Asthma and Children
Asthma is one of the most common chronic diseases among children. It is estimated that one in every 10 children suffers from some form of asthma. Common symptoms are chronic cough, wheezing and shortness of breath.
What are the differences between children and adult asthma?
Infants or children do not know how to tell doctors their condition, which is an important difference between them and adult patients. Asthma symptoms include persistent cough (especially after waking up in the morning or when sleeping at night), breathlessness and wheeze; but sometimes not all of them are present in a patient. Chronic coughing, for example, may be the only symptom present among children. Parents need to pay attention to the daily condition of their children so they can provide doctors with more information that will help with the diagnosis.
Is wheezing the same as asthma?
Wheezing is a whistling sound when breathing. It is often described as a hissing sound. But it is not the same as asthma. Wheezing may be caused by many factors, among which viral bronchitis is the most common. Viral bronchitis has symptoms similar to those of asthma. Even doctors may not be able to differentiate between these two conditions immediately when making a clinical diagnosis. Infants with skin allergy, eczema, nasal allergy or those having allergy-prone parents are more likely to develop asthma. Recurrent wheezing may also be an indicator of the disease.
Wheezing in some infants may be caused by inhaled foreign objects, heart failure, congenital malformation of the trachea or gastro-esophageal reflux (acid reflux). These symptoms must not be overlooked and advice should be sought from doctors promptly.
When is the onset of asthma?
The median age for asthma onset is about four years. But some infants show asthma symptoms before they turn one. The age of onset is related to genetic factors or the environment. Many people start to develop the disease in adulthood.
Is total recovery possible with asthmatic children?
Sixty percent of children will outgrow their asthma before reaching adulthood. Generally speaking, it is easier for children with mild or occasional symptoms to recover fully. But more than 20 percent of patients have relapse when they become adults.
Are asthma drugs safe?
Many people are concerned whether asthma drugs are addictive, whether drug tolerance develops after long-term use and whether there are many side effects with the inhaled steroids.
In fact, asthma drugs are safe to use if you follow the doctor’s instruction properly. Likewise, preventive, anti-inflammatory medicines for long-term use are safe and effective to control asthma, reducing the number of attacks and related symptoms. The drugs are not addictive and tolerance will not develop over long-term use.
Most preventive drugs are inhaled. There are also oral tablets and liquids. Use inhalation medicine with a holding chamber or with a mask to make it easier to send the drugs into the lungs. When using the medicine, we need to pay attention to the age and ability of child patients. Please seek your doctor’s advice when choosing medicine, inhalers or an inhalation accessory device.
Life at school
School children need to carry their medicine and a holding chamber with them. Parents must inform class teachers and physical education teachers of the condition of their children, including the severity of asthma and the contingency plan during an asthma attack. These will provide proper care for their children at school.
If a child has an attack at school, teachers need to note the following:
- Help the child calm down and sit down and breathe slowly.
- Help him/her breathe in a bronchodilator (which is usually blue).
- Call his/her parents/doctor.
- In severe cases (the patient not being able to walk or talk properly, experiencing breathing difficulty or his/her lips turning blue), send the patient to the emergency room promptly.
Asthmatic children need physical activity
Parents and teachers need to engage asthmatic children in physical education when their condition is stable. Prepare them with enough warm-up exercises and ask them to bring along a bronchodilator. For children who would normally experience an attack after exercising, ask them to use a bronchodilator beforehand. Asthmatic children need to improve their health and lung function through physical activity. This will benefit their physical as well as their mental development as they enjoy the time together with their classmates.
Asthmatic children need to grow up in an active and healthy lifestyle
- Teach them to avoid allergens, second-hand and third-hand smoke; control asthma with appropriate medicine; engage in enough exercise. All these prevent reoccurrence of the disease.
- Let children enjoy healthy mental development. They need to learn to accept their physical condition and ability so that they can develop to their full potential.
Medicines for your child
There are two main types of asthma medicines, called relievers and preventers, and they work in different ways. Most asthma medicines are breathed in through an inhaler. This is a very effective way of taking the medicine, as it goes straight to the lungs.
Inhalers can be in a spray form (aerosol) or a dry powder form. Aerosol inhalers can be taken through a device called a spacer. Spacers make your child's inhaler easier to use and more effective.
- Reliever inhalers help to relieve symptoms when they happen
- Preventer inhalers help to protect the airways and reduce the chance of getting asthma symptoms
- Other medicines are also available - these include long-acting reliever and preventer tablets.
Everyone with asthma should have a reliever inhaler. Reliever inhalers are usually blue. Relievers are medicines that children can take immediately when asthma symptoms appear. They quickly relax the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again.
- Relievers are essential in treating asthma attacks. Your child should take a dose of reliever inhaler when they start having asthma symptoms.
- Children with asthma need to keep their reliever inhalers with them or close at hand at all times. You may never know when they might need it.
- If your child is using their reliever inhaler three or more times a week, it could mean their asthma is not controlled properly. Ask your doctor or asthma nurse to review your child's asthma.
Not all relievers work well for all children under one year old. Your doctor will probably try different relievers to find the one that works best for your child.
Preventers protect the lining of the airways. Preventer inhalers are usually brown, red or white.
They help to calm down the swelling in the airways and stop them from being so sensitive. This means that your child is less likely to react badly when she/he comes across an asthma trigger. However, not all children and young people will need a preventer inhaler.
Preventer inhalers are usually prescribed for children and young people using their reliever inhaler three or more times a week.
Most children or young people who need preventer medicines will receive a preventer inhaler from their doctor or asthma nurse that contains inhaled steroids. There are several kinds of inhaled steroids, but they all work in the same way.
- Preventers reduce the risk of severe attacks.
- Their protective effect builds up over a period of time, so they need to be taken every day, usually morning and evening, even if your child is feeling well.
- When your child first starts using them, it may take up to 14 days before you notice any improvement in asthma symptoms.
- They are usually recommended if your child needs to use a reliever more than once a day on a regular basis.
What is a spacer?
Spacers are a useful way of ensuring children, especially young children, take the whole dose of medicine that is delivered through an inhaler.
In addition to relievers and preventers, other types of asthma medicine are also available. These include long-acting relievers and non-steroidal preventer tablets. These are usually used in addition to inhaled preventers.
A short course of steroid tablets (usually three to five days) is sometimes needed to treat a child's asthma after an asthma attack. They are very effective at bringing severe asthma symptoms under control quickly.
Your child should not experience any side effects from an occasional course of steroid tablets.
Are there any side effects to my child's asthma medicines?
Relievers are a very safe and effective medicine and have very few side effects. Your child cannot overdose on reliever medicine. Some relievers can temporarily increase your child's heartbeat, give them mild muscle shakes or make your child a bit hyperactive but this is usually when relievers are given in high doses or as a syrup. These side effects generally wear off within a few minutes or hours at most.
The possibility of side effects from taking inhaled preventer medicine is very low. This is because the inhaled medicine goes straight down to the airways where it is needed. Preventer medicines can lower the body's resistance to chickenpox (see the steroid tablet section below)Talk to your doctor or asthma nurse about any concerns you have about the side effects of your asthma medicines.
If your child uses preventer medicine there is a small risk of them having a sore tongue or throat, hoarseness of the voice and a mouth infection called thrush. To help prevent these side effects, ensure your child rinses their mouth out and brushes their teeth after using their preventer inhaler. Using a spacer will also help reduce the possibility of thrush.
Your child's doctor or asthma nurse should monitor your child closely if they are taking preventer medicines - especially for growth.
It is possible that long-term and high-dose use of preventer medicines (inhaled steroids) may cause some other side effects . That is why your child's doctor or asthma nurse will try to keep your child on the lowest dose to control their symptoms.
Talk to your doctor or asthma nurse about any concerns you have about the side effects of your asthma treatment.
Some children or young people with asthma will need to use an occasional short course of steroid tablets (1-5 days) to bring severe asthma symptoms under control.
- For some children this can lower the body's resistance to chickenpox. If your child has had a short course of steroid tablets in the previous three months and comes into contact with chickenpox, go and see your doctor. If your doctor thinks your child is at risk from chicken pox they can give your child an injection to protect them.
- The other possible side effects from taking a short course of steroid tablets are mood swings an dincreased hunger.
Concerns about inhaled steroids
Many parents worry about giving their child steroids to treat their asthma. Here are some points to remember:
- The steroids used to treat asthma are called corticosteroids. These are a copy of those produced naturally in our bodies.
- They are completely different to the anabolic steroids associated with bodybuilders and athletes.
- Most children use inhaled steroids that go straight down to the airways, so very little is absorbed into the rest of the body.
- Your doctor should prescribe the lowest possible dose of inhaled steroids to get your child's asthma under control.
- Low doses of inhaled steroids do not cause side effects and have no effect on growth.
- It is important that your child is regularly reviewed by your doctor or nurse to ensure that they are using the lowest dose needed to control their asthma.
Controlling yout children’s asthma
Over time, you and you child will become more able to recognise when their symptoms are getting worse.
Make sure you have a written personal asthma action plan for your child and that they have regular asthma reviews. These will help you to control your child's symptoms.
Is your child's asthma getting worse?
The following signs could mean that your child's asthma is getting worse:
- Wheezing and coughing first thing in the morning
- Increased wheezing and coughing after exercise, or doing less exercise
- Waking at night with a cough or wheeze
- If the reliever inhaler is not providing relief of symptoms after 3-4 hours
- Needing more and more reliever medicine with less and less effect.
You can agree a personal action plan with your doctor or nurse so that you know what to do if any of these happen.