Asthma in Children:

What Parents Should Know

Dr. Lou Romig

With much attention recently focused on COVID-19, it is important to remember there are other pediatric illnesses that remain prevalent in children. Asthma is at the top of this list, with 8 percent of children under the age of 17 having a diagnosis of asthma in Florida in 2019. Here is what parents should know about asthma in children.

How common is asthma in children?

Asthma is the number one chronic illness in children in the U.S., and the third leading cause of hospitalization of children under 15 years of age. Hospitals report over half a million emergency department visits for children with asthma every year in the U.S.

What is asthma?

Asthma is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day. Asthma is often found in individuals who are noted to have various types of allergic conditions, including seasonal/environmental allergies and atopic dermatitis or eczema.

The symptoms of asthma are caused primarily by bronchospasm. Bronchospasm occurs when the muscles in the walls of the small air passages of the lungs contract, narrowing the airways and making it harder for air to pass through them. At the same time, inflammation occurs and causes mucus production and some swelling of the linings of the small airways, resulting in further resistance to air flow. Treatment centers on reducing both the muscle spasm and the inflammation.

What causes asthma?

Asthma is often familial. It can be triggered by viral respiratory infections, weather changes, seasonal and environmental allergies, and even stress. Asthma attacks all age groups but often starts in childhood.

Can you outgrow asthma?

About half of all kids diagnosed with asthma under 5 years of age will have their symptoms disappear over time, but half of those will resume having symptoms again during adulthood. True remission occurs only in about 25 percent of children. Many children who appear to have “grown out” of their asthma may never have had asthma at all.

Is Reactive Airways Disease the same as asthma?

Reactive airways disease (RAD) is a term often used to describe a child who has asthma-like symptoms who has not been officially diagnosed with asthma. It is hard to make an official diagnosis in children under 5 years of age because testing for bronchospasm requires the cooperation of the child.

When my child wheezes, she gets treated for bronchitis. Is that the same as asthma?

Bronchitis simply means inflammation in the airways that causes coughing, sometimes for long periods of time. The inflammation can cause wheezing as well. Most often, this is due to one or more viral infections. Coughing from some viral infections can last for weeks. Bacterial bronchitis in children is relatively uncommon, especially in children with coughing for less than a month. There is usually no need to treat a child with a short-term cough/wheezing with antibiotics. Medications used for asthma may be tried for bronchitis but should not be continued if they do not help.

If my child wheezes, does it mean he has asthma?

Not necessarily – bronchospasm can be caused by multiple types of viral respiratory infections, including croup, various types of pneumonia and bronchiolitis. Wheezing can also be caused by moderate to severe allergic reactions. The diagnosis of asthma is one made primarily based on repeated episodes of bronchospasm over time. The diagnosis of asthma generally cannot be made based on one episode of wheezing.

What are the most common symptoms of asthma?

A child with asthma may experience one or more of the following symptoms.

• Wheezing
• Cough
• Chest tightness/pain
• Vomiting with hard cough
• Hoarse voice
• Shortness of breath
• Shortness of breath/cough specifically with exercise

When should I worry about potential danger signs?

Seek immediate medicine attention if your child exhibits any of these symptoms.

• Constant coughing that does not improve with Albuterol treatments.
• Poor appetite or repeated vomiting after eating or drinking.
• Your child can’t speak or can only speak in short phrases.
• Your child is too sleepy or coughs so much they can’t sleep.
• Your child is obviously having to work hard to breathe.
• You can see the muscles sucking in between the ribs and/or above the breastbone and/or collar bones when your child breathes (“labored breathing”).

 How is asthma treated?

Prevention methods may include:

• Recognition and avoidance of triggers
• Daily use of preventive medications, possibly including allergy medications.
• Short acting inhaler use before triggers like running or playing outside in allergy season.

For acute asthma attacks:

• Short acting inhalers/nebulizer treatments (Albuterol). Inhalers with spacer chambers can be effective even for young children.
• Acute courses of inhaled steroids
• Acute courses of oral steroids
• Rest
• Hydration

Parents should remain cognizant of recognizing your child’s asthma-related symptoms and begin treatment as soon as possible. The longer the symptoms go without good treatment, the harder they can be to treat.