hard that he or she has to stop in midsentence to catch his or her breath
• Using abdominal muscles to breathe
• Widening the nostrils when breathing in
• Laboring so hard to breathe that the abdomen is sucked under the ribs when he or she breathes in

Screening and diagnosis

Asthma is a very individual condition. Your child's doctor will consider the nature and frequency of symptoms along with results from screening tests to rule out other diseases before diagnosing asthma.

First, the doctor will ask for a detailed description of your child's symptoms and ask about your family history of asthma or allergic diseases such as eczema, hives or hay fever.

In children 6 years of age and older, doctors diagnose asthma with the same tests used to identify the disease in adults. Pulmonary function testing (spirometry), which measures the amount of air inhaled, is key to the diagnosis. Your child may have pulmonary function tests at rest, after exercising and after taking asthma medication. Allergy tests also may be part of the evaluation.

While it is possible for infants and toddlers to have asthma, it may be difficult for your doctor to diagnose because tests aren't accurate before 6 years of age. Some children also simply outgrow asthma-like symptoms — 80 percent of infants with wheezing episodes have no signs of asthma by age 3. Your doctor will rely on detailed information about symptom type and frequency when considering an asthma diagnosis in a young child. Sometimes a diagnosis is not made until later, after months or years of symptom observation.

Complications

Treatment for persistent asthma includes inhaled corticosteroids, which reduce the chronic inflammation in the airways. High doses of these medications have been associated with slightly slowed growth in children, but research has shown that the effect is minor and possibly reversible. Nevertheless, your child's doctor should monitor growth and consider dosage or medication changes if any measurements are concerning.

Treatment

The goal of asthma treatment is to get the asthma under control. Well-controlled asthma means that your child has:

• Minimal or no symptoms
• Few or no attacks
• No limitations on physical activities or exercise
• Minimal use of fast-acting inhalers
• Few or no side effects from medications

Treating asthma involves both preventing asthma symptoms and treating an asthma attack in progress. Preventive medications reduce the inflammation in your child's airways that can lead to symptoms. "Relief" medications quickly open airways that are swollen and limiting breathing. If your child has symptoms more than twice a week before starting treatment, the doctor will probably prescribe a combination of long-term anti-inflammatory drugs and a fast-acting bronchodilator.

Anti-inflammatory drugs
The most widely used and effective anti-inflammatory medications for asthma are inhaled corticosteroids, which have a relatively low risk of side effects and reduce the need for additional medications. Inhaled corticosteroids, which are taken every day, include fluticasone (Flovent HFA), beclomethasone (Qvar), budesonide (Pulmicort Turbuhaler) and mometasone (Asmanex). Another anti-inflammatory drug (Advair), combines an inhaled corticosteroid (fluticasone) and a long-acting inhaled bronchodilator (salmeterol). Other long-term control medications are available and might be suitable for your child, such as montelukast (Singulair), zafirlukast (Accolate), theophylline and inhaled cromolyn (Intal).

Bronchodilators
Short-acting bronchodilators — often called "rescue" medications — stop the symptoms of an asthma attack in progress. The most commonly used short-acting beta-2 agonist for asthma is albuterol (Proventil HFA, Ventolin HFA). If you find your child needs to use the bronchodilator more than two times a week, adjustments may need to be made to long-term medications to maintain better control.

For children younger than age 3 who have symptoms of asthma, many times doctors will use a "wait-and-see" approach. This is because the long-term effects of asthma medication on infants and young children are unknown. If an infant or toddler has frequent or severe wheezing episodes, a course of medication may be prescribed to see if the wheezing improves symptoms. Newer delivery devices with face masks make it possible for even infants and toddlers to use metered dose inhalers. Children younger than 2 months, however, usually need to use a nebulizer to take medication for asthma. A nebulizer is a machine that turns liquid medication into fine droplets. Your baby wears a face mask and breathes normally while the nebulizer delivers the correct dosage of medication, converting it to a fine mist for your child to breathe in.

Your child's symptoms and triggers are likely to change over time, so treatment should be evaluated periodically to ensure that the asthma is controlled. The doctor may adjust dosages — up and down — over a period of time before finding the right treatment for your child.

Prevention

Careful planning and steering clear of asthma triggers are the best ways to prevent asthma attacks.

• Avoid triggers. As much as possible, avoid the allergens and irritants that your child's doctor has identified as asthma triggers.
• Ban smoking around your child. Exposure to tobacco smoke during infancy is a strong risk factor for childhood asthma, as well as a common trigger of asthma attacks.
• Encourage your child to be active. As long as your child's asthma is well controlled, regular physical activity can condition the lungs to work more efficiently.
• Have a plan. Work with your child's doctor to develop an asthma action plan, and make sure all of your child's caregivers — child care providers, teachers, coaches, and the parents of your child's friends — have a copy.
• Use a peak flow meter. This tool can detect decreases in lung function before your child feels any symptoms, giving you important information on how to treat your child's asthma from day to day.

Coping skills

It can be stressful to manage a chronic condition like asthma in your child. Keep these tips in mind to make life as normal as possible:

• Encourage normal play and activity. Don't limit your child's activities out of fear of an attack. Work with your doctor until you're confident that the asthma is under control.
• Make treatment a regular part of life. If your child has to take daily medication, don't make a big deal out of it — it should be as routine as eating breakfast or brushing teeth.
• Be calm and in control when facing asthma symptoms. Don't get rattled if you see asthma symptoms progressing. Focus on the asthma action plan and involve your child in each step so that he or she understands what's happening.