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Definition

Air travels in and out of the lungs through bronchial tubes. Asthma is a chronic condition causing narrowing of the airways or tubes of the lungs. The airways become narrow from tightening of the airway muscles and swelling of airway lining from inflammation and extra mucus. The airway narrowing makes it hard for your child to breathe. There are different degrees of asthma. Some people may have mild asthma with rare flare-ups. Others may have a severe, constant asthma.

Inflamed Bronchial Tube

Inflammed Lung and asthma

© Nucleus Medical Media, Inc.

Causes

Tightening of the muscles around the airway and chronic inflammation cause airways to narrow. This makes it hard to breathe.

The exact causes of asthma are unknown, but genetics play a role.

Certain conditions are known to trigger an asthma attack. These include:

  • Respiratory infection—more common in younger children
  • Exercise, especially in cold air—more common in teenagers
  • Substances that cause allergies include:
    • Pollen
    • Dust
    • Animal dander
    • Mold
    • Food, rarely
  • Sinus infections
  • Tobacco smoke or other chemical irritants
  • Sudden change in weather
Risk Factors

Factors that may increase your child’s chance of asthma include:

  • Family history
  • History of allergies and/or eczema
  • Exposure to tobacco smoke
  • Respiratory infections before age one and common colds before six months of age
  • Premature birth
  • Chlorinated pool use in children who are already at risk for asthma
  • Taking medications such as acetaminophen
Symptoms

Symptoms may include:

  • Shortness of breath
  • Coughing
  • Trouble breathing
  • Wheezing
  • Chest tightness
  • Fatigue
  • Complaints of chest pain or odd sensations
  • Difficulty during feeding in infants
  • Trouble sleeping
  • Avoiding exercise or sports
Diagnosis

Your doctor will ask you about your child’s symptoms and medical history. A physical exam will be done. The doctor will listen to your child’s lungs. Your doctor may refer your child to a specialist. A pulmonologist focuses on the lungs. An allergist/immunologist focuses on allergies.

Your child's lungs may be tested. This can be done with:

  • Spirometry test
  • Challenge test
  • Medication trial

Images may be taken of your child's bodily structures. This can be done with x-ray.

Your child may be tested for common allergens that may trigger symptoms. This can be done with skin testing.

Your child's oxygen concentration may be measured. This can be done with pulse oximetry.

Treatment

Talk with your child’s doctor about the best plan for your child. You and your child's doctor should also create an asthma action plan. This is a plan your child will follow to help control asthma and handle asthma attacks. Treatment will vary based on symptoms and the number of asthma episodes your child has. It is important that you stick to your child's treatment plan.

Treatment options include the following:

Lifestyle Changes

You can help your child reduce the chance of triggering an asthma attack by making lifestyle changes, such as:

  • Know what your child is allergic to and avoid known triggers. These may include certain pollen, dust, foods, and air pollution.
  • Avoid outside activities if there are high levels of air pollution, pollen, or mold spores.
  • Keep your windows closed during seasons with high pollen or mold spores. Air conditioning may help filter out allergens during warm seasons.
  • Consider getting a portable HEPA unit air cleaner to use in sleeping areas, for your heating/cooling system, and your vacuum cleaner.
  • Avoid exposing your child to tobacco smoke.
  • Have proper heating, cooling, and ventilation systems in your home.
  • Keep the humidity down in your house. This may help prevent the growth of mold.
Medications

Medications used to treat asthma fall into one of two categories:

  • Medications used to treat an asthma attack:
    • Bronchodilators used in nebulizers and inhalers—These are sometimes called rescue medications and are used to quickly treat breathing difficulties.
      • Albuterol
      • Levalbuterol
      • Ipratropium
      • Pirbuterol
    • Corticosteroids given by mouth may be used for short times to control swelling
  • Long-term control:
    • Inhaled corticosteroids
    • Long-acting beta agonist—in most cases, prescribed with an inhaled corticosteroid
    • Leukotriene modifiers such as montelukast and zafirlukast
    • Cromolyn or nedocromil
    • Zileuton, a 5-lipoxygenase inhibitor
    • Theophylline
    • Combination medications that include a long-acting bronchodilator and an inhaled corticosteroid

In addition to the medications, children older than six months should get a yearly flu shot. Children with asthma are at a higher risk of having complications from the flu.

Immunotherapy

Your child’s asthma may be triggered by allergies. In this case, your doctor may recommend allergy shots. These shots are small amounts of an allergen injected into the skin. Over time, your child will react less to the specific allergen(s). With less triggers, the asthma also decreases.

Sublingual immunotherapy may also be used. This type of treatment involves putting the allergic substances under the tongue, rather than using allergy shots.

Prevention

There are no known ways to prevent your child from developing asthma. You can encourage your child with asthma to reduce the risk of asthma episodes by following the treatment plan and avoiding triggers. General guidelines include:

  • Avoid strong chemicals or odors like perfume.
  • Avoid challenging outdoor exercise during days with high air pollution, a high pollen count, or a high ozone level.
  • If cold weather triggers your asthma, avoid strenuous activities in cold weather. If you must, use a scarf or mask to warm the air before it reaches your lungs.
  • Avoid secondhand smoke. Do not allow anyone to smoke in your home.
  • Don't use a wood-burning stove or fireplace, including unvented gas fireplaces.

RESOURCES:

American Academy of Allergy, Asthma, & Immunology
http://www.aaaai.org

Asthma and Allergy Foundation of America
http://www.aafa.org

CANADIAN RESOURCES:

Asthma Society of Canada
http://www.asthma.ca

Canadian Lung Association
http://www.lung.ca

References:

Asthma in children: complications. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 10, 2013. Accessed September 9, 2013.

Asthma overview. American Academy of Allergy, Asthma, & Immunology website. Available at: http://www.aaaai.org/patients/allergic_conditions/pediatric_asthma/diagnosis_asthma.stm. Accessed September 9, 2013.

SW Stoloff. The current and future state of asthma treatment. Clinical Cornerstone: The Current and Future State of Asthma Treatment. 2008; 8(4):26-43.

What causes asthma? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_Causes.html. Accessed September 9, 2013.

10/9/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Mireku N, Wang Y, et al. Changes in weather and the effects on pediatric asthma exacerbations. Ann Allergy Asthma Immunol. 2009;(3):220-224.

10/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Bernard A, Nickmilder M, et al. Impact of chlorinated swimming pool attendance on the respiratory health of adolescents. Pediatrics. 2009;124(4):1110-1118.

8/23/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Beasley R, Clayton T, et al. Acetaminophen use and risk of asthma, rhinoconjunctivitis and eczema in adolescents: ISAAC phase three. Am J Respir Crit Care Med. 2010 Aug 13 early online.

10/8/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Ducharme F, Chroinin M, et al. Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children. Cochrane Database Syst Rev. 2010;(5):CD005535.

5/4/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Woodfine L, Neal RD, et al. Enhancing ventilation in homes of children with asthma: pragmatic randomised controlled trial. Br J Gen Pract. 2011;61(592):e724-732.

8/27/2013 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Kim JM, Lin SY, et al. Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. Pediatrics. 2013 Jun;131(6):1155-67.



Last reviewed September 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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