Asthma is a lifelong respiratory condition that affects your airways, specifically the branches that come off your central windpipe (trachea) ie your medium-sized bronchi. During an asthma attack, these airways become inflamed and temporarily narrow, and the muscles around the airways spasm. This makes it difficult to breathe and results in the hallmark symptom of asthma, wheezing.
Although the most common symptom of childhood asthma is wheezing, which is sometimes noticeable without listening for it with a stethoscope, there are other, more subtle symptoms. This includes periodic nighttime coughing or coughing when running around, especially when outdoors in cold weather.
Asthma is one of the most misdiagnosed chronic (long-term) conditions in children. This is partly because, unlike other chronic conditions, such as diabetes, there is no single test that can definitively determine whether or not your child has asthma. Also, in young children, the main symptom of asthma, wheezing, can occur for several other reasons.
The immune system in young children is still developing, which makes them more prone to catching colds and viruses. These infections can cause wheezing or result in conditions, such as viral wheeze, croup or bronchiolitis, which also cause wheezing. These conditions are less common in older children, from around age six onwards. Consequently, a recurrent wheeze in an older child can be easier to diagnose as asthma.
Often a child with asthma is diagnosed after recovering from a cold when their parent notices that they are still struggling to breathe easily. Depending on the severity of their breathing difficulties, they may be seen by their GP, an out-of-hours service or in A&E. A doctor will ask detailed questions about their medical history and any previous episodes of wheezing or breathlessness, and listen to their chest using a stethoscope. On detecting wheezing, the doctor will prescribe treatment with a bronchodilator drug to resolve the narrowing of their airways.
Depending on the severity of their symptoms, they may be given an inhaler with a spacer device, so they can administer the bronchodilator drug at home, or they will stay in hospital and be treated with the drug via nebulisation therapy. If your child responds to treatment, they may receive a diagnosis of asthma.
Asthma has many different triggers but one of the most common is viruses eg respiratory syncytial virus (RSV), which causes bronchiolitis and rhinoviruses, which cause colds. In the UK, this makes asthma attacks more common in the winter.
Allergens can also trigger asthma. Depending on the type of allergen, the severity of your child’s asthma may vary seasonally eg if their asthma is triggered by grass, they may be fine throughout winter but struggle in the summer when they are spending more time outdoors.
Other allergens include dust mites, fungi, mould, weeds, trees and animal dander. Even if you do not have a pet at home, if your neighbours have pets, your child may still be exposed to high enough levels of dander to trigger their asthma. Asthmatics tend to be more sensitive to cat dander than dog dander.
Other asthma triggers include strong perfumes, incense, pollution (eg vehicle fumes), stress and anxiety. Exercise, laughing and crying can also trigger asthma attacks.
Triggers vary between asthmatics but can also overlap.
Asthma not only causes the airways to become inflamed but also increases the amount of mucus lining the airways. Consequently, if asthma is left untreated, this excess mucus can build up, increasing the chances of it becoming infected. This can lead to further respiratory illnesses, such as pneumonia or bronchiectasis.
Untreated asthma in children can also lead to poor growth and poor performance at school, as well as chest deformities and poor lung function. It is, therefore, essential to seek medical help and adhere to the treatment prescribed.
Asthma attacks are treated with bronchodilator drugs to widen the narrowed airways. Your child will be prescribed a reliever inhaler with a spacer device. This is used when an attack occurs to help relieve your child’s symptoms. If your child has a severe attack and needs to go to hospital, they may also be prescribed a course of steroids to reduce the inflammation of their airways.
If your child needs to use their reliever inhaler three or more times a week, you should see a GP. They will be assessed and may need to use a preventer inhaler — this is used every day to reduce the inflammation of their airways. Preventer inhalers reduce the frequency and severity of asthma attacks but won’t stop them completely.
If your child has received a diagnosis of asthma, they will need regular monitoring eg via an asthma clinic. This will allow your doctor to check whether their medication is appropriate or whether it can be reduced or needs to be increased.
Although asthma is a lifelong condition and your child will need lifelong management, if treated appropriately and consistently, they can lead a full life.
It is important to know that once your child has started treatment with an inhaler, it can take up to three months before your child’s symptoms improve.
Dr Maitra is a Consultant in Paediatric Respiratory Medicine at Spire Manchester Hospital treating children with complex respiratory problems and sleep problems. He is also Director of the Cystic Fibrosis Unit, which is currently the largest such unit in the UK, and is involved with multiple national and international organisations that promote the cause of respiratory health in children.
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.