5 Symptoms Of Asthma In Children, Causes & Management

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A few substances such as cigarette smoke, cold air, or pollen may trigger asthma in kids. This chronic inflammatory disease occurs when the airways are obstructed repeatedly due to the body’s sensitivity to certain triggers.

Exposure to these triggers may result in airway inflammation, leading to airway edema (swelling), bronchospasm (obstruction or narrowing of the airways), and increased mucus production. All of these may lead to difficulty in breathing among children.

Although asthma is a non-communicable disease, it is the most common chronic disease among children. As per the Centers for Disease Control and Prevention, nearly 5.1 million children under 18 years experience childhood asthma in the US.

Most symptoms of childhood asthma appear before the age of five years. However, they may appear at any age. Read on to know more about this disease, its causes, risks, signs, complications, diagnosis, treatment, and prevention.

Risk Factors And Causes Of Asthma In Children

Asthma occurs due to the swelling (inflammation) of the tubes (airways) that carry air to and from the lungs. This may make the airways narrower and more sensitive than usual. Exposure to the following triggers may increase the risk for asthma in children.

  • Exercise
  • Smoke
  • Pollution
  • Cold air
  • Infections such as flu or cold
  • Allergies to pollen, animal fur, dust mites
  • Having parents with asthma
  • Obesity
  • A diet lacking in vitamins C and E and omega-three fatty acids

Certain prenatal factors, such as maternal smoking during pregnancy and being born prematurely, also increase the risk for asthma in children. Identifying and avoiding triggers and risk factors may help keep asthma symptoms under control.

Signs And Symptoms Of Asthma

Asthma symptoms may vary in each child, and the symptoms can be less severe at times and flare-up at other times. In addition, most children may have sudden onset of symptoms after exposure to asthma triggers.

The common signs and symptoms of childhood asthma may include the following.

  1. Cough: Children with asthma may have a constant cough that comes and goes. Night coughs are also seen in some children.
  2. Wheezing: Whistling sound or noisy breathing is heard in most cases.
  3. Shortness of breath: Children with asthma may experience breathing difficulties when active, such as during exercise.
  4. Chest tightness: The narrowed airway can make it difficult to inhale and exhale air. Thus, the child may feel as though someone is squeezing or sitting on their chest.
  5. Tiredness and weakness

Some children may have asthma attacks that occur due to bronchospasm. This is when the muscles surrounding the airways contract. As a result, severe asthma symptoms are seen during asthma attacks.

Children with asthma can also have anxiety and stress due to breathing issues. Asthma symptoms can also be seen in other conditions. Thus, it is recommended to seek medical care for the exact diagnosis and treatment.

Complications Of Asthma In Children

The following complications may occur due to uncontrolled or poorly managed asthma in children.

  • Permanent or lasting airway damage that increases the risk for pneumonia, gastroesophageal reflux, and obstructive sleep apnea
  • Severe asthma attacks
  • Increased emergency room or hospital stay
  • Missing school and other activities

Some children may develop side effects from the long-term use of asthma medications. For example, inhaled oral corticosteroids may be associated with fungal infections, Cushing syndrome, weight gain, and metabolic dysfunctions. You may talk to the doctor to know the precautions to prevent these medication side effects.

Diagnosis Of Asthma

Doctors may diagnose asthma in children depending on the symptoms. The following tests are ordered to confirm the diagnosis.

  • Spirometry is done using a device called a spirometer to check lung function. This test measures the amount of air breathed in and out of the lungs. Although it can be done in young children, spirometry is usually done for children older than six years.
  • Chest radiographs or X-rays (CXRs) help visualize lung changes, such as bronchial wall thickening in some cases. However, this is more useful to exclude other concurrent illnesses, such as pneumonia, since most children with asthma may have normal chest radiographs.
  • Allergy tests are often done to identify and exclude allergies that may trigger or worsen asthma.
  • Peak flow monitoring is done to measure the amount of air blown out of the lungs using a peak flow meter. This can also be done at home and is often recommended to monitor asthma symptoms in children.

Doctors may also recommend CT scans for some children to exclude certain conditions. CT scanning can give a better visualization of the lungs and airways than chest radiographs.

Treatment For Asthma

Both allergists and pulmonologists treat asthma in children. Asthma treatment may vary depending on the frequency and severity of symptoms in each child. The following medications are usually prescribed for childhood asthma.

  • Quick-relief

Children with breathing difficulties, cough, or wheezing require quick-relief medicines. Intravenous and oral corticosteroids and short-acting beta-agonists such as Ventolin HFA (albuterol) are common quick-relief medications. Children with asthma should always carry these medicines, which are usually available in the form of an inhaler, for use at the first signs of asthma. Younger children can also take inhaled medications, such as albuterol, in a nebulized form using a special device called a nebulizer.

  • Long-term control

Long-term control medications reduce airway inflammation and prevent asthma attacks and symptoms in children. Immunomodulatory agents such as Nucala (mepolizumab), theophylline, leukotriene modifiers such as Singulair (montelukast), and inhaled corticosteroids such as Pulmicort Flexhaler are some common medicines given for long-term asthma control.

Allergies that trigger asthma are also treated with medications and immunotherapy (allergy shots). In addition, doctors may create an asthma action plan for each child for long-term control. This plan helps the parents decide the next step, such as when to change medicines or seek emergency help, based on the child’s symptoms. Schools and daycares often require that children have copies of their asthma plans on file.

How To Prevent Asthma In Children?

The following tips may help to prevent asthma attacks in some children.

  • Limit exposure to triggers
  • Do not smoke near a child or indoors
  • Maintain a healthy weight
  • Promote physical activity
  • Treat heartburn or severe acid reflux promptly
  • Visit a doctor as per schedule

In addition to these precautions, you may ensure that your child is protected from vaccine-preventable diseases by giving them childhood vaccinations as per schedule. For example, pneumococcal vaccinations and annual flu shots are recommended for children with asthma since they have a high risk for flu and pneumococcal pneumonia complications.

Also, although nasal spray vaccines (LAIV) for flu are contraindicated for children with asthma, flu shots (injections) are beneficial and safe for children with asthma.

Lifestyle And Home Remedies To Prevent Asthma

You may also try the following lifestyle modifications and home remedies to reduce your child’s exposure to asthma triggers.

  • Maintain low humidity at home by using a dehumidifier (air dryer) device if you live in a damp climate.
  • Reduce pet dander at home by vacuuming frequently if you have a pet. It is best to avoid pets with feathers and fur if the child has an allergy to dander. However, if you already have a pet, keep them out of the child’s room and groom and bathe them regularly.
  • Use air conditioning at home to reduce pollen from entering indoors. This may also reduce indoor humidity and exposure to dust mites. Consider keeping the windows closed during the pollen season.
  • Check the indoor air quality and use a small particle filter (HEPA filter) in the ventilation system if needed. You should also check the air conditioning and heating systems every year.
  • Avoid exposure to cold air and dry air by wearing a mask outdoors.
  • Clean the house regularly to keep dust to a minimum. You may dry dust-proof pillow covers and bedsheets in the child’s room. Consider removing carpets and use washable curtains in their rooms.

Does Childhood Asthma Recur?

Some children may outgrow asthma symptoms or show significant improvement during their teenage years. However, nearly half of them may have asthma again in their 30s or 40s. Unfortunately, there is no known way to predict who will outgrow the condition or have it recur during adulthood. However, proper management of asthma allows most children and teens to have a normal active life without major complications.

Constant cough, wheezing sound, dyspnea, chest tightening, and exhaustion are common symptoms of asthma in kids. Although the treatment process is lengthy and the condition is rarely completely cured, adhering to treatment regimens can help prevent complications and reduce asthma symptoms. Also, avoid asthma triggers, such as smoke, pollen, or extreme exercises, since the lungs of asthmatics can be extra sensitive. You should also ensure that your child has a medication-filled inhaler on hand and understands how to use it to prevent worsening of the symptoms.

Key Pointers

  • Pollution, smoke, exercise, cold air, and allergy to pollens and dust mites are some factors that can trigger an episode of asthma.
  • Asthma symptoms vary from one child to another and can be less severe at times and too severe the other times.
  • Poorly managed or uncontrolled asthma could lead to complications, such as permanent airway damage.
  • Identifying triggers and avoiding them, and following the prescribed treatment course could help treat, manage, and even prevent asthma in children.

References:

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Dr. Jessica Madden

(MD, FAAP, IBCLC)
Jessica Madden is a pediatrician, neonatologist, lactation consultant, and mother of four, who has been taking care of newborns since 2001. She works as a neonatologist in the NICU at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, and founded Primrose Newborn Care, a newborn medicine and “4th trimester” home-visiting and telemedicine practice, in 2018.  Dr. Madden is a Fellow... more

Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more