Kids Health Info

Asthma

  • Asthma is a common condition caused by narrowing of the small air passages in the lungs. The narrowing happens when air passages become swollen and inflamed, causing more mucus to be produced. In addition, the muscle bands around the air passages become tighter. These changes make it harder for air to get in and out of the lungs, and cause wheeze, cough and problems with breathing.

    Wheezing is very common in babies and toddlers, but not all children with wheeze go on to develop asthma. About one in four children will be diagnosed with asthma sometime during childhood.

    With the right treatment, nearly all children with asthma will be able to join in sport and lead active lives. Children with asthma should have an Asthma Action Plan that will tell you how to prevent asthma episodes (sometimes called asthma attacks) and how to manage asthma episodes when they happen.

    Asthma can be unpredictable, and affects each child differently. Many children will grow out of their asthma.

    Signs and symptoms of asthma

    Common signs that your child is having an episode of asthma are:

    • Breathing problems – your child might be out of breath at rest, feel tightness in the chest, have to work hard to breathe, or be unable to complete full sentences due to feeling out of breath. They might seem to be lacking energy.
    • Wheezing – when your child’s breathing sounds like whistles.
    • Coughing – this usually happens at night or early hours of the morning; when the weather is cool; and during exercise. Cough alone does not mean asthma.

    The above are the symptoms of a mild asthma episode. These symptoms will often go on for two to three days, and sometimes longer. Most asthma episodes are mild.

    In a severe episode of asthma:

    • your child might struggle to breathe, become very distressed, exhausted or even limp
    • you may see deep sucking movements at their throat or chest as they try to breathe.

    Call an ambulance immediately in a severe episode of asthma.

    What causes asthma?

    The cause of asthma is often not known. It can run in families, and some children's asthma is related to other conditions, such as eczema, hay fever and allergies.

    There are many things that can trigger an asthma episode. The most common trigger is a respiratory infection caused by a virus, such as a cold. Other common asthma triggers include:

    • exercise
    • changes in the weather or windy conditions
    • dust mites in the house, pollens or pets.

    Cigarette smoke, even on clothes or furniture, can trigger an asthma episode, so do not allow anyone to smoke in your home or around your child.

    While it is not always possible to know when an episode will occur, it is helpful for you to know what may trigger your child’s asthma, so you can try to avoid it.

    When to see a doctor

    If your child has problems breathing, wheezing or coughing, it is important to take them to the GP to discuss whether it might be asthma. If your child has asthma, ask your GP to create an Asthma Action Plan. The plan will tell you how to prevent asthma episodes and how to manage episodes when they happen.

    Treatment – Asthma Action Plans

    Your child's Asthma Action Plan should be kept in a place where you can find it easily. Make sure anyone caring for your child knows your child has asthma and understands what to do during an asthma episode.

    Prevention is the most important part of treatment. Avoid triggers that commonly result in an asthma episode, and keep other conditions like hay fever and eczema under control.

    The two types of medication most often used by children with asthma are relievers and preventers. In some more serious cases, controllers may be required.

    Relievers

    Relievers help open up the airways to make it easier to breathe. They relax the narrowing of the breathing tubes and make it easier for air to get through, relieving the symptoms of asthma. They work very quickly – usually in minutes. The most common reliever medication is salbutamol, commonly known as Ventolin.

    During an episode of asthma, your child will need their reliever every two to four hours. Once the initial episode has improved, your child will need to keep taking the reliever three to four times a day until the cough and wheeze are gone.

    Your GP may also prescribe prednisolone (a type of steroid). This helps by making the breathing tubes more responsive to Ventolin. It also helps prevent the lining of the air passages from swelling or restricting.

    Preventers

    Preventers help prevent episodes of asthma from happening. Flixotide or Pulmicort are preventers that are inhaled, and Singulair is a preventer in tablet form. Preventer medicines have to be taken every day.

    Not all children need preventer medicine. If your child is showing symptoms of asthma more than once a week, your GP may suggest preventer medicine. Children taking preventers need to see the GP regularly, to make sure the medicines are working well. The GP will adjust the dose of medicine as needed. 

    Controllers 
    When symptoms of asthma cannot be controlled by preventers alone, a group of medicines called symptom controllers, such as Serevent and Formoterol, may also be used. They help in a similar way to Ventolin and Bricanyl, but are long-acting. Symptom controllers are always used in addition to preventers, and are often combined into one inhaler. 

    Giving asthma medicine

    Inhalation is the best way to take most asthma medicines. Nebulisers are machines that change liquid medication into a vapour that can be inhaled through a mask or mouthpiece. Most children will use spacer devices with puffers, which work just as well as nebulisers. Spacer devices are cheaper, faster and much more portable than nebulisers, which are usually used in hospitals and ambulances.

    Make sure your child knows how to take their asthma medications, and that you understand how to assist them. See our fact sheet Asthma – use of spacers.

    Make sure your child carries their asthma medication with them at all times.

    What to do during an episode of asthma

    If your child is having an asthma episode, follow the advice in your child’s Asthma Action Plan, or follow the below 4x4x4 asthma first aid steps:

    1. Sit your child comfortably upright and remain calm.
    2. Shake a blue reliever puffer and give four separate puffs through a spacer, if available. 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 there is still no improvement, call an ambulance immediately. State that your child is having an asthma emergency. Continuously repeat steps 2 and 3 while waiting for the ambulance.

    Key points to remember

    • Ask your doctor for an Asthma Action Plan.
    • Reliever treatment should be taken to relieve symptoms of asthma.
    • Preventer treatment 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 has an asthma episode, follow their Asthma Action Plan or the 4x4x4 asthma first aid steps.
    • Call an ambulance if your child’s symptoms get worse very quickly, or if they are severely short of breath, unable to talk, or their lips turn blue.

    For more information

    Common questions our doctors are asked

    Do I wake my child for her asthma medication if she is asleep?

    Generally no. If you can't hear any coughing or wheezing, and they are not working hard to breathe comfortably, then don't wake your child.

    When do I take my child to the GP or doctor?

    If you are using reliever medications frequently and think a preventer might be helpful, see your GP. Always see your GP when you are worried, or if the medications used at home are not working.

    When do I take my child to the nearest emergency department?

    If your child is finding it difficult to breathe or if your child is unable to talk. Call an  ambulance if there is minimal improvement after taking a reliever.

    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.

    Should my child go on antibiotics when he gets a cold, to prevent an asthma attack from happening?

    Colds are respiratory infections caused by a virus. Viruses are not killed by antibiotics. Therefore, antibiotics are not used to prevent episodes of asthma. Your GP will prescribe antibiotics for your child if they have a chest infection that is caused by a bacteria.

    Is it safe to give my child prednisolone?

    You may have heard about possible side effects from prednisolone. These side effects happen when the medicine is given for months at a time, and will not happen when the prednisolone is given for just a few days.


    Developed by The Royal Children's Hospital. We acknowledge the input of RCH consumers and carers.

    Reviewed May 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

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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.