By Laura Gerald MD, MPH.

It’s the middle of the night and instead of sleeping peacefully, your child is coughing and having difficulty breathing.

This can be a very frightening experience, but if your child has asthma, this can also be a common scenario. The encouraging thing is that there are several steps you can take to help control your child’s asthma. This article outlines those steps.

How to know if your child has asthma

First we should review what asthma is and how you would know if your child has it. Asthma is one of the most common chronic illnesses of childhood. It is a disease characterized by inflammation in the lungs. It causes periodic and recurring episodes of difficulty breathing that usually result from some sort of trigger. What you may notice in your child is coughing, shortness of breath, chest tightening and working very hard to breathe, or wheezing. These symptoms may be most noticeable or worse at night. Asthma may run in families and occur with other diseases or conditions such as allergies or skin problems like eczema or atopic dermatitis.
Most people with asthma develop symptoms before they reach school age. However, a diagnosis may be delayed because there is no single test for asthma. A healthcare provider would make the diagnosis based upon the patient’s history of symptoms, physical examination, and perhaps by the results of a lung function test if the child can perform one. Once a child is diagnosed with asthma, many parents wonder if they will grow out of it. This can be tricky to predict because a lot of pre-school age children may exhibit some signs of asthma, like wheezing, but may not ultimately have the disease. So it is true that some children who wheeze when they are smaller stop wheezing as they get older. However, children who wheeze because of asthma, many of whom also have allergies and a family history of asthma, will not grow out of the disease.

The best thing to do if you think your child may have asthma is to see their healthcare provider.

Regular Asthma Check ups

If your child has asthma, it is important to have regular asthma check ups. These asthma visits may be needed as often as one to four times a year depending upon how severe the disease is. During the visits your healthcare provider can review how often your child has symptoms and what may be triggering them, and can make changes in medications if needed. They may also recommend that your child see a specialist.

Avoiding things that make asthma worse

Most asthma attacks or exacerbations are triggered by something. It is important to try to identify what your child’s triggers are so that those things can be avoided or minimized. Examples of common triggers include viral infections such as colds, house dust mites, smoke, pollen or other allergens in the air, animals, exercise, air pollution, and changes in weather.

Some triggers may be avoided. For example, it can be helpful to decrease humidity or mold in your home, and use special covers on mattresses and pillows to reduce dust mites. Never allow smoking in your home. Other suggestions are to remove upholstered furniture, carpet, and stuffed or live animals from the rooms of children with asthma. Some triggers may be treated. For example, it may help to take medicines to reduce symptoms of allergies.

Avoiding triggers should not mean that your child cannot be active. Physical activity and sports are not just allowed but encouraged. There are Olympic and professional athletes who have asthma, so if your child is having difficulty with exercise, an adjustment in medications and simple preventive techniques may be all that is needed to allow participation. For example, your child may need to take medicine and warm up just before physical activity.

Medications for asthma

Asthma is a serious but treatable condition. Medications are generally safe and effective in preventing asthma attacks and in treating them if they occur. Some people with asthma only have intermittent symptoms and may only need to take quick reliever medicine as needed. Other people with asthma have more severe or persistent symptoms and have to take medicines every day to help control symptoms and prevent asthma attacks. It is important to understand whether medicines are to be taken daily or as needed. It is also important to be able to recognize worsening symptoms, and to know when to seek medical help immediately. It may be helpful to have these instructions on a written asthma action plan.  

Asthma medicines may come in the form of pills, inhalers, or nebulization solutions. Your child may also have additional asthma equipment like peak flow meters and spacers for inhalers. These devices and techniques may be confusing, but it is important to know the proper way to take medicine and use asthma equipment. Not taking medicines as prescribed and not using equipment properly may result in more frequent asthma attacks for your child. Inform your child’s doctor or pharmacist if you need help understanding their medicine or equipment.

Goals of asthma treatment

Most children with asthma can lead a normal, active life. It can be challenging to take medicines every day and avoid things that make asthma worse, but the rewards of controlling asthma are greater than the sacrifices. With well controlled asthma, your child can participate in sports and other physical activity, sleep through the night, go to school without missing days, and avoid the disruption of frequent emergency room visits or hospital stays. Although there is currently no cure, remember that asthma can be controlled.

Reference: National Asthma Education and Prevention Program Expert Panel Report 3. Guidelines for the Diagnosis and Management of Asthma. Summary Report 2007. U.S. Department of Health and Human Services: National Institutes of Health; National Heart, Lung, and Blood Institute.

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