Asthma in Children

Definition

• Wheezing: a high-pitched whistling sound produced during breathing out
• Recurrent attacks of wheezing, coughing, chest tightness, and difficulty in breathing
• Often associated with sneezing and a runny nose
• Usually no fever
• Also called reactive airway disease (RAD)

Causes

Asthma is an inherited type of “twitchy” lung. The airways go into spasm and become narrow when allergic or irritating substances enter them. Viral respiratory infections trigger most attacks, especially in younger children. If asthma is caused by pollens, the asthma only flares up during a particular season. Asthma often occurs in children who have other allergies such as eczema or hay fever. Although an emotional stress can occasionally trigger an attack, emotional problems are not the cause of asthma. Some common triggers are listed under “Prevention.”

Expected Course

Although asthma attacks may be frightening, they are treatable. When medicines are taken as directed, the symptoms are reversible and there are no permanent lung changes. Although asthma can be a long-lasting disease, over half of children outgrow it during adolescence.

Home Care

Asthma is a chronic disease that requires close follow-up by a physician who coordinates your child’s treatment program. If you have any doubt about whether your child is wheezing, start the following asthma medicines. The later medicines are begun, the longer it takes to stop the wheezing. Once medicine is begun, your child should keep taking it until he has not wheezed or coughed for 48 hours (should take medicine for 7 days minimum). If your child has one or more attacks of wheezing each month, he probably needs to be on continuous medicines.

Asthma Inhalers

Your child’s metered-dose inhaler will come with directions. You will need to carefully follow the instructions on how to use the inhaler.
1. The canister must be shaken.
2. The inhaler should be held 2 inches in front of the open mouth.
3. Your child should breathe out completely.
4. The spray should be released at the start of slowly breathing in.
5. The breath should be held for 10 seconds after the lungs are filled.
6. Wait 10 minutes before taking the second puff.

NOTE:

These inhalers usually can’t be coordinated by children less than 6 years old unless you also use a plastic airway spacer (or chamber).

Oral Asthma Medicines

Although inhaled medicines work best for asthma, some children also need to take medicines by mouth.

Begin Treatment Early

Many children wheeze soon after they get coughs and colds. For some children, itching of the neck or chest means an asthma attack will soon begin. If this is the case for your child, start the asthma medicine or inhaler at the first sign of any coughing or itching. The best “cough medicine” for a child with asthma is the asthma medicine. Always keep this medicine handy; take it with you on trips. If your supply runs low, obtain a refill.

Fluid Intake

Fluids keep the normal lung mucus from becoming sticky. Encourage your child to drink one glass of some fluid every 2 hours while awake (½ glass in children under 5 years of age). Clear fluids are best. Sipping warm fluids may improve the wheezing.

Exercise-induced Asthma

Most people with asthma also get 20 to 30 minute attacks of coughing and wheezing with strenuous exercise. Running, especially in cold air, is the main trigger. This problem should not interfere with participation in most sports nor require a physical education excuse. The symptoms can be prevented by using an oral asthma medicine 90 minutes before exercise or an inhaler 10 minutes before exercise. Children with asthma usually have no problems with swimming or sports not requiring rapid breathing.

Going to School

Asthma is not contagious. Your child should go to school during mild asthma attacks but avoid physical education on these days. Arrange to have the asthma medicines available at school. If your child uses an inhaler, he should be permitted to keep it with him so he can use it readily. For continued wheezing, your child should be seeing a physician on a daily basis.

Common Mistakes

The most common mistake is delaying the start of asthma medicines or not replacing them when they run out. Nonprescription inhalers and medicines are not helpful. Another common error is keeping a cat that your child is allergic to. Also, prohibit all smoking in your home; tobacco smoke can persist for up to a week. In addition, don’t panic during asthma attacks. Fear can make tight breathing worse, so try to remain calm and reassuring to your child. Finally, don’t let asthma restrict your child’s activities, sports, or social life.

Prevention By Avoiding Asthma Triggers

Try to discover and avoid the substances that trigger attacks in your child (consider strong odors such as cologne, exhaust fumes, and frying foods). Routinely avoid common triggers such as feather pillows and tobacco smoke. Try to keep pets outside or at least out of your child’s room. Learn how to dust proof your child’s bedroom. Change the filters on your hot air heating system or air conditioner regularly. If there has been any recent contact with grass, pollen, weeds, or animals that your child might be allergic to, the pollen remaining in the hair and clothing is probably keeping the wheezing going. Have your child shower, wash his hair, and put on clean clothes.

Call our office immediately if:

• The wheezing is severe.
• The breathing is labored.
• Your child is unable to sleep or speak.
• The lips are bluish or dusky.
• Pain develops in the chest or neck.
• The medicines are vomited.
• The wheezing is not improved after the second dose of asthma medicine.

Within 24 hours if:

• Fluid intake is poor.
• Your child has congested sinuses or a yellow nasal discharge.
• The theophylline medicine may be causing vomiting or stomach pain.
• You feel your child is getting worse.

During regular hours if:

• The wheezing is not completely cleared by 5 days.
• Your child has been hospitalized within the past year for asthma.
• You have other questions or concerns.