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Asthma in children

Published by Bupa's health information team, September 2008.

This factsheet is for parents of children who have asthma, or who would like information about it.

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.

Animation - How an asthma attack occurs
Symptoms of asthma
Causes of asthma
Diagnosis of asthma
Treatment of asthma
Asthma attacks - what to do
Living with asthma
Questions and answers
Related topics
Further information
Sources

How an asthma attack occurs

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About asthma

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.

Symptoms of asthma

The symptoms of asthma may be mild, moderate or severe. They may include:

coughing
wheezing
shortness of breath
tightness in the chest

These symptoms tend to be variable and may stop and start. They are usually worse at night.

Causes of asthma

The exact cause of asthma isn't 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.

Diagnosis of 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.

Treatment of asthma

Asthma can't 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.

Medicines

Inhalers

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 isn't 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 doesn't 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's 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.

Other medicines

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're 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.

Nebulisers

Nebulisers make a mist of water and asthma medicine that is breathed in. They can deliver more of the medicine to exactly where it's needed than conventional inhalers can.

Nebulisers are often used in hospital, or by the emergency services in the event of a severe attack.

Nebulisers aren't available on the NHS in England and Wales as they are not recommended for regular use for most children. Some nebulisers are available on the NHS in Scotland for certain children with very severe asthma, so please contact your GP for advice.

Asthma attacks - what to do

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 (don't lie them down) and try to relax them
wait five to 10 minutes - if the symptoms don't 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.

Living with asthma

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.