How to manage asthma in children

Asthma is the most common chronic disease of childhood, affecting 1 in 10 children. It is also the number one reason that children miss school, visit an emergency room, and are admitted to hospital.

By Dr Aruna Lakhan

Asthma is a condition of the small airways. Children with asthma have sensitive airways that are easily irritated by a number of things called triggers. Some examples of triggers include upper respiratory viral infections, allergies, irritants, weather changes and exercise. The triggers cause swelling and inflammation of the lining of the airways and tightening of the muscles around the airways. This makes it hard for air to flow in and out of the lungs.

Airways become super-sensitive or hyper-reactive to things that do not bother people with normal lungs. The "twitchy" lungs overreact even to cold air, exercise, and smoke. The airway narrowing or obstruction and "twitchiness" cause the asthma symptoms to come in "waves" called flares or attacks. The more inflammation in the airways, the more sensitive the airway tubes are to triggers and the more likely you are to have a flare or other symptoms, like night-time coughing or shortness of breath with exercise. That’s why treating the airway inflammation is so important in caring for your child’s asthma.

What causes asthma in children?

Asthma can affect anyone – young or old, male, or female, and people of all races and ethnic backgrounds, but certain genetic and environmental factors might increase the risk, such as: • Having family members, especially a parent, with asthma or allergies. • Premature birth or lung injury from premature birth. • Exposure to viruses or allergens at an early age. • Cigarette smoke or pollution exposure during pregnancy or early on in life.

Asthma symptoms

The most important asthma symptoms in children are: • Coughing caused by the need to cough up extra mucous in the lungs or from the irritation of the airways. • Wheezing made by air exiting the narrow lung passages. • Shortness of breath. • Chest tightness or pain.

Asthma attacks or flares come and go. When an attack begins, you will notice that your child's symptoms become worse and may worsen quickly. New night-time symptoms are signs that a new flare, or worsening of asthma control, has started.

The lungs will make a lot of mucous, and your child may try to cough it up. Some children may even gag or vomit after a coughing spell.

Diagnosing asthma

Your child’s paediatrician will take a detailed history and examine your child. Most children with asthma have had symptoms for a long time. If your doctor suspects asthma, a blowing test (peak flow) will be done to check the child’s lung function. This measures how fast the child can blow the air out of their lungs. If it is low, asthma could be the reason.

A more detailed lung function test, called a spirometry, may be necessary to confirm the diagnosis. In children under five, where a peak flow and lung function is not possible, the diagnosis of asthma is more difficult and is usually made from a thorough history and examination, followed by a trial therapy.

Treatments for asthma

You will need to work closely with your paediatrician to control your child's asthma. Because asthma is a chronic disease, to keep your child’s symptoms well controlled, certain treatments need to be given every day – even when the child feels fine and has no symptoms.

Some children need medication yearround, while others need to be on treatment during certain times of the

year (for example, viral season or allergy season). The goal of treatment is to make sure your child is on the lowest dose of medicine possible to keep their symptoms under control.

The treatment of asthma is in the form of inhaled medication. There are two types of treatment – controllers and relievers. Controllers are taken regularly to prevent asthma symptoms. The most common controllers are steroids. They reduce the risk of an asthma attack by decreasing the inflammation in the lungs. They take about two weeks to start working and must be used every day.

Relievers work immediately by relaxing the muscles of the airways (for example, Ventolin and Asthavent pumps). They should only be used when symptoms are present. If they are needed more than twice a week, then your child’s asthma is not well controlled, and you should consult your doctor. Some children need additional medication to control their asthma. These come in the form of chewable tablets or sprinkles for the little ones. It helps reduce the inflammation in the lungs and is highly effective if used together with inhaled steroids.

A spacer or aero chamber is a plastic holding chamber which all children using inhaled medication should use as it helps to deliver the medication into the lungs more effectively.

Asthma is not a condition that can be cured, but most children and adolescents can gain good control of their asthma. With proper treatment for asthma, the goal is to have minimal or no asthma symptoms between flares and reduce the frequency and severity of asthma flares.

Another important goal of asthma treatment in children is to ensure that it limits their physical activities as little as possible. When the asthma is effectively managed, they should be able to participate in exercise and sports.

Helpful tips on managing your child’s asthma

To ensure that your child’s asthma is well controlled, treatment should be reviewed at least every six months, more often if severe or not well controlled.

1. Record your child’s asthma symptoms in a diary. Record the symptoms that your child experiences during the day and night, whether their sleep is disturbed due to symptoms, and how often they need to take their reliever medication due to symptoms.

Providing this information to your child’s doctor will assist in prescribing the appropriate medication.

2. Have a written asthma action plan. This is a written plan designed especially for your child to help you manage their asthma. It will give you information on what to do if your child’s asthma worsens. It also gives you a clear guide of when to seek medical help. Ask your child’s doctor to write one for you.

3. Tell your child’s teachers and carers. To assist children’s schools and day care staff, it is important they are aware that your child has asthma. You should provide them with access to your child’s reliever medication and spacer device. They should be shown how to administer the medication and given instructions on when and how the medication should be given.  Dr Aruna Lakhan is a paediatrician who specialises in childhood lung conditions. She sees children of all ages, from newborn to 18 years of age at her practise at Life Vincent Pallotti Hospital, Pinelands, Cape Town.