Asthma and Children
Approximately 6.8 million children have been diagnosed with asthma according to the Centers for Disease Control and Prevention (CDC). Asthma is one of the most common, serious, chronic diseases among children, accounting for 13 million absences from school each year. Some other statistics about childhood asthma include:
- Asthma is the third-ranking cause of childhood hospitalizations under the age of 15.
- Asthma is one of the most common chronic illnesses in children.
Although childhood asthma symptoms are the same as adult asthma symptoms, they may not be as noticeable and easy to detect. Wheezing, often a positive indicator of asthma, may not be as noticeable in a child with asthma as in an adult. However, most children who have asthma will cough - a common characteristic of asthma, regardless of age. If your child coughs after running or crying, or during the night, consult a physician for a diagnosis. Your child may have "hidden" (undiagnosed) asthma. Other childhood asthma symptoms may include the following:
- Frequent coughing or respiratory infections, such as pneumonia or bronchitis, may indicate undiagnosed asthma.
- Infants with asthma may have a rattly cough, rapid breathing, and many respiratory infections.
- Chest tightness and shortness of breath, which may lead to severe anxiety, may be a symptom of childhood asthma.
- Unexplained irritability, which may be attributed to the discomfort of the chest tightness, can be a sign of asthma.
The symptoms of childhood asthma may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
Childhood asthma is caused by the child's genetic predisposition and allergies. The majority of children with asthma have allergies. Even exposure to low-grade allergens (those that do not cause significant allergic reactions) may increase the severity of a child's asthma. In addition, allergies may play a role in undiagnosed asthma cases.
The basic cause of the lung abnormality in asthma is not yet known, although healthcare professionals have established that it is a special type of inflammation of the airway that leads to the following:
- contraction of airway muscles
- mucus production
- swelling in the airways
It is important to know that asthma is not caused by emotional factors - as commonly believed years ago. Emotional anxiety and nervous stress can cause fatigue, which may affect the immune system and increase asthma symptoms, or aggravate an attack. However, these reactions are considered to be more of an effect than a cause.
As determined by the National Institutes of Health, the following is a guideline used by physicians to help determine the extent of asthma in your child. It is classified as "steps," because each child may step up or step down to different levels at any time.
The steps are as follows:
- Step 1 or mild intermittent asthma
This group of children has symptoms less than two times a week, do not have problems in between flare-ups, and only have short flare-ups from a few hours to a few days. Nighttime symptoms occur less than two times a month.
- Step 2 or mild persistent
This group of children has symptoms more than two times a week, but no more than one time per day, and may have activity levels affected by the flare-ups. Nighttime symptoms occur greater than two times a month.
- Step 3 or moderate persistent
This group of children have symptoms every day, use their rescue medication every day, may have activity levels affected by the flare-ups, and have exacerbations greater than or equal to two times a week. Nighttime symptoms occur greater than one time a week.
- Step 4 or severe persistent
This group of children has symptoms constantly, have a decrease in their physical activity, and have frequent flare-ups. Nighttime symptoms occur frequently also.
Exercise, such as running, may trigger an asthma attack in the majority of children with asthma. However, with proper management of the child's asthma, a child with asthma can maintain full participation in most sports. Aerobic exercise actually improves airway function by strengthening breathing muscles. Some tips for exercising with asthma include the following:
- Have your child breathe through the nose and not the mouth to warm and humidify the air before it enters the airways.
- Take asthma medication before exercising, as recommended by your physician.
- Carry an inhaler, just in case of an asthma attack.
- Wear an allergy mask during pollen season.
- During cold weather, wear a scarf over the mouth and nose, so that the air breathed in is warm and easier to inhale.
Although more than 6.8 million US children have been diagnosed with asthma, according to the CDC, many others who have asthma go undiagnosed. Children with undiagnosed or "hidden" asthma have symptoms that go undetected. The symptoms may cause a certain degree of airway obstruction (such as wheezing or breathlessness) that can only be detected with pulmonary function testing. If your child experiences frequent respiratory illnesses and airway obstruction, be sure to ask your child's physician about pulmonary function testing to diagnose or rule out asthma.
Currently, there is no cure for asthma. However, like adult asthma, childhood asthma can often be controlled with prescription medications that may help to prevent or relieve symptoms, in addition to education regarding the proper management of asthma.
Persons with asthma can learn to identify and avoid the things that trigger an asthma attack, and educate themselves about medications and other asthma management strategies.
According to the most recent Guidelines for the Diagnosis and Management of Asthma, published by the National Heart, Lung, and Blood Institute (NHLBI), the four components of continually managing asthma include:
- Identify and minimize contact with asthma triggers.
- Understand and take medications as prescribed.
- Monitor asthma to recognize signs when it is getting more severe.
- Know what to do when asthma symptoms become severe.
Working with a healthcare professional is the best way to manage asthma. With the establishment of an asthma management plan, a person with asthma becomes more educated about medications and other preventive measures. The more information a person with asthma has, the better asthma can be controlled.
The use of medications in children is highly individualized based on the severity of the child's symptoms, the age of the child, and the ability of the child to take inhaled medications. The following are the most commonly used medications:
These medications are used to help open the narrowed lungs and may relieve coughing, wheezing, shortness of breath, or difficulty in breathing. These are usually considered "rescue medications" for acute attacks of asthma. Types of bronchodilators are beta-agonists, theophylline, and anticholinergics. These medications come inhaled, in pill form, liquid, or injectables.
The short-acting bronchodilators are used as needed as symptoms occur. Longer acting bronchodilators may be used for maintenance or on a daily basis to help control flare-ups from occurring.
- anti-inflammatory medications
These medications help to decrease the inflammation that is happening in the airways with asthma. These include two types of medications:
- nonsteroidal anti-inflammatory medications
Cromolyn and nedocromil are two types of nonsteroidal medications that are usually inhaled by the child.
These medications can be given in a variety of ways. Some of them are inhaled, while others may be taken as a pill or liquid, or even injections. Talk with your physician about the best choice for your child.
These are a relatively new type of medication being used to help control the symptoms of asthma. These medications help to decrease the narrowing of the lung and to decrease the chance of fluids in the lungs. These are usually given by mouth.
How asthma will affect a child throughout his/her lifetime varies, depending on the child. Many infants and toddlers have an episode or two of wheezing during viral illnesses (cold, flu, etc.). However, the majority of these children do not go on to develop asthma later in life. For some children with persistent wheezing and asthma during childhood, the condition improves during the teenage years. About half of the children who have asthma at a young age appear to "outgrow" it, although the asthma symptoms may reappear later in life. According to the American Academy of Allergy, Asthma, and Immunology, asthma cannot be cured, but can be controlled during life with proper and adequate diagnosis, education, and treatment.
Some children with asthma may need to take their medications during school hours. It is important that the child, family, physician, and school staff all work together toward meeting the child's asthma treatment goals. To ensure optimal asthma care for your child at school, the American Academy of Allergy, Asthma, and Immunology recommends the following:
- Meet with teachers, the school nurse, and other relevant school staff to inform them about your child's condition, special needs, and asthma management plan in case of an urgent or emergent situation.
- Educate school personnel on your child's asthma medications and how to assist during an asthma attack. It is also important to inform them to refrain from altering your child's asthma care management plan in an emergent situation unless approved by your child's physician.
- Ask school staff to treat your child "normally" when the asthma is under control.
- Before starting a physical education class, educate that teacher or coach on exercise-induced asthma.
- Check indoor air quality, allergens, and irritants in the school.
- Take steps to prevent asthma symptoms from starting that could hamper your child's energy level.
- Ensure your child's emotional well-being by reassuring him/her that asthma does not have to slow him/her down or make him/her different from the other children.
Preventing allergy-induced asthma attacks by avoiding triggers that cause the allergy may be complicated. Allergens that cause an allergic reaction can by anywhere, depending on your child's specific allergy. Triggers of childhood asthma may include:
- inhaled irritants, such as secondhand smoke
- certain weather conditions, such as cold air
- physical expressions of emotion, such as crying, laughing, or yelling
Eliminating these allergens may include:
- Keep the house as clean and dust-free as possible.
- Cover your child's bed with a spread during the day, to minimize dust build-up in the bedding and pillows.
- Remove stuffed animals, books, ornate furniture, wool blankets, knickknacks, feather pillows, blinds, draperies, and other dust collectors from your child's room.
- Put plastic coverings on pillows and mattresses to avoid exposure to mold. Feather and foam rubber pillows should be avoided, and pillows should be replaced each year.
- Change out the water in humidifiers, dehumidifiers, and vaporizers daily to prevent mold build-up.
- Keep bathrooms clean and ventilated, and disinfect them with a fungicide once a week to prevent mold build-up.
- Keep the windows closed and use the air conditioning to avoid bringing outdoor air inside. Be sure to change the filters on the air conditioning and furnace often.
- Remove carpets, or use a tight-weave carpet.
- Avoid cats and dogs.
- Keep your child indoors for a couple of hours after the grass has been mowed.
- Avoid the outdoors during peak pollen season. During the day, try to avoid being outside during peak pollen hours. To find out when the peak pollen season and hours are, check your local newspaper or television news station for a daily report.
- Remove dead plants and dried flowers to avoid airborne debris.
However, with proper management of the asthma, such as avoiding triggers, taking prescribed medications, monitoring for warning signs, and knowing what to do during an asthma attack, a child with asthma can conduct a healthy and active lifestyle.
Having asthma does not have to mean having less fun than other adolescents. However, if you are sensitive to certain allergens, such as cigarette smoke, perfumes, or after-shaves, be sure to tell your friends and dates in advance.
It is important to tell friends and dates what triggers the asthma, such as cigarette smoke or even perfumes or after-shaves, depending on your sensitivity. In addition, make sure to continue taking the asthma medication as prescribed. If you have exercise-induced asthma, you may need to take your preventive medicine before participating in any physical activities, such as dancing. Always consult your physician if you have questions about your asthma.
It is very important to be honest with your child about his/her disease, the severity of the disease, and the use of medications. Always remember as your child grows, independence is an important goal for a child. They do no want to be different, yet they will need guidance and supervision on any restrictions they might have.
This age group relies completely on the parents. They understand little about the disease. The most important factor with this age group is to make medication time a fun one, while stressing the importance of taking the medications. Let them assist in any way possible.
- school age
This group has an increased ability to understand their disease and its impact. They should be taught about their medications, how to exercise restriction, and how to avoid their triggers. They should be allowed to play with peers and monitor their own symptoms.
Generally, teens resist having to take chronic medications, do not like having restrictions on their life, and do not want to be different. It is crucial to involve your teen in every aspect of the management of his/her asthma. They should help with goal setting and help decide which medications work best for them. Asthma "contracts" can be used to give the teen control, but allow for supervision from the parents.