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. It is harder for air to get through, making it harder to breathe and causes wheezing, coughing and problems with breathing.

About one in four children will have wheezing sometime during childhood. Different things trigger asthma attacks for different children. It is not always possible to know when an attack will occur but some common triggers are colds, exercise, changes in weather, cigarette smoke, dustmites, pollens and pets. It would be helpful for you to know of anything that triggers asthma in your child so you can avoid them where possible.

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:

Cough - coughing usually happens at night, during the early hours of the morning, when the weather is cool, and during exercise.
Wheeze 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 2 to 3 days, or sometimes more. Once the initial attack has improved, your child will need Ventolin 3 to 4 times a day until the cough and wheeze are gone.

Causes

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

Triggers

There are many different things that can start or trigger an asthma attack. 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 6 to 8 times a year, and often more frequently. If your child is prone to asthma he is 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, and so these medicines are not usually needed for acute attacks of asthma.
Exercise
Changes in the weather
Cigarette smoke
House dustmites
Pollens
Pets

It would be helpful for you to know of anything that triggers asthma in your child, so that you can avoid it where possible.

Treatment

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

1/ Relievers - help during an attack and act quickly, such as:

Ventolin (most common), Bricanyl, Respolin.

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

For acute attacks, your child will need Ventolin every 2 to 4 hours. If your child needs it more often, you should consult your doctor.

Prednisolone (a type of steroid).

It helps by making the breathing tubes react more to Ventolin. 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 6 to 8 hours to work. Your child will usually need it for 2 to 4 days. You may have read about 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 a few days.

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

Becotide, Intal, Becloforte, Flixotide, Tilade, Pulmicort.

Preventative 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 preventative medicines. They willmake sure that they are working and adjust the dose of medicine as needed.

Treatment between attacks

Most children with asthma who only wheeze with viral infections do not need any treatment between the attacks.
Some children have cough or wheeze at night, or if they run around. 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 they work just as well in most cases.
See factsheet: Asthma 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.
Read factsheet: Asthma Spacers

Asthma Action Plans

If your child has asthma, then 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

Sit your child down and remain calm.
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.
Wait four minutes. If there is no improvement in your child’s asthma repeat step 2.
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 cough or wheeze, then don't wake your child.
When do I take my child to the general practitioner?
When you are worried, or if the medications given 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 6-8 of these a year.

Key points to remember

Relieving treatment (eg Ventolin, Bricanyl, Respolin) should be taken to relieve symptoms of asthma such as cough, wheeze, or shortness of breath.
Preventative treatment (eg Intal, Becotide, Becloforte, Pulmicort ), should be taken every day, if it has been prescribed by your doctor.
Make sure you and your child know how to take asthma medications.
Make sure your child has their asthma medication with them at all times.
If your child is finding it difficult to breathe, or is unable to talk, or turning blue when coughing, follow your child’s Action Plan or the four-step action plan.
Ensure people caring for your child know that they have asthma and what to do during an asthma attack.
Asthma affects each child differently and asthma is unpredictable.

For more information

Factsheet: Asthma Spacers
Talk to your family doctor

Developed by the RCH Dept of General Medicine. First published 2000. Reviewed September 2008.