Asthma In Children

Asthma is a common long-term condition that can be effectively controlled in most children. The severity of asthma symptoms varies between children, from mild to severe.

In the UK, over 1.1 million children have asthma. 

What is asthma?

Asthma affects the airways, the small tubes known as the bronchi, that carry air in and out of the lungs. If your child has asthma, the airways of their lungs are more sensitive than normal.

When your child comes into contact with something that irritates their lungs, known as a trigger (see below), their airways narrow, the lining becomes inflamed, the muscles around them tighten, and there is an increase in the production of sticky mucus or phlegm.

This makes it difficult to breathe and causes symptoms such as:

• wheezing
• coughing
• shortness of breath
• tightness in the chest

Asthma attack

A sudden, severe onset of symptoms is known as an asthma attack, or an acute asthma exacerbation. Asthma attacks can sometimes be managed at home but may require hospital treatment. They are occasionally life threatening.

The symptoms of asthma can range from mild to severe. When asthma symptoms get significantly worse it is known as an asthma attack.

The common symptoms of asthma include:

• feeling breathless (sometimes gasping for breath)
• a tight chest, like a band tightening around it
• wheezing (there may be a whistling sound when your child breathes)
• coughing, particularly at night and early morning
• attacks triggered by exercise, exposure to allergens and other triggers

Symptoms vary between children and they may have one or more of these symptoms. If symptoms become worse during the night or with exercise, your child's asthma may not be well controlled. Take your child to see their doctor or asthma nurse.

Asthma attack

A severe asthma attack usually develops slowly, taking 6 to 48 hours to become serious. However, for some children, asthma symptoms can get worse quickly.

Be aware of any signs of worsening asthma in your child. These may include:

• your child becoming more wheezy, tight chested or breathless 
• the reliever inhaler (usually blue) not helping as much as usual
• a drop in peak expiratory flow rate (see diagnosing asthma in children for more information)

If you notice your child's symptoms getting worse, do not ignore them. Contact your GP or asthma clinic, or consult their asthma action plan, if they have one.

Signs of a severe asthma attack include:

• the reliever inhaler does not help symptoms at all
• the symptoms (wheezing, coughing, tight chest) will be severe and constant
• breathing very fast and too breathless to complete a sentence in one breath or too breathless to talk or feed 
• a racing pulse
• feeling agitated or restless 
• lips or finger nails may turn blue

Call 999 and ask for an ambulance if your child has severe symptoms of asthma.

You may be advised to give extra doses of the reliever inhaler while you are waiting for the ambulance.

Causes of asthma

The exact cause of asthma is not yet fully understood. Asthma often runs in families and a child is more likely to have asthma if one or both parents have the condition.

There are also a range of asthma triggers, although everyone’s asthma is different and people may have several triggers.

An upper respiratory tract infection, such as a cold or flu is the most common trigger of an asthma attack. Other common triggers include:

• exercise, especially in cold weather
• an allergy to and contact with house dust mites, animal fur, grass and tree pollen
• exposure to air pollution, especially tobacco smoke

There is no single known cause of asthma. However, certain things may increase the likelihood of your child developing asthma.

This can be due to your child’s genes or their environment, particularly in early life.

Increased risk

The likelihood of developing wheezing and asthma is increased if:

• there is a family history of asthma or other related allergic conditions (known as atopic conditions) such as eczema, hay fever or a food allergy 
• your child develops another atopic condition such as eczema, hay fever or a food allergy
• your child develops acute bronchiolitis (a lung infection, common in babies, that is caused by a virus )
• your child is exposed to tobacco smoke, particularly if the child's mother smokes during pregnancy
• your child was born prematurely
• your child was born with a low birth weight (less than 2kg or 4.5lb)

Asthma triggers

Asthma can have a range of triggers, but they do not affect everyone in the same way. Once you know what your child’s asthma triggers are, you can try to avoid them.

Triggers include:

• Airway and chest infections – Upper respiratory infections, which affect the upper airways, are often caused by cold and flu viruses and are a common trigger of asthma. 
• Allergens – Pollen, dust mites, animal fur or feathers, for example, can all trigger asthma.
• Airborne irritants – Cigarette smoke, chemical fumes and atmospheric pollution may trigger asthma.
• Medicines – The class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, can trigger asthma for some people, although are fine for most. Children under 16 years of age should not be given aspirin. 
• Emotional factors – Asthma can be triggered by emotions, such as stress or laughing.
• Foods containing sulphites – Sulphites are naturally occurring substances found in some food and drink. They are also sometimes used as a food preservative. Food and drinks that are high in sulphites include concentrated fruit juice, jam, prawns and many processed or pre-cooked meals. Most children with asthma do not have this trigger, but some may.
• Weather conditions – A sudden change in temperature, cold air, windy days, poor air quality, and hot, humid days are all known triggers for asthma.
• Indoor conditions – Mould or damp, house dust mites and chemicals in carpets and flooring materials may trigger asthma.
• Exercise – Sometimes, people with asthma find their symptoms are worse when they exercise.
• Food allergies – Although uncommon, some people may have allergies to nuts or other food items, known as an anaphylactic reaction. If so, these can trigger severe asthma attacks.

Want to know more?

• Asthma UK: Asthma triggers A-Z.
• Causes of food allergies.  

What happens during an asthma attack?

During an asthma attack:

• the bands of muscles around the airways tighten
• there is increased inflammation in the linings of the airways and they become swollen
• the airways produce sticky mucus or phlegm, which can further narrow the airways

This narrows the passages of the airways, making it more difficult for air to pass through (in other words, making it more difficult to breathe). This can cause the characteristic wheezy noise. However, not everyone with asthma will wheeze. In a life-threatening attack, there may not be a wheezy sound.

An asthma attack can happen at any time. However, there are usually warning signs for a couple of days before, such as symptoms getting worse, especially during the night, and an increased need to use the reliever inhaler.

Asthma can sometimes be life threatening. See treating asthma in children for more information about how to manage your child’s asthma. Speak to your doctor or asthma nurse for further advice.

If your child or someone else is having a severe asthma attack and are unable to breathe, dial 999 immediately to request emergency medical treatment.

Want to know more?

• Asthma UK: Information for parents.

Asthma is more common in young boys than young girls. However, this changes as children get older and, after puberty, asthma is more common in girls.

During teenage years, the symptoms of asthma may disappear. However, asthma can return in adulthood.

It can be difficult to diagnose asthma in children as many other conditions can cause similar symptoms.

Diagnosis

Asthma can be difficult to diagnose in young children because many other conditions can cause similar symptoms.

Most children develop the symptoms of asthma by the time they reach school age. Some children also have other allergic (atopic) conditions such as eczema and hay fever.

There is no simple test to diagnose asthma, but certain combinations of symptoms and signs make it likely that your child has asthma.

Seeing your GP

Your GP will ask about your child's symptoms and listen to their chest. They will want to know when and how often your child has symptoms and if you have noticed anything that might trigger them. The GP will also ask about your child's medical history and whether there is a history of allergic conditions in your family.

If your GP suspects your child may have asthma, a number of tests can be carried out to confirm the diagnosis.

Sometimes, children may be given an asthma inhaler as a trial treatment. If this helps their symptoms, the child probably has asthma. However, asthma medicines can be relatively ineffective in infants and young children, so a negative response may not definitely rule out asthma.

Spirometry

To assess how well your child’s lungs work, a breathing test called spirometry is carried out at the GP surgery. This test can only be done reliably in children over the age of five.

Your child will be asked to breathe into a machine called a spirometer. The spirometer takes two measurements: the volume of air that your child can breathe out in one second (called the forced expiratory volume in one second or FEV1) and the total amount of air that your child can breathe out (called the forced vital capacity or FVC).

Your child may be asked to do the test a few times to get a consistent reading.

The readings are compared with normal measurements for children of your child’s age. This will show if your child’s airways are obstructed.

Sometimes, an initial set of measurements is taken, and then your child is given a medicine to open up the airways (a reliever inhaler). Another reading is then taken. If the reading is much higher after taking the medicine, this suggests your child has asthma.

Peak expiratory flow rate test

A small hand-held device, known as a peak flow meter, can also be used to measure whether the lung airways are narrowed. The peak flow meter measures the highest flow of air that we can blow out of our lungs during one breath. This is called the peak expiratory flow rate (PEFR).

You may be given a peak flow meter to take home and a diary to record measurements of your child’s peak flow. Your child’s diary will also have a space for you or your child to record their symptoms. This will help you recognise when your child’s asthma is getting worse.

The PEFR test is only suitable for children over five years of age.

Other tests

Some children may need more tests. Additional tests may confirm the diagnosis of asthma or may help diagnose a different condition that causes symptoms similar to those of asthma. The results of these tests will help you and your doctor plan your child’s treatment.

Airway responsiveness tests

This test is used to see how the airways react when stimulated. The most common test of this type in children is an exercise test.

Your child will blow into a peak flow meter or a spirometer and then be asked to run as hard as they can for a few minutes. After the run, the breathing tests will be repeated. A significant decrease in the measurements may indicate your child has asthma.

Tests of airway inflammation

These tests are normally done in a hospital asthma clinic.

• Phlegm sample – the doctor may take a sample of phlegm to check whether there is inflammation in the lungs.
• Nitric oxide concentration – as your child breathes out, the level of nitric oxide in the breath is measured. A high level of nitric oxide can be a sign of airway inflammation.

Allergy testing

Skin testing or a blood test can sometimes help establish whether your child’s asthma is associated with specific allergies, such as allergies to dust mites, pollen and foods.

Treating asthma in children

While there is no cure for asthma, there are effective treatments that can help control the condition. Treatment is based on two important goals:

• relieving symptoms 
• preventing future symptoms and attacks from developing

Treatment involves a combination of medicines, a personal asthma action plan and avoiding potential asthma triggers.

Read more about how asthma in children is treated.