All About Asthma in Children

Indoor Air Pollution and Asthma in Children

All About Asthma in Children | Johns Hopkins Medicine

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All About Asthma in Children | Johns Hopkins Medicine

Asthma is a chronic, inflammatory lung disease involving recurrent breathing problems. The characteristics of asthma are three airway problems:

  • Obstruction
  • Inflammation
  • Hyperresponsiveness

What are the symptoms of asthma?

Common symptoms of asthma are listed below. However, each individual may experience symptoms differently.

In some cases, the only symptom is a chronic cough, especially at night, or tightness, noisy breathing, or wheezing. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

Asthma may resemble other respiratory problems, such as emphysema, bronchitis, and lower respiratory infections. Many people with asthma do not know they have it. Consult your doctor for a diagnosis.

What causes asthma?

The basic cause of the lung abnormality in asthma is not yet known, although health care professionals have established that it is a special type of inflammation of the airway that leads to the following:

  • Contraction of airway muscles
  • Mucus production
  • Swelling in the airways

It is important to know that asthma is not caused by emotional factors—as was commonly believed years ago. Emotional anxiety and nervous stress can cause fatigue, which may affect the immune system and increase asthma symptoms or aggravate an attack. However, these reactions are considered to be more of an effect than a cause.

What happens during an asthma attack?

People with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult. These problems are caused by an oversensitivity of the lungs and airways:

  • Lungs and airways overreact to certain triggers and become inflamed and clogged.
  • Breathing becomes harder and may hurt.
  • There may be coughing.
  • There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because:
    • Muscles that surround the airways tighten, and the inner lining of the airways swells and pushes inward.
    • Membranes that line the airways secrete extra mucus.
    • The mucus can form plugs that further block the air passages.
    • The rush of air through the narrowed airways produces the wheezing sounds.

What are the risk factors for an asthma attack?

Although anyone may have an asthma attack, it most commonly occurs in:

  • Children and adolescents between age 5 and 17
  • Females
  • People living in urban communities
  • Exposure to tobacco smoke

Other factors include:

  • Family history of asthma
  • Personal medical history of allergies

How is asthma diagnosed?

To diagnose asthma and distinguish it from other lung disorders, doctors rely on a combination of medical history, physical examination, and laboratory tests, which may include:

  • Spirometry. A spirometer is a device used by your doctor that assesses lung function. Spirometry is the evaluation of lung function with a spirometer. The test is performed by blowing as hard as possible into a tube connected to a small machine (a spirometer) that measures the amount of air breathed out and in as well as the speed it is breathed out. This is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:
    • To determine how well the lungs receive, hold, and utilize air
    • To monitor a lung disease
    • To monitor the effectiveness of treatment
    • To determine the severity of a lung disease
    • To determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
  • Peak flow monitoring (PFM). A device is used to measure the fastest speed in which a person can blow air the lungs. To use a peak flow meter, a person takes a deep breath in and then blows as hard and fast as possible into a mouthpiece.

    During an asthma or other respiratory flare-up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM.

    This measurement is very important in evaluating how well or how poorly the disease is being controlled.

  • Chest X-rays. This diagnostic test uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • Blood tests. Blood tests are used to analyze the amount of carbon dioxide and oxygen in the blood.

  • Allergy tests.

What is the treatment for asthma?

Specific treatment for asthma will be determined by your doctor :

  • Your age, overall health, and medical history
  • Your symptoms
  • Extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

As of yet, there is no cure for asthma. However, it can often be controlled with prescription medications that may help to prevent or relieve symptoms, and by learning ways to manage episodes.

How is asthma managed?

People with asthma can learn to identify and avoid the things that trigger an episode. They can also educate themselves about medications and other asthma management strategies:

  • Asthma is a chronic disease. It has to be cared for all the time—not just when symptoms are present:
    • The four parts of continually managing asthma are:
      • Identify and minimize contact with asthma triggers.
      • Understand and take medications as prescribed.
      • Monitor asthma to recognize signs when it is getting worse.
      • Know what to do when asthma gets worse.
  • Working with a health care professional is the best way to take care of asthma.

  • The more information a person with asthma has, the better asthma can be controlled.

Four components of asthma treatment

  1. The use of objective measures of lung function—spirometry, peak flow expiratory flow rate—to access the severity of asthma, and to monitor the course of treatment.

  2. The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airways.

  3. The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy.

  4. Patient education that includes a partnership among the patient, family members, and the doctor.


All About Asthma in Children

All About Asthma in Children | Johns Hopkins Medicine

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Asthma is a long-term (chronic) lung disease that causes your child's airways to become sensitive to certain things (triggers). Several things happen to the airways when a child is exposed to triggers:

  • The lining around the airways swell.
  • The muscles around the airways tighten.
  • The airways make more thick mucus than normal.

All of these things will cause the airways to narrow. This makes it difficult for air to go in and your child’s lungs and causes the symptoms of asthma.

What causes asthma in a child?

The exact cause of asthma is not known. Researchers think it is partially passed down through families. But it can also be caused by many other things such as the environment, infections, and chemicals.

Which children are at risk for asthma?

A child is more ly to get asthma if he or she:

  • Is age 5 to 17 years old
  • Has family members with asthma
  • Has allergies
  • Is around tobacco smoke
  • Is around air pollution
  • Has another health problem such as sinus problems and being overweight

What are the symptoms of asthma in a child?

Symptoms can occur a bit differently in each child. Children with asthma have times when they have few, if any symptoms. They also have times when symptoms flare up. Symptoms may include:

  • Cough that is either constant or comes and goes
  • Wheezing or whistling sound that is heard while your child is breathing
  • Trouble breathing or shortness of breath while your child is active
  • Chest tightness
  • Tiredness
  • Cough at night
  • Noisy breathing

The symptoms of asthma can be other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is asthma diagnosed in a child?

To diagnose asthma, your child’s healthcare provider may recommend these tests:

  • Spirometry. A spirometer is a device used to check lung function. It can be done in young children, including infants. 
  • Peak flow monitoring. A peak flow meter is used to measure the amount of air a child can blow the lungs. This measurement is very important in checking how well your child’s asthma is being controlled.
  • Chest X-rays. This diagnostic test uses invisible energy beams to make images of internal tissues, bones, and organs on film.
  • Allergy tests. Allergy tests can show if your child has allergies that may be causing or worsening asthma.

How is asthma treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Your child’s healthcare provider may refer you to a pulmonologist. This is a doctor with special training to treat lung conditions. Your child may also be referred to an asthma and allergy specialist. Your child’s treatment is how severe his or her symptoms are and how easily they are controlled. Treatment includes finding triggers and ways to avoid them. It will also include medicines.

Asthma medicines include:

  • Bronchodilators. These medicines are used to help open the narrowed airways. They may relieve coughing, wheezing, shortness of breath, or difficulty breathing.
  • Anti-inflammatory medicines. These medicines help decrease the inflammation in the airways.
  • Anti-leukotrienes. These medicines help decrease the narrowing of the airways. These are usually given by mouth.
  • Immunotherapy. This can be used for severe asthma attacks in children ages 12 and older.

What are the complications of asthma in a child?

Asthma that is not well controlled may cause:

  • Severe asthma attacks
  • Lasting damage to the airways
  • Increased time in the hospital or the emergency department
  • Missed school or other activities

What can I do to prevent asthma in my child?

Asthma can’t be completely prevented. There are steps you can take to reduce the chance of your child developing asthma. They include:

  • Avoiding secondhand smoke
  • Avoiding air pollution

In most children, asthma flare-ups can be prevented by:

  • Avoiding known triggers
  • Carefully managing symptoms
  • Taking medicines as instructed

How can I help my child live with asthma?

You can help manage your child’s asthma by:

  • Finding out your child’s triggers and keeping him or her away from them.
  • Giving your child medicine as directed to prevent symptoms.
  • Creating and keeping an Asthma Action Plan.
  • Closely watching asthma signs and symptoms to know when they are getting worse.
  • Knowing what to do when asthma gets worse.

Work with your child’s healthcare provider to find the best way to take care of your child’s asthma. There are guidelines for children from newborn to age 4, ages 5 to 11, and ages 12 and older.

The more information a person with asthma has, the better the asthma can be controlled.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider if your child’s symptoms are not well-controlled. For example, your child is waking at night with symptoms or is having trouble with daily activities.

Call your child’s healthcare provider or get medical help right away if your child has severe symptoms. These severe symptoms can include trouble:

  • Breathing
  • Sleeping
  • Walking
  • Talking

Key points about asthma in children

  • Asthma is a long-term (chronic) lung disease that causes the airways to swell and make more mucus, and the muscles around the airways to tighten.
  • Asthma symptoms include trouble breathing, wheezing, chest tightness, and coughing.
  • Staying away from those things that cause asthma symptoms (triggers) is an important part of asthma treatment.
  • Medicines are used to prevent and control symptoms during flare-ups.
  • Asthma can cause serious complications if it is not well-controlled.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.


Childhood Asthma

All About Asthma in Children | Johns Hopkins Medicine

Childhood asthma is the same lung disease adults get, but kids often have different symptoms. Doctors also call this pediatric asthma.

If your child has asthma, their lungs and airways can easily get inflamed when they have a cold or are around things pollen. The symptoms may make it hard for your child to do everyday activities or sleep. Sometimes, an asthma attack can result in a trip to the hospital.

There’s no cure for asthma in children, but you can work with your child’s doctor to treat it and prevent damage to their growing lungs.

Not all children have the same asthma symptoms. A child may even have different symptoms from one episode to the next. Signs and symptoms of asthma in children include:

  • A cough that doesn’t go away (which may be the only symptom)
  • Coughing spells that happen often, especially during play or exercise, at night, in cold air, or while laughing or crying
  • A cough that gets worse after a viral infection
  • Less energy during play
  • Avoiding sports or social activities
  • Trouble sleeping because of coughing or breathing problems
  • Rapid breathing
  • Chest tightness or pain
  • Wheezing, a whistling sound when breathing in or out
  • Seesaw motions in their chest (retractions)
  • Shortness of breath
  • Tight neck and chest muscles
  • Feeling weak or tired
  • Trouble eating, or grunting while eating (in infants)

Your child's doctor should check out any illness that makes it hard for them to breathe.

Experts sometimes use the terms “reactive airways disease” and “bronchiolitis” when talking about wheezing with shortness of breath or cough in infants and toddlers. Tests may not be able to confirm asthma in children younger than 5.

When to get emergency care:

A severe asthma attack needs medical care right away. Watch for these signs:

  • Stopping in the middle of a sentence to catch a breath
  • Using stomach muscles to breathe
  • A belly that sinks in under their ribs when they try to get air
  • Chest and sides that pull in as they breathe
  • Widened nostrils
  • Fast heartbeat
  • Sweating more than usual
  • Chest pain

Common triggers include:

  • Airway infections. This includes colds, pneumonia, and sinus infections.
  • Allergens. Your child might be allergic to things cockroaches, dust mites, mold, pet dander, and pollen.
  • Irritants. Things air pollution, chemicals, cold air, odors, or smoke can bother their airways.
  • Exercise. It can lead to wheezing, coughing, and a tight chest.
  • Stress. It can make your child short of breath and worsen their symptoms.

Asthma is the leading cause of long-term illness in children. It affects about 7 million kids in the United States. Those numbers have been going up, and experts aren’t sure why.

Most children have their first symptoms by age 5. But asthma can begin at any age.

Things that can make a child more ly to have asthma include:

Your child’s asthma symptoms may be gone by the time you get to the doctor’s office. You have an important role in helping your doctor understand what’s going on. A diagnosis will include:

  • Questions about medical history and symptoms. Your doctor will ask about any breathing problems your child may have had, as well as any family history of asthma, allergies, eczema, or other lung disease. Describe your child's symptoms in detail, including when and how often they happen.
  • Physical exam. Your doctor will listen to your child's heart and lungs and look in their nose or eyes for signs of allergies.
  • Tests. Your child might get a chest X-ray. If they’re 6 or older, they may have a simple lung test called spirometry. It measures the amount of air in your child’s lungs and how fast they can blow it out. This helps the doctor find out how severe their asthma is. Other tests can help find asthma triggers. They may include allergy skin testing, blood tests (IgE or RAST), and X-rays to tell if sinus infections or gastroesophageal reflux disease (GERD) is making asthma worse. A test that measures the level of nitric oxide (eNO) in your child’s breath can also point to inflamed airways.

When it’s not under control, asthma can cause problems :

  • Severe attacks, sometimes leading to ER visits or stays in the hospital
  • Missed school and other activities
  • Fatigue
  • Stress, anxiety, and depression
  • Delays in growth or puberty
  • Damaged airways and lung infections
  • Death

Avoiding triggers, using medications, and keeping an eye on daily symptoms are the best ways to control asthma in children of all ages.

There are two main types of asthma medications:

  • Quick-relief medications help with sudden symptoms. Your child will take them for fast help during an asthma attack.
  • Long-acting medications prevent airway inflammation and keep asthma under control. Your child will probably take them every day.

your child's history, their doctor will come up with an asthma action plan and give you a copy of it. This plan describes when and how they should use asthma drugs, what to do when asthma gets worse, and when to seek emergency care. Make sure you understand this plan, and ask the doctor any questions you may have.

Give copies to your child’s caregivers and teachers so they’ll know what to do if the child has an asthma attack away from home.

Many asthma medications contain steroids, which could have side effects. They can irritate your child’s mouth and throat. Some research shows that over time, they might cause slow growth, bone problems, and cataracts.

After your child takes them, their body might not be able to make as many natural steroids. But without treatment, asthma can lead to health problems and hospital visits.

You and your doctor should talk about the pros and cons of medication when you make an asthma action plan.

Infants and toddlers might take some of the same types of asthma drugs as older children and adults. Inhaled steroids can be key to managing long-term asthma or wheezing in infants.

Children under 4 may get lower doses and take their medications through an asthma nebulizer. This device changes the medicine from a liquid to a mist that your child breathes into their lungs. The doctor will tell you how often to give these breathing treatments. It’s usually up to four times a day, about 10 to 15 minutes at a time. To use the nebulizer:

  • Wash your hands.
  • Put the medicine in the nebulizer.
  • Connect the tubes from the compressor to the base.
  • Attach the mouthpiece or mask.
  • Turn the compressor on and watch for a light mist to come from the nebulizer.
  • Put the mask on your child’s face, or put the mouthpiece in their mouth and have them close their lips around it.
  • Have them breathe in and out until their treatment time is up.
  • Turn the nebulizer off when the medicine is gone.
  • Have your child cough to clear out any mucus.

There are guidelines for managing asthma in children up to age 4. This includes the use of quick-relief medications ( albuterol) for off-and-on symptoms.

A low dose of an inhaled steroid, cromolyn, or montelukast (Singulair) is the next step up. After age 4, the focus shifts from symptom control to disease management.

If your child’s asthma is under control for at least 3 months, their doctor may lower their treatment.

Instead of a nebulizer, older kids may be able to use a metered dose inhaler (MDI) with a spacer. A spacer is a chamber that attaches to the inhaler and holds the burst of medication. This lets your child breathe the medication into their lungs at their own pace. To use an inhaler with a spacer:

  • Wash your hands.
  • The first time you use it, prime the inhaler by spraying it 4 times into the air.
  • Put the inhaler into the opening at the end of the spacer.
  • Shake it for 10 seconds.
  • Have your child turn their head to the side and breathe out.
  • Have them close their mouth around the mouthpiece of the spacer.
  • Tell them to take a slow deep breath.
  • Make them hold it in and count to 10.
  • Have them slowly breathe out.
  • If your doctor prescribes two puffs of medicine, wait 1 minute after the first puff and then do it all again.
  • Help them rise their mouth, brush their teeth, or get a drink of water.

To prevent asthma attacks or to keep them from getting worse, focus on known triggers with steps these:

  • Don’t let anyone smoke in your home or car.
  • Clean bedding and carpets often to fight dust mites.
  • Keep pets your child’s bedroom. An air filter can help with allergens.
  • Get regular pest control to avoid cockroaches.
  • Fix leaks and use dehumidifiers to prevent mold.
  • Don’t use scented cleaning products or candles.
  • Check daily air quality reports in your area.
  • Help your child stay at a healthy weight.
  • If they have heartburn, keep it under control heartburn.
  • If exercise is a trigger, your child’s doctor might give them medicine to help keep their airways open during activity.
  • Make sure they get a flu shot every year.

There’s no cure for asthma, but your child can learn to control it. They should be able to:

  • Prevent long-term symptoms
  • Go to school every day
  • Avoid asthma symptoms at night
  • Take part in daily activities, play, and take part in sports
  • Avoid urgent visits to the doctor, emergency room, or hospital
  • Use and adjust medications to control symptoms with few or no side effects

If they have trouble meeting all of these goals, ask their doctor for advice.

There’s a lot that experts don’t know about infant lung function and asthma. But they believe that a child is more ly to be diagnosed with asthma after the age of 7 if they’ve had multiple wheezing episodes, have a mother with asthma, or have allergies.

Once a child’s airways become sensitive, they stay that way for life. But about 50% of children see a sharp drop in asthma symptoms once they reach their teens. It may seem they’ve outgrown their asthma, but some will have symptoms again as adults. There’s no way to predict what may happen with your child.

By learning about asthma and how to control it, you take an important step toward managing your child's condition. Work closely with their care team to learn all you can about asthma, how to avoid triggers, what medications do, and how to give treatments.


Allergy & Asthma Network: Mothers of Asthmatics: “School House: Keeping Healthy at School.” 

American Academy of Allergy, Asthma & Immunology: “Tips to remember: Childhood asthma,” “Childhood Asthma,” “Pediatric Asthma Definition.”

American Lung Association: “Asthma.” 

Allergy & Asthma Network: Mothers of Asthmatics: “Off to School with Confidence.”

Asthma and Allergy Foundation of America: “Asthma in Infants.”

Mayo Clinic: “Nitric oxide test for asthma,” “Childhood asthma.”

American Academy of Pediatrics: “Asthma Triggers and What to do About Them.”

Cleveland Clinic: “Home Nebulizer,” “Stress and Asthma.”

The Children’s Hospital of Philadelphia: “Safety of Steroids for Asthma.”

Nationwide Children’s Hospital: “How to Use an Inhaler with a Spacer and Mouthpiece.”

Johns Hopkins Medicine: “All About Asthma in Children.”

National Health Service (U.K.): “Asthma.”

Medscape: “Pediatric Asthma.”

Nemours/KidsHealth: “Asthma.”

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