Overview
Childhood asthma is a chronic disease characterized by inflammation and narrowing of the airways in children, leading to shortness of breath, wheezing, and cough. It affects 7-10% of children; it is one of the most common chronic childhood diseases.
Asthma may behave differently in children; in some it decreases or disappears with growth, while in others it continues into adulthood. With early diagnosis and proper treatment, children can lead a normal life.
Symptoms
- Wheezing (especially when exhaling)
- Dry, recurring cough (especially at night, early morning, with exercise, in cold)
- Shortness of breath
- Chest tightness
- Fatigue
- Inability to complete sentences due to breathlessness
- Frequent respiratory infections (recurrent "pneumonia" may actually be asthma)
- Rapid, deep breathing
- Use of neck and chest muscles for breathing ("rib retractions")
Asthma attack symptoms (emergency):
- Severe shortness of breath
- Inability to talk; speaking in short phrases
- Bluish lips and nails
- Flaring of nostrils
- Extreme restlessness or lethargy
- No response to rescue inhaler
Causes and Triggers
Triggers:
- Allergens: pollen, dust mites, mold, animal dander, cockroaches
- Respiratory infections (especially viral)
- Cold and dry air
- Exercise
- Air pollution, cigarette smoke, perfume
- Stress and strong emotions (crying, laughing)
- Reflux
- Some food allergies
- Some medications
Risk Factors
- Family history (parents with asthma or allergies)
- Atopic dermatitis (eczema)
- Food allergies
- Frequent respiratory infections in early childhood
- Low birth weight
- Secondhand smoke
- Air pollution
- Obesity
- Male sex (more common in childhood)
Complications
- Severe asthma attacks, hospitalizations
- School absenteeism
- Sleep disturbances
- Growth and developmental issues (in uncontrolled asthma)
- Permanent changes in airway structure ("airway remodeling")
- Life-threatening attacks
- Side effects of long-term medications
When to See a Doctor
Scheduled visit:
- Recurring cough, wheezing
- Shortness of breath with exercise
- Cough waking from sleep at night
- Symptoms not resolving after a cold
- Child with family history of asthma and symptoms
Emergency (call emergency services):
- Severe shortness of breath
- Inability to speak
- Bluish color
- Extreme restlessness or lethargy
- No response to rescue inhaler
Diagnosis and Treatment
Diagnosis:
- Detailed history and physical examination
- Pulmonary function test (in children over 5)
- Peak flow meter
- Allergy tests
- Chest X-ray (to rule out other diseases)
- Bronchodilator response
Treatment:
Treatment is divided into two groups:
1. Controller (daily) treatment:
- Inhaled corticosteroids (budesonide, fluticasone) — main medication
- Leukotriene antagonists (montelukast)
- Long-acting bronchodilators (only in combination inhalers)
- Biological therapies (in severe cases): omalizumab, dupilumab
2. Rescue (attack) treatment:
- Short-acting bronchodilators (salbutamol) — needed during a crisis
- Oral corticosteroids during an attack (short-term)
- If hospitalization is needed: oxygen, nebulizer, IV medications
Proper inhaler use is critical. Use of a spacer with inhalers is essential in children.
Prevention and Lifestyle
- Avoid triggers
- Keep your home free of dust, fur, and mold
- Avoid environments where people smoke (especially indoors)
- Wash bedding in hot water
- Use anti-mite mattress covers
- Prefer hard floors over carpets
- Manage seasonal allergies
- Get annual flu and pneumococcal vaccines
- Keep up with routine vaccinations
- Healthy weight, balanced nutrition
- Regular moderate exercise
- Breathing exercises
- Prepare an asthma action plan (what to do during an attack)
- Inform the school
- Do not skip medications