Essential Drug List

  Asthma in Children

Asthma is the leading cause of chronic illness in children. It affects as many as 10%-12% of children in the U.S. and, for unknown reasons, is steadily increasing. It can begin at any age, but most children have their first symptoms by age 5.

What Makes a Child More Likely to Develop Asthma?

There are many risk factors for developing childhood asthma. These include:

• Presence of allergies
• Family history of asthma and/or allergies
• Frequent respiratory infections
• Low birth weight
• Exposure to tobacco smoke before and/or after birth
• Being male
• Being black
• Being raised in a low-income environment

Why Are More Children Getting Asthma?

No one really knows why more and more children are developing asthma. Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution, and second-hand smoke.

Others suspect that children are not exposed to enough childhood illnesses to build up their immune system. And still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.

How Can I Tell if My Child Has Asthma?

Signs and symptoms to look for include:

• Frequent coughing spells, which may occur during play, at night, or while laughing. It is important to know that cough may be the only symptom present.
• Less energy during play
• Rapid breathing
• Complaint of chest tightness or chest "hurting"
• Whistling sound (wheezing) when breathing in or out
• See-saw motions (retractions) in the chest from labored breathing. Shortness of breath, loss of breath
• Tightened neck and chest muscles
• Feelings of weakness or tiredness

Keep in mind that not all children have the same asthma symptoms, and these symptoms can vary from episode to episode in the same child. Also note that not all wheezing or coughing is caused by asthma.

In kids under 5 years of age, the most common cause of asthma symptoms is upper respiratory viral infections such as the common cold.

If your child has problem breathing, take him or her to the doctor immediately for an evaluation.

How Is Asthma Diagnosed In Children?

Asthma is often difficult to diagnose in infants. However, in older children the disease can often be diagnosed based on your child's medical history, symptoms, and physical exam.

• Medical History and Symptom Description. Your child's doctor will be interested in any history of breathing problems you or your child may have had, as well as a family history of asthma, allergies, a skin condition called eczema, or other lung disease. It is important that you describe your child's symptoms -- cough, wheezing, shortness of breath, chest pain or tightness -- in detail, including when and how often these symptoms have been occurring.
• Physical Exam. During the physical examination, the doctor will listen to your child's heart and lungs.
• Tests. Many children will also have a chest X-ray and pulmonary function tests. Also called lung function tests, these tests measure the amount of air in the lungs and how fast it can be exhaled. The results help the doctor determine how severe the asthma is. Generally, children younger than 5 are unable to perform pulmonary function tests. However, it is often difficult to obtain accurate pulmonary function tests in children. Thus doctors rely heavily on history, symptoms and examination in making the diagnosis.

Other tests may also be ordered to help identify particular asthma triggers. These tests may include allergy skin testing, blood tests, and X-rays to determine if sinus infections or gastro esophageal reflux disease is complicating asthma.

How Is Asthma Treated In Kids?

Based on your child's history and the severity of asthma, his or her doctor will develop a care plan, called an "asthma action plan." The asthma action plan describes when and how your child should use asthma medications, what to do when asthma gets worse, and when to seek emergency care for your child. Make sure you understand this plan and ask your child's doctor any questions you may have.

Your child's asthma action plan is important to successfully controlling his or her asthma. Keep it handy to remind you of your child's daily asthma management plan, as well as to guide you when your child develops asthma symptoms.

In addition to following your child's asthma action plan, you want to make sure exposure to asthma triggers is limited, and preferably avoided.

What Asthma Medications Can Children Take?

If an infant or child is experiencing symptoms of asthma requiring treatment with a bronchodilator more than twice a week, most doctors recommend daily anti-inflammatory medication.

Asthma medications that are given to adults and older children can also safely be prescribed to toddlers and younger children. Medications that are approved for younger children are given in doses adjusted for their age and weight. In the case of inhaled medications, a different delivery device based on the child's age and ability may be required.

How Do I Give My Child Asthma Medication?

You will probably give your child asthma medications using a home nebulizer, also known as a breathing machine. A nebulizer delivers asthma medications, usually bronchodilators, by changing them from a liquid to a mist. Your child gets the medicine by breathing it in through a facemask. These breathing treatments usually take about 10-15 minutes and are given several times a day. Your child's doctor will tell you how often to give your child breathing treatments, based on the severity of his or her asthma.

Like some toddlers, your child may be able to use a metered dose inhaler (MDI) with a spacer. A spacer is a chamber that attaches to the MDI and holds the burst of medication. This allows your child to breathe the medication into his lungs at his own pace. Talk with your child's doctor to see if an MDI with spacer is right for your child.

How Do I Know When My Child's Asthma Is Well Controlled?

You know your child's asthma is well controlled if, with medications, your child:

• Lives an active, normal life
• Has few troublesome symptoms
• Attends school every day
• Performs daily activities without difficulty
• Stops urgent visits to the doctor, emergency department, or hospital
• Controls asthma by adjusting his or her medication with little or no side effects

By learning about asthma and how it can be controlled, you take an important step toward managing your child's disease. We encourage you to work closely with your child's asthma care team to learn all you can about asthma, how to avoid triggers, what medications do, and how to correctly give them. With proper care, your child can live free of asthma symptoms and maintain a normal, healthy lifestyle.

Will My Child Outgrow Asthma?

Once a person's airways become sensitive, they remain that way for life. However, about 50% of children experience a noticeable decrease in asthma symptoms by the time they become adolescents, therefore appearing to have "outgrown" their asthma. About half of these children will develop symptoms again in their 30's and/or 40's. Unfortunately, there is no way to predict whose symptoms will decrease during adolescence and whose will return later in life.

What Do I Do When My Child Has an Asthma Attack?

If your child is showing symptoms of an asthma attack:

• Give your child his/her reliever medicine according to the asthma action plan.
• Wait 5-15 minutes. If the symptoms disappear, your child should be able to resume whatever activity they were doing. If symptoms persist, follow your child's asthma action plan for further therapy. If your child fails to improve or you are not sure what action to take, call your child's physician.
• Danger signs are severe wheezing, severe coughing, trouble walking and/or talking or blue lips and/or fingernails. If any of these are present go to the emergency department or call 911.

Learn how to help your child manage an asthma attack at school.

Refresh your memory. Read the basics on asthma.

View the full table of contents for the asthma guide.

Reviewed by the doctors at The Cleveland Clinic Department of Allergy and Immunology. Edited by Charlotte E. Grayson, MD, June 2003.

Copyright ©2003, The Cleveland Clinic.