Kids Health Info

Asthma

  • Asthma is a common condition caused by narrowing of the small air passages (breathing tubes/bronchi) in the lungs. The narrowing happens because the air passages become swollen and inflamed. This makes it harder for air to get through and causes wheezing, coughing and problems with breathing.

    About one in four children will have wheezing sometime during childhood. With the right medicine and treatment, nearly all children with asthma will be able to join in sport and lead active lives.

    Signs and symptoms

    The most common signs of asthma are:

    • Coughing - which usually happens at night, during the early hours of the morning, when the weather is cool and during exercise.
    • Wheezing - when breathing sounds like whistles.
    • Breathing problems.

    If your child has wheezing, coughing or problems breathing, it is important to talk to your doctor about whether it might be asthma.

    Symptoms of asthma will often go on for two to three days, and sometimes longer. Once the initial attack has improved, your child will need Ventolin three to four times a day until the cough and wheeze are gone.

    Causes

    • The cause of asthma is often not known.
    • Asthma often runs in families.
    • Asthma can be related to other conditions such as eczema, hayfever and allergies.

    Triggers

    There are many different things that can trigger, or start, an asthma attack. While it is not always possible to know when an attack will occur, some common trigger factors are:

    • Colds - The most common trigger that starts an acute attack of asthma is a respiratory (chest) infection caused by a virus. Virus infections are very common in young children and happen about six to eight times a year, and often more frequently. If your child is prone to asthma they are likely to wheeze and cough at these times. If asthma is triggered by a viral infection, your child may have a fever and clear, runny nose. Viruses are not killed by antibiotics. Therefore, antibiotics are not usually needed for acute/sudden attacks of asthma.
    • Exercise.
    • Changes in the weather.
    • Cigarette smoke.
    • House dustmites.
    • Pollens.
    • Pets.

    It would be helpful for you to know what may trigger asthma in your child so you can help avoid it where possible.

    Treatment

    Asthma can be well controlled in nearly all children with the right medicine. The two types of medication used by children are:

    Relievers

    Relievers help during an attack and act quickly. These include:

    • Ventolin (most common), Bricanyl, Respolin

    These are called bronchodilators and have the best effect when they are inhaled. They relax the narrowing of the breathing tubes and make it easier for air to get through.

    For acute/sudden attacks, your child will need Ventolin every two to four hours. If your child needs it more often, you should speak with your doctor.

    • Prednisolone (a type of steroid)

    Prednisolone helps by making the breathing tubes react to Ventolin more. It also reduces the swelling of the lining of the air passages.  Prednisolone is given as a syrup or tablet and will often take about six to eight hours to work. Your child will usually need to take it for two to four days. You may have read about possible side effects from prednisolone. These happen when the medicine is given for months at a time. These side effects will NOT happen when the prednisolone is given for just a few days.

    Preventers

    Preventers help prevent attacks from happening and are usually inhaled, such as:

    • Flixotide, Pulmicort, Singulair (Singulair is a tablet)

    Preventer medicines have to be taken every day.  Not all children need preventer medicine.

    Your child will need to see their local doctor regularly if they have preventer medicines. The doctor will make sure the preventer medicines are working and will adjust the dose of medicine to suit your child's needs.

    Controllers

    When symptoms of asthma cannot be controlled by preventers alone, a group of medicines called symptom controllers, such as Serevant and Formoterol, may also be used. They help in a similar way to Ventolin and Bricanyl but continue working for longer. Sympton controllers are used in addition to preventers, and as a result are often combined into one inhaler. For example, Seretide is a combination inhaler containing Flixotide (preventer) and Serevent (symptom controller). Similarly, Symbicort contains Pulmicort (preventer) and Formoterol (symptom controller). Symptom controllers must never be used by themselves; they must always be used with a preventer.

    Treatment between attacks

    • Most children with asthma who only wheeze when they have a viral infection do not need any treatment between the attacks.
    • Some children cough or wheeze at night, or if they run around or become excited. If these symptoms are happening more than once a week then your doctor might suggest you try a medicine to help prevent asthma.
    • Inhalation is the best way to take most asthma medicines. Spacer devices are much cheaper than nebuliser pumps. If used properly, in most cases they will work just as well.
    • See Kids Health Info factsheet:   Asthma - Use of spacers.

    Care at home

    • You will learn how to manage most attacks of asthma at home.
    • With good treatment, nearly all children with asthma will be able to join in sport and leisure activities and lead active lives.

    Asthma Action Plans

    If your child has asthma, ask your doctor to write down an Asthma Action Plan. The plan will tell you how to prevent asthma attacks and how to manage asthma attacks when they happen. The plan should be kept in a place where you can find it easily.

    Four-Step Action Plan

    1. Sit your child down and remain calm.
    2. Immediately shake a blue reliever puffer and give four separate puffs through a spacer. Give one puff at a time and ask your child to take four breaths from the spacer after each puff.
    3. Wait four minutes. If there is no improvement in your child's asthma repeat step 2.
    4. If still no improvement after four minutes, call an ambulance immediately. State that your child is having an asthma attack. Continuously repeat steps 2 and 3 while waiting for the ambulance.

    Some common questions

    • Do I wake my child for medication if they are asleep?
      Generally no. If you can't hear any coughing or wheezing, then don't wake your child.

    • When do I take my child to the GP or doctor? 
      When you are worried, or if the medications used at home are not working.

    • When do I take my child to the nearest children's emergency department?
      • If your child is finding it difficult to breathe.
      • If your child is unable to talk.
    • How much activity can I let my child do?
      Once properly controlled, your child should be encouraged to take part in all usual activities. There is no need to restrict activity.

    • Will my child grow out of asthma?
      Many children improve as they get older. Discuss this with your doctor.

    • What triggers an asthma attack?
      The most common trigger is a virus infection. Most children get six to eight of these a year.

    Key points to remember

    • Reliever treatment (e.g. Ventolin, Bricanyl, Respolin) should be taken to relieve symptoms of asthma such as coughing, wheezing, or shortness of breath.
    • Preventer treatment (e.g. Pulmicort) should be taken every day, if it has been prescribed by your doctor.
    • Make sure your child knows how to take their asthma medications, and that you understand how to assist them.
    • Make sure your child carries their asthma medication with them at all times.
    • If your child is finding it difficult to breathe, or is unable to talk, or turns blue when coughing, follow your child's Action Plan or the four-step action plan.
    • Ensure people caring for your child know your child has asthma and understand what to do during an asthma attack.
    • Asthma affects each child differently and asthma is unpredictable.

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    Disclaimer
    This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.