This topic provides information about asthma in children. If you are looking for information about asthma in teens and adults, see the topic Asthma in Teens and Adults.
Asthma makes it hard for your child to breathe. It causes swelling and inflammation in the airways that lead to the lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for your child to breathe. These flare-ups are also called asthma attacks or exacerbations.
Asthma affects children in different ways. Some children only have asthma attacks during allergy season, when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.
Even if your child has few asthma attacks, you still need to treat the asthma. If the swelling and irritation in your child’s airways isn't controlled, asthma could lower your child's quality of life, prevent your child from exercising, and increase your child's risk of going to the hospital.
Even though asthma is a lifelong disease, treatment can control it and keep your child healthy. Many children with asthma play sports and live healthy, active lives.
Experts do not know exactly what causes asthma. But there are some things we do know:
Symptoms of asthma can be mild or severe. When your child has asthma, he or she may:
Many children with asthma have symptoms that are worse at night.
Along with doing a physical examination and asking about your child’s symptoms, your doctor may order tests such as:
Your child needs routine checkups so your doctor can keep track of the asthma and decide on treatment.
There are two parts to treating asthma, and they are outlined in the asthma action plan. The goals are to:
If your child needs to use the quick-relief medicine more often than usual, talk to your doctor. This is a sign that your child’s asthma is not controlled and can cause problems.
Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your child’s asthma action plan.
You can prevent some asthma attacks by helping your child avoid those things that cause them. These are called triggers. A trigger can be:
It can be scary when your child has an asthma attack. You may feel helpless, but having an asthma action plan will help you know what to do during an attack. An asthma attack may be bad enough to need urgent medical care. But in most cases you can take care of symptoms at home if you have a good asthma action plan.
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|Asthma: Identifying Your Triggers|
|Asthma: Measuring Peak Flow|
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Learning about asthma:
Living with asthma:
The cause of asthma is unknown. Health experts believe that inherited, environmental, and immune system factors combine to cause inflammation of the bronchial tubes, which carry air to the lungs. This can lead to asthma symptoms and asthma attacks.
Symptoms of asthma can be mild or severe. Your child may have no symptoms; severe, daily symptoms; or something in between. How often your child has symptoms can also change.
Symptoms of asthma may include:
If your child has only one or two of these symptoms, it does not necessarily mean he or she has asthma. The more of these symptoms your child has, the more likely it is that he or she has asthma.
Many children have symptoms that become worse at night (nocturnal asthma). In all people, lung function changes throughout the day and night. In children with asthma, this often is very noticeable, especially at night. Nighttime cough and shortness of breath occur frequently. In general, waking at night because of shortness of breath or cough indicates poorly controlled asthma.
Asthma is classified as intermittent, mild persistent, moderate persistent, and severe persistent.
It can be hard to know how severe your child's asthma attack is. Knowing this is important, because severe attacks may require emergency treatment. But in most cases you can take care of your child's symptoms at home with an asthma action plan, which is a written plan that tells you which medicine your child needs to use and when you should call a doctor or seek emergency treatment.
An asthma attack occurs when your child's symptoms suddenly increase. While some asthma attacks occur very suddenly, many get worse over a period of several days.
Things that can lead to an asthma attack or make one worse include:
Most asthma attacks result from a failure to control asthma with medicines. When your child strictly follows his or her asthma action plan and takes all medicines correctly, it is possible to prevent attacks.
Sometimes asthma does not respond to treatment because children are not taking their medicines or are not taking them correctly, are not avoiding triggers, and are otherwise not following their asthma action plan. It is very important that you and other caregivers make sure your child is following his or her action plan to keep asthma from getting worse and to reduce the risk of death from asthma.
By following asthma plans, most children who have asthma can live a healthy, full life.
Many things can increase a child's risk for asthma. Some of these are not within your control; others you can control.
Experts are also not sure about the effect that pets in the home have on getting asthma. Some research shows that having cats or dogs in the home increases an adult's risk of getting asthma.9 But other research has seemed to show that being around pets early in life might protect a child against getting asthma.10
If your child already has asthma and allergies to pets, having a pet in the home may make his or her asthma worse.
Your child may be at increased risk for severe asthma attacks if he or she:
Triggers also may make asthma worse and may lead to asthma attacks.
Call 911 or other emergency services immediately if your child has severe asthma symptoms (in the red zone of the asthma action plan) and you have followed the plan, but:
Call your doctor immediately if your child:
Call your doctor if your child:
If your child has not been diagnosed with asthma but has asthma symptoms, call your doctor and make an appointment for an evaluation.
Watchful waiting is a period of time during which you and your doctor observe your child's symptoms or condition without using medical treatment.
If you think your child has asthma, watchful waiting is not appropriate. See your doctor.
Diagnosing asthma in babies and toddlers is often very difficult. Symptoms may be the same as those of other diseases, such as infection with respiratory syncytial virus (RSV) or inflammation of the lungs (pneumonia), sinuses (sinusitis), and small airways (bronchiolitis). If you have a very young child, spirometry is not practical. So the diagnosis is made based on your report of symptoms.
A newer test to monitor asthma is the NIOX nitric oxide test system. This test measures nitric oxide in exhaled air. A decrease in nitric oxide suggests that treatment may be reducing inflammation caused by asthma. But some experts believe that this test is not useful for monitoring asthma.11 Currently, this test is not widely used in Canada.
Asthma sometimes is hard to diagnose because symptoms vary widely from child to child and within each child over time. Symptoms may be the same as those of other conditions, such as influenza or other viral respiratory infections. Tests that may be done to determine whether diseases other than asthma are causing your child's symptoms include:
You need to monitor your child's condition and have regular checkups to keep asthma under control and to review and possibly update your child's asthma action plan. The frequency of checkups depends on how your child's asthma is classified. Checkups are recommended:
During checkups, your doctor will ask you and your child whether symptoms and peak expiratory flow have held steady, improved, or become worse. He or she will also ask about asthma attacks during exercise, at night, or after laughing or crying hard. You and your child track this information in an asthma diary.
Your child may be asked to bring the peak expiratory flow meter and inhaler to an appointment so your doctor can see how he or she uses them. Based on the results, your child's asthma category may change. And your doctor may change the medicines your child uses or how much medicine he or she uses.
If your child has persistent asthma and takes medicine every day, your doctor may ask about his or her exposure to substances (allergens) that cause an allergic reaction. For more information about tests for allergies, see the topic Allergic Rhinitis.
Although your child's asthma cannot be cured, you can manage the symptoms with medicines and other measures.
It's very important to treat your child's asthma. Although he or she may feel good most of the time, even mild asthma can cause changes to the airways that speed up and make worse the natural decrease in lung function that occurs as we age.12
Your child can expect to live a normal life by following his or her asthma action plan. Asthma symptoms that are not controlled can limit your child's activities and lower his or her quality of life.
By following your child's treatment plan, you can help your child meet these goals:
For more information, see:
Asthma education programs provided by certified asthma educators (CAEs) are available in most areas. Ask your doctor or contact the Asthma Society of Canada, the Canadian Lung Association, or the Canadian Network for Asthma Care to learn about asthma education programs. For more information, see the Other Places to Get Help section of this topic.
Babies and small children need early treatment for asthma symptoms to prevent severe breathing problems. They may have more serious problems than adults because their bronchial tubes are smaller.
An asthma action plan tells you which medicines your child takes every day and how to treat asthma attacks. It may also include an asthma diary where your child records peak expiratory flow (PEF), symptoms, triggers, and quick-relief medicine used for asthma symptoms. This helps you to identify triggers that can be changed or avoided and to be aware of your child's symptoms. A plan also helps you make quick decisions about medicine and treatment. For more information, see:
Your child will take several types of medicines to control his or her asthma and to prevent attacks. These include:
You and your child will learn how to use a metered-dose inhaler (MDI) or dry powder inhaler (DPI). An MDI delivers inhaled medicines directly to the lungs. Most doctors recommend using a spacer with an MDI. For more information, see:
For more information, see the Medications section of this topic.
Your child needs to monitor his or her asthma and have regular checkups to keep asthma under control and to ensure the right treatment. The frequency of checkups depends on how your child's asthma is classified.
It is easy to underestimate the severity of your child's symptoms. You may not notice them until his or her lungs are functioning at 50% of the personal best peak expiratory flow (PEF).
Measuring PEF is a way to keep track of asthma symptoms at home. It can help you and your child know when lung function is becoming worse before it drops to a dangerously low level. This is done with a peak flow meter. For more information, see:
Being around triggers increases symptoms. Try to avoid situations that expose your child to irritants (such as smoke or air pollution) or substances (such as animal dander) to which he or she may be allergic. For more information, see:
Special things to think about in treating asthma include:
If your child's asthma is not improving, talk with your doctor and:
If your child's medicine is not working to control airway inflammation, your doctor will first check to see whether your child is using the inhaler correctly. If your child is using it correctly, your doctor may increase the dosage, switch to another medicine, or add a medicine to the existing treatment.
If your child's asthma does not improve with treatment, he or she may require more treatment, including larger doses of corticosteroids or other medicines. An asthma specialist typically prescribes these medicines.
If your child has a severe asthma attack (the red zone of the asthma action plan), give him or her medicine based on the action plan. Talk with a doctor right away about what to do next. This is especially important if your child's peak expiratory flow (PEF) does not return to the green zone or stays within the yellow zone after he or she takes medicine.
Your child may have to go to the hospital or go to the emergency room for treatment.
At the hospital, your child will probably receive inhaled beta2-agonists and corticosteroids. He or she may be given oxygen therapy. Doctors will assess your child's lung function and condition. Depending on the response, further treatment in the emergency room or a stay in the hospital may be needed.
While there is no certain way to prevent asthma, experts continue to look at things that may reduce a child's chance of getting asthma.
Common irritants in the air, such as tobacco smoke and air pollution, can cause asthma symptoms in some children.
Controlling tobacco smoke is important because it is a major cause of asthma symptoms in children and adults. If your child has asthma, try to avoid being around others who are smoking. And ask people not to smoke in your house.
Consider keeping your child inside when air pollution levels are high. Other irritants in the air (such as fumes from gas, oil, or kerosene, or wood-burning stoves) can sometimes irritate the bronchial tubes. Avoiding these may reduce asthma symptoms.
No one is sure if breast-feeding affects a child's risk of getting asthma.
Mothers are still encouraged to breast-feed their children for all the other proven health benefits that come from breast-feeding.
You can limit the impact asthma has on your child's life by learning about asthma and learning how you can help your child follow his or her treatment plan.
For more information on how to monitor and treat asthma, see:
It is easy to underestimate the severity of asthma. Measuring peak expiratory flow (PEF) is a way to keep track of asthma symptoms at home and to know when your child's lung function is getting worse before it drops to a dangerously low level. For more information, see:
A trigger is anything that can lead to an asthma attack. If your child can avoid triggers, he or she may reduce the chance of having an asthma attack. For more information, see:
Your child may be allergic to certain substances (allergens). You may reduce your child's asthma symptoms by limiting exposure to those substances.
It also may be necessary to avoid exposure to other types of triggers that cause asthma symptoms.
Coughing and wheezing can wake your child. Special problems that might cause night symptoms include:
Treating a sinus infection, cold, or allergies can keep your child’s symptoms from occurring at night.
Taking medicines is an important part of asthma treatment. But it can be hard to remember to take them. To help you and your child remember, understand the reasons people don't take their asthma medicines. And then find ways to overcome those obstacles, such as taping notes on the bathroom mirror.
Most medicines for asthma are inhaled. With inhaled medicines, a specific dose of the medicine can be given directly to the bronchial tubes, avoiding or decreasing the effects of the medicine on the rest of the body. Delivery systems for inhaled medicines include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler (MDI) is usually used by older children, and nebulizers are used most often with infants.
For more information, see:
To manage your child's asthma:
It is important to treat your child's asthma attacks quickly. If your child does not improve soon after treating an attack, talk with a doctor.
Medicine does not cure asthma. But it is an important part of managing the condition. Medicines for asthma treatment are used to:
Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks. Most children with persistent asthma need to use long-term medicines daily. Quick-relief medicines are used as needed and provide rapid relief of symptoms during asthma attacks.
Most medicines for asthma are inhaled, because a specific dose of the medicine can be given directly to the bronchial tubes. Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.
Many doctors recommend that every child who uses a metered-dose inhaler (MDI) also use a spacer, which is attached to the MDI. A spacer may deliver the medicine to your child's lungs better than an inhaler alone. And for many people a spacer is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and the need for oral corticosteroids.
For more information on using an inhaler, see:
The most important asthma medicines are:
Long-term medicines sometimes used alone or with other medicines for daily treatment include:
Other medicines may be given in some cases.
Medicine treatment for asthma depends on your child’s age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.
Your child’s doctor will work with you and your child to help find the number and dose of medicines that work best.
There has been some worry that children who use inhaled corticosteroids may not grow as tall as other children. In the studies done so far, there was a very small difference in height and growth in children using inhaled corticosteroids compared to children not using them.
When these children stopped using inhaled corticosteroids, their growth increased. It is expected that even though using inhaled corticosteroids may slow growth at first, children will still grow to a normal height.19 But no study has gone on long enough for experts to be sure. The difference in height is very small, and this effect is rare. But children using inhaled corticosteroids should have their height checked once or twice a year.
Allergy shots (immunotherapy) may be recommended for children who have asthma symptoms when they are around substances to which they are allergic (allergens). Allergy shots have been shown to reduce asthma symptoms and the need for medicines in some people.22 But allergy shots are not equally effective for all allergens. Allergy shots should not be given when asthma is poorly controlled. For more information, see:
Research has shown that (in addition to taking medicine) family therapy, such as counselling, may be helpful to children who have asthma.23 In one small study, peak expiratory flow and daytime wheezing improved in children who had therapy compared with those who didn't. Another small study found that children showed overall improvement from therapy.
A review of complementary and alternative treatments for treating asthma in children concluded that none have been proved to improve asthma symptoms and some may have harmful side effects.24 The therapies reviewed included:
Talk to your doctor before your child tries a complementary or alternative treatment.
|Asthma Society of Canada|
Asthma-Kids is an interactive Web site designed to help children learn about asthma and how to control it while having fun.
|Allergy/Asthma Information Association (AAIA)|
|295 The West Mall, Suite 118|
|Toronto, ON M9C 4Z4|
The Allergy/Asthma Information Association (AAIA) provides information and education materials for Canadians with allergy and asthma.
|Asthma Society of Canada|
|130 Bridgeland Avenue|
|Toronto, ON M6A 1Z4|
The Asthma Society of Canada provides information and education programs for Canadians with asthma and supports asthma research.
|Canadian Allergy, Asthma, and Immunology Foundation (CAAIF)|
|774 Echo Drive|
|Ottawa, ON K1S 5N8|
The Canadian Allergy, Asthma, and Immunology Foundation (CAAIF) provides information and education programs for Canadians with allergy, asthma, and allergic diseases, and supports asthma research in these areas.
|Canadian Lung Association|
|3 Raymond Street|
|Ottawa, ON K1R 1A3|
The Canadian Lung Association focuses on research, education, and the promotion of respiratory health. The organization offers educational information on a variety of diseases and environmental threats, as well as information on research, support groups, and resources for children and teachers. Call to find a local office in your area.
|KidsHealth for Parents, Children, and Teens|
|4600 Touchton Road East, Building 200|
|Jacksonville, FL 32246|
This Web site is sponsored by Nemours Foundation. It has a wide range of information about children's health, from allergies and diseases to normal growth and development (birth to adolescence). This Web site offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly e-mails about your area of interest.
- Bush RK (2002). Environmental controls on the management of allergic asthma. Medical Clinics of North America, 86(3): 973–989.
- McGeady SJ (2004). Immunocompetence and allergy. Pediatrics, 113(4): 1107–1113.
- Martinez FD (2002). Development of wheezing disorders and asthma in preschool children. Pediatrics, 109(2): 362–367.
- Rodriguez MA, et al. (2002). Identification of population subgroups of children and adolescents with high asthma prevalence: Findings from the third National Health and Nutrition Examination. Archives of Pediatrics and Adolescent Medicine, 156(3): 269–275.
- Eichenfield LF, et al. (2003). Atopic dermatitis and asthma: Parallels in the evolution of treatment. Pediatrics, 111(3): 608–616.
- Guilbert T, Krawiec M (2003). Natural history of asthma. Pediatric Clinics of North America, 50(3): 524–538.
- Gilliland FD, et al. (2006). Regular smoking and asthma incidence in adolescents. American Journal of Respiratory and Critical Care Medicine, 174(10): 1094–1100.
- Etzel RA (2003). How environmental exposures influence the development and exacerbation of asthma. Pediatrics, 112(1): 233–239.
- Jaakkola JJK, et al. (2002). Pets, parental atopy, and asthma in adults. Journal of Allergy and Clinical Immunology, 109(5): 784–788.
- Ownby DR, et al. (2002). Exposure to dogs and cats in the first year of life and risk of allergic sensitization at 6 to 7 years of age. JAMA, 288(8): 963–972.
- Szefler SJ, et al. (2008). Management of asthma based on exhaled nitric acid in addition to guideline-based treatment for inner-city adolescents and young adults: A randomised controlled trial. Lancet, 372(9643): 1065–1072.
- Jarjour NN, Kelly EAB (2002). Pathogenesis of asthma. Medical Clinics of North America, 86(3): 926–936.
- Oddy WH (2004). A review of the effects of breastfeeding on respiratory infections, atopy, and childhood asthma. Journal of Asthma, 41(6): 605–621.
- Kull I (2004). Breast-feeding reduces the risk of asthma during the first 4 years of life. Journal of Allergy and Clinical Immunology, 114(4): 755–760.
- Sears MR, et al. (2002). Long-term relation between breast-feeding and development of atopy and asthma in children and young adults: A longitudinal study. Lancet, 360(9337): 901–907.
- Burgess SW, et al. (2006). Breastfeeding does not increase the risk of asthma at 14 years. Pediatrics, 117(4): 787–792.
- Kramer MS, et al. (2007). Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: Cluster randomised trial. BMJ. Published online September 11, 2007 (doi: 10.1136/bmj.39304.464016.AE).
- Lemanske RF Jr (2003). Viruses and asthma: Inception, exacerbations, and possible prevention. Proceedings from the Consensus Conference on Treatment of Viral Respiratory Infection-Induced Asthma in Children. Journal of Pediatrics, 142(2, Suppl): S3–S7.
- Guilbert TW, et al. (2006). Long-term inhaled corticosteroids in preschool children at high risk for asthma. New England Journal of Medicine, 354(19): 1985–1997.
- Salpeter SR, et al. (2004). Meta-analysis: Respiratory tolerance to regular beta2-agonist use in patients with asthma. Annals of Internal Medicine, 140(10): 802–813.
- Rachelefsky G (2003). Treating exacerbations of asthma in children: The role of systemic corticosteroids. Pediatrics, 112(2): 382–397.
- Abramson MJ, et al. (2010). Injection allergen immunotherapy for asthma. Cochrane Database of Systematic Reviews (8). Oxford: Update Software.
- Yorke J, Shuldham C (2005). Family therapy for asthma in children. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
- Bukutu C, et al. (2008). Asthma: A review of complementary and alternative therapies. Pediatrics in Review, 29(8): e44–e49.
Other Works Consulted
- Bisgaard H, et al. (2006). Intermittent inhaled corticosteroids in infants with episodic wheezing. New England Journal of Medicine, 354(19): 1998–2005.
- Gold DR, Fuhlbrigge AL (2006). Inhaled corticosteroids for young children with wheezing. Editorial. New England Journal of Medicine, 354(19): 2058–2060.
- Gotzsche PC, Johansen HK (2008). House dust mite control measures for asthma. Cochrane Database of Systematic Reviews (2).
- Joint Task Force on Practice Parameters (2005). Attaining optimal asthma control: A practice parameter. Journal of Allergy and Clinical Immunology, 116(5): S3–S11. Available online: http://www.allergyparameters.org/file_depot/0-10000000/30000-40000/30326/folder/73825/2005+Asthma+Control.pdf.
- Kovesi T, et al. (2010). Achieving control of asthma in preschoolers. Canadian Medical Association Journal, 182(4): E172–E183.
- Lougheed MD, et al. (2010). Canadian Thoracic Society asthma management continuum—2010 consensus summary for children six years of age and over, and adults: Canadian Respiratory Journal, 17(1): 15–24. Available online: http://www.respiratoryguidelines.ca/canadian-thoracic-society-asthma-management-continuum-%E2%80%93-2010-consensus-summary-for-children-six-year.
- Malveaux FJ, et al., eds. (2009). State of childhood asthma and future directions: Strategies for implementing best practices. Pediatrics, 123(Suppl 3).
- Montgomery M (2007). Asthma in infants and children. In J Gray, ed., Therapeutic Choices, 5th ed., pp. 640–656. Ottawa: Canadian Pharmacists Association.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Primary Medical Reviewer||Brian D. O'Brien, MD - Internal Medicine|
|Specialist Medical Reviewer||Lora J. Stewart, MD, MPH - Allergy and Immunology, Pediatrics|
|Last Revised||May 11, 2011|
Last Revised: April 11, 2012
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