About asthma in children
What is asthma in children?
In childhood asthma, the lungs and airways become easily inflamed when exposed to certain triggers, such as inhaling pollen or catching a cold or other respiratory infection. Childhood asthma can cause bothersome daily symptoms that interfere with play, sports, school and sleep. In some children, unmanaged asthma can cause dangerous asthma attacks.
Childhood asthma isn't a different disease from asthma in adults, but children face unique challenges.
What are the symptoms for asthma in children?
Common childhood asthma signs and symptoms include:
- Frequent Coughing that worsens when your child has a viral infection, occurs while your child is asleep or is triggered by exercise or Cold air
- A whistling or Wheezing sound when breathing out
- Shortness of breath
- Chest congestion or tightness
Childhood asthma might also cause:
- Trouble sleeping due to shortness of breath, Coughing or wheezing
- Bouts of Coughing or Wheezing that get worse with a Cold or the flu
- Delayed recovery or Bronchitis after a respiratory infection
- Trouble breathing that hampers play or exercise
- Fatigue, which can be due to poor sleep
asthma signs and symptoms vary from child to child, and might get worse or better over time. Your child might have only one indication, such as a lingering Cough or chest congestion.
It can be difficult to tell whether your child's symptoms are caused by asthma. Periodic or long-lasting Wheezing and other asthma-like symptoms can be caused by infectious Bronchitis or another respiratory problem.
What are the causes for asthma in children?
Childhood asthma causes aren't fully understood. Some factors thought to be involved include:
- Inherited tendency to develop allergies
- Parents with asthma
- Some types of airway infections at a very young age
- Exposure to environmental factors, such as cigarette smoke or other air pollution
Increased immune system sensitivity causes the lungs and airways to swell and produce mucus when exposed to certain triggers. Reaction to a trigger can be delayed, making it more difficult to identify the trigger. Triggers vary from child to child and can include:
- Viral infections such as the common cold
- Exposure to air pollutants, such as tobacco smoke
- Allergies to dust mites, pet dander, pollen or mold
- Physical activity
- Weather changes or cold air
Sometimes, asthma symptoms occur with no apparent triggers.
What are the treatments for asthma in children?
Initial treatment depends on the severity of your child's asthma. The goal of asthma treatment is to keep symptoms under control, meaning that your child has:
- Minimal or no symptoms
- Few or no asthma flare-ups
- No limitations on physical activities or exercise
- Minimal use of quick-relief (rescue) inhalers, such as albuterol (ProAir HFA, Ventolin HFA, others)
- Few or no side effects from medications
Treating asthma involves both preventing symptoms and treating an asthma attack in progress. The right medication for your child depends on a number of things, including age, symptoms, asthma triggers and what seems to work best to keep his or her asthma under control.
For children younger than age 3 who have mild symptoms of asthma, the doctor might use a wait-and-see approach. This is because the long-term effects of asthma medication on infants and young children aren't clear.
However, if an infant or toddler has frequent or severe wheezing episodes, a medication might be prescribed to see if it improves symptoms.
What are the risk factors for asthma in children?
Factors that might increase your child's likelihood of developing asthma include:
- Exposure to tobacco smoke, including before birth
- Previous allergic reactions, including skin reactions, food allergies or hay fever (allergic rhinitis)
- A family history of asthma or allergies
- Living in an area with high pollution
- Respiratory conditions, such as a chronic runny or stuffy nose (rhinitis), inflamed sinuses (sinusitis) or pneumonia
- Heartburn (gastroesophageal reflux disease, or GERD)
- Being male
Is there a cure/medications for asthma in children?
Long-term control medications
Preventive, long-term control medications reduce the inflammation in your child's airways that leads to symptoms. In most cases, these medications need to be taken daily.
Types of long-term control medications include:
Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex HFA), ciclesonide (Alvesco), beclomethasone (Qvar Redihaler) and others. Your child might need to use these medications for several days to weeks before getting the full benefit.
Long-term use of these medications has been associated with slightly slowed growth in children, but the effect is minor. In most cases, the benefits of good asthma control outweigh the risks of possible side effects.
- Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). They help prevent asthma symptoms for up to 24 hours.
Combination inhalers. These medications contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include fluticasone and salmeterol (Advair Diskus, Advair HFA), budesonide and formoterol (Symbicort), fluticasone and vilanterol (Breo Ellipta), and mometasone and formoterol (Dulera).
In some situations, long-acting beta agonists have been linked to severe asthma attacks. For this reason, LABA medications should always be given to a child with an inhaler that also contains a corticosteroid. These combination inhalers should be used only for asthma that's not well-controlled by other medications.
- Theophylline. This is a daily pill that helps keep the airways open. Theophylline (Theo-24) relaxes the muscles around the airways to make breathing easier. It's mostly used with inhaled steroids. If you take this drug, you'll need to have your blood checked regularly.
- Immunomodulatory agents. Mepolizumab (Nucala), dupilumab (Dupixent) and benralizumab (Fasenra) might be appropriate for children over the age of 12 who have severe eosinophilic asthma. Omalizumab (Xolair) can be considered for children age 6 or older who have moderate to severe allergic asthma.
Quick-relief medications quickly open swollen airways. Also called rescue medications, quick-relief medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your child's doctor recommends it.
Types of quick-relief medications include:
- Short-acting beta agonists. These inhaled bronchodilator medications can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA). These medications act within minutes, and effects last several hours.
- Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. They can cause serious side effects when used long term, so they're only used to treat severe asthma symptoms on a short-term basis.
Treatment for allergy-induced asthma
If your child's asthma is triggered or worsened by allergies, your child might benefit from allergy treatment, such as the following, as well:
- Omalizumab (Xolair). This medication is for people who have allergies and severe asthma. It reduces the immune system's reaction to allergy-causing substances, such as pollen, dust mites and pet dander. Xolair is delivered by injection every two to four weeks.
- Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.
- Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your child's immune system reaction to specific allergens.