Asthma is a common lung condition in which the airways become narrow making it hard to breath leading to wheeze, cough and shortness of breath. Approximately 1 in 10 children have asthma and it is one of the most common reasons that children present to the hospital or doctors. Having a child with asthma can be daunting but by recognising the signs of asthma, being on the correct medication and having an asthma action plan, symptoms can be well controlled.
What causes Asthma?
Asthma occurs when, in response to certain triggers, the muscles around the airways tighten, become swollen and produce more mucous. This makes the airways narrow and it harder to breath. Triggers can include;
- Viral infections (colds and flu’s)
- Allergens such as dust mites, pollen, mould, and animals.
- Inhaled irritants such as pollution, and cigarette smoke.
- Weather conditions – such as cold or dry air.
- Exercise
- Some medicines (such as aspirin, non-steroidal anti-inflammatories like ibuprofen)
Not every child has the same trigger and some children have more than one. Knowing and minimising exposure to triggers can help you manage your child’s asthma.
Children are more at risk of developing asthma if it runs in the family or if they have a history of eczema or hayfever. Unfortunately we can’t change genetics!
What are the Symptoms of Asthma?
Common symptoms of asthma include;
- Cough
- Wheeze
- Shortness of breath
- Chest tightness
Symptoms are often worse at night, early in the morning, and in response to triggers such as viruses and exercise.
Diagnosing Asthma
Diagnosing asthma can be tricky in children, especially in those under 5 years of age. This is because there are a lot of other conditions that can cause wheeze in young children such as viral infections (colds and flu) . A lung function test called spirometry can be used to help diagnose asthma however most children under 5 are unable to perform this test. Diagnosis is therefore based on the presence of recurrent symptoms, their response to asthma medications and if there is a family history of asthma. This requires regular assessment by the child’s doctor. A large proportion of kids under 5 will ‘grow out’ of their asthma and have no symptoms later in life.
Treatment of Asthma
The goal of treating asthma is to control symptoms and to reduce the number of flare ups.
This can be done by avoiding or reducing triggers where possible and by the use of asthma medications. The most common way for children to take asthma medication is by breathing it into the lungs via an inhaler or puffer.
Treatment depends on how severe the child’s symptoms are. The most commonly used medication are divided into two groups:
- Relievers – are used to treat asthma when symptoms occurs. They relax the smooth muscle around the airways causing them to open up. They work quickly and usually last 4 hrs. The most commonly used reliever is the ‘’blue puffer’’ Salbutamol (Ventolin) and is usually given via a spacer in children.
- Preventers – are used when children are getting frequent symptoms and need to use their reliever treatment often. They work by reducing the swelling and mucous production in the airways and make them less sensitive to triggers. They do not work straight away like relievers and can take up to a few weeks before symptoms improve. Preventatives need to be given every day and are either steroid based inhaler’s (e.g flixotide, pulmicort) or non-steroid based (e.g Montelukast/singulair tablets) depending on your child’s needs. Not all children with asthma require a preventative however if they are getting asthma symptoms at least once a week you should discuss with your GP if they require a trial of a preventative medications.
Rescue treatment in the form of oral steroids (liquid or tablet form) is sometimes required for severe flare ups if the reliever and preventative medications are not controlling symptoms properly. They may be given to you by your doctor or hospital but usually only have to be taken for 3 – 5 days.
Side effects of treatment
- Possible side effects of reliever medication can include a rapid heart rate, shaky hands and hyperactivity.
- Side effects of steroid inhaled puffers include oral thrush, and voice changes. This risk can be reduced by rinsing out their mouth after use and using a spacer.
- Montelukast or Singulair tablets have had rare reports of behavioural changes in children. You should discuss this with your doctor if you are concerned.
The Use of Asthma Puffers and Spacers
Asthma puffers are best given to children via a spacer. If they are under 4 they should use a spacer with a mask. A spacer is a clear plastic chamber that you can connect the puffer to at one end and it has a mouth piece at the other. When you administer one puff into the plastic chamber the child takes several breaths to inhale the medication. This process is repeated until they have completed their required dose. It is tricky for children to coordinate using a puffer without a spacer and some adults are better off using spacers too! Studies have shown that using Ventolin via a spacer is just as effective as using a nebuliser (a machine that delivers liquid Ventolin via a mask). Your doctor, nurse, asthma educator or chemist can show you how to use a puffer and spacer correctly.
Asthma Action Plan
If your child has asthma it is important that it is reviewed with your doctor at least every 6 months. Your doctor can write an Asthma Action Plan which outlines how to treat their asthma symptoms when it is well controlled, poorly controlled and what to do in the event of an emergency. A copy of this plan can be provided to any of your child’s carers (e.g pre-school and primary school teachers) so they know what to do if your child experiences any asthma symptoms while they are under their care.
Summary
Asthma is common in children and is a frequent cause of hospital admissions but it can be controlled if it is well managed. Ensure that you are aware of what triggers your child’s asthma, what their symptoms are, that they are on the correct medication and are using it properly. An asthma action plan should be completed at least every year to make sure they are on the optimal treatment.
Resources
In an emergency call triple zero
Your local Emergency Department
Your GP
Asthma Australia – www.asthmaaustralia.org.au
Sydney Children’s Hospitals Network – www.asthmainchildren.org.au