Childhood Asthma

If your child has asthma, you are not alone. Asthma is the most common chronic disease of childhood, affecting approximately 5 million children.

What is asthma?

• Asthma is a chronic (recurring) inflammatory disorder of the airways.
• Inflammation (swelling) in the lungs makes it difficult for air to flow through the lungs.
• Inflammation may also make air passages more sensitive to things that can trigger asthma.

What happens during an asthma attack?

• Air passages in the lungs become swollen, narrow and produce thick mucous.
• Muscles around the airways become tight.
• The tightening of the muscles, called bronchospasm, causes airways to become more narrow.

What are the symptoms of asthma?
Common asthma symptoms are:

• Coughing (for some children, coughing is the only symptom)
• Shortness of breath
• Tightness in the chest
• Wheezing

Some early clues that asthma may be developing are:

• breathing changes or coughing
• feeling tired
• trouble sleeping
• less energy for exercise
• dark circles under the eyes
• chin or throat itchiness

Each child's symptoms are different. The early warning signs of asthma are important to learn about and watch for, so you can be aware that an asthma episode may be developing and seek medical care if necessary.

When is asthma an emergency?
Severe asthma symptoms require immediate attention and can be a life threatening emergency. If you see them in your child, seek emergency treatment immediately. Some examples of severe symptoms are:

• severe coughing, shortness of breath, tightness in the chest and/or wheezing
• difficulty talking
• breathing hard and fast
• nasal flaring
• hunched shoulders
• chest and neck muscles pull in when your child breathes
• lips or fingernails turn gray or blue

How can you help control your child's asthma?
Asthma is not the same in every person. For some, symptoms are mild, while for others they can be very serious. There is no cure for asthma, but symptoms almost always can be controlled and your child can lead a normal, active life.

Things you can do to best control your child's asthma:

• Regular check-ups with your child's doctor or nurse are very important, even if you think your child has been symptom-free. Your child's doctor/nurse is your partner in controlling your child's asthma. Remember to tell them about any changes in your child's home, school, activities, or overall health.
• Be sure your child takes all medications prescribed for her asthma. There are two types of asthma medicines:
• 'Controller' or 'preventative' medicines keep airways from swelling, and make them less sensitive to triggers. It is important to take this type of medicine every day to keep asthma in control. These can be either inhalers or pills.
• 'Reliever' medicine quickly opens the airways when symptoms occur. These 'reliever' medicines act by stopping the muscles around the airways from tightening, helping the airway to open up. These are inhalers.
• Most inhaled medicines should be taken using a spacer device. A spacer device is a tool to help your child breathe inhaled medicine more easily. If your doctor prescribes an inhaled medicine ask if a spacer device is needed.

• Follow a written asthma management plan written by you and your child's doctor or nurse. It should tell what medications to give your child to keep her asthma under control. It also should tell what to do when your child's asthma worsens, including what medications to give and when to contact your child's doctor and/or go to the emergency room.
• Monitor your child's asthma with a peak flow meter. Children approximately 6 years and older can tell how well their lungs are working by using a peak flow meter. This easy-to-use plastic tool measures how well air flows from the lungs. By breathing once into the device, blowing out as hard and as quickly as possible, you can measure the lungs' current capacity. Ask your doctor or nurse if a peak flow meter should be part of your child's asthma management plan.
• Identify your child's triggers (things that cause asthma symptoms to start). Everyone's asthma triggers are different so it can be difficult to determine exactly what your child's triggers are. Your child's doctor may refer her to an allergy specialist for testing. You can learn how to help your child avoid triggers once you know what things are in your home, in your child's school, and outdoors make your her asthma worse.

What is an asthma trigger?
There are two types of triggers that may make your child's asthma worse: irritants and allergies.

What is an irritant?
Irritants are substances that bother the nose, throat, or airways. Common irritants include:

• Cigarette smokeIt is important that no one smokes in the home or car with a child who has asthma.
• Strong smells Avoid aerosol sprays, perfumes, and strong smelling cleaning solutions in your home. Try to clean when your child is not home.
• Colds Teach your child to wash her hands often. Many children with asthma should get the flu shot every year. Check with your child's doctor to see if this is right for your child.

What is an allergy?
Some common allergies include:

• Pets - Keep furry or feathered animals out of the home.
• Pests - (mice, cockroaches) Keep kitchen clean and all food in closed containers. A professional exterminator is the best way to control household pests.
• Dust mites - Wash bedding in hot water. Remove stuffed animals and toys from your child's bed. Try to dust and vacuum once a week while the allergic child is not in the room. It may be helpful to cover mattress and pillows with mite-proof covers.
• Mold - Mold growth can be found on bathroom tiles, in basements and outdoors in soil, leaves, and compost piles. Diluted household bleach or Lysol (can be used for cleaning to prevent mold build-up. Using a dehumidifier regularly will help prevent mold growth in your home. Avoid plants, aquariums and humidifiers in your child's room.
• Pollen - Keep windows and doors closed during high pollen seasons and use air conditioning with a filter that can be cleaned often. Shower and wash hair after being outside for a long time.

How do allergies affect asthma?
Many children with asthma have allergies, which can make their asthma worse. In children with allergies, the immune system becomes sensitive to things called allergens. Exposure to these allergens increases inflammation (swelling) in the airways, and can cause asthma symptoms. Ongoing inflammation of the airways causes the airways to be more sensitive to triggers.

If you suspect that your child has allergies, talk to your child's doctor or nurse about a referral to see an allergy specialist. A specialist can tell you exactly what your child is allergic to so that you can know what things your child should avoid.

With careful management by parents, doctors and the child, asthma symptoms can be controlled so that children with asthma can lead normal, active and healthy lives.

Children's Hospital Boston is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 347 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. For more information, go to www.childrenshospital.org.