Asthma is a disease of the lungs, and the most common chronic disease in children. Common symptoms of asthma include wheezing, cough, chest tightness, and trouble breathing. Asthma is likely caused by a combination of genetic and environmental factors, so it can run in families. Genetically, asthma, allergies and eczema are connected, so it is common for a child with asthma to also have a history of allergies or eczema. Asthma cannot be cured, but it can be controlled, and some children do outgrow it. Certain things can cause asthma to flare up, these are called triggers. Common asthma triggers include:
- viral respiratory infections (colds, influenza)
- cold air
- air pollution
Some triggers should be avoided. For example, when the air quality is poor, (as it was this summer with the smoke from the fires in Canada) people with asthma should avoid being outside. People with asthma should not smoke cigarettes or vape – honestly no one should, it’s bad for healthy lungs too. Other triggers cannot be avoided; anyone with a child in daycare knows there is little you can do to avoid those daycare colds, and we do not want kids with asthma to avoid exercise. This is where medicines to manage asthma come in. A common concern I hear from parents with asthma is that their child will not be able to play sports, but this is not the case. Many elite athletes, including some professional athletes and Olympians, have asthma that they are able to manage with medications and still perform at a high level.
Asthma is usually treated with inhaled medicines (medicines that you breathe in). This can be done with an inhaler, or with a nebulizer machine. Occasionally we also use oral medicine (medicines that you take by mouth, such as a pill or liquid medicine). Your pediatric provider can help you make an asthma action plan – a written plan that tells you when to use which medicine.
To understand the medicines for asthma I think it is helpful to understand what is going on in the lungs. Asthma is a disease of the small airways in the lungs. The airways get narrower making it harder for air to get out. This is caused by 2 main problems:
- bronchospasm – the muscles around the airway get tight and squeeze the airway to make it smaller
- inflammation – the lining of the airways get swollen and make mucous that clogs the airway
The most common treatments for asthma targets the 2 main problems
- For bronchospasm, we use a bronchodilator (medicine that relaxes the muscles in the airway). This is usually the ‘rescue’ medicine – it helps right away when a child is having coughing or wheezing. This medicine is usually used when the child is having symptoms of their asthma or before exercise. The most common one we use is called albuterol.
- For inflammation we use steroid medicines. Some children need to be on inhaled steroids every day to keep the inflammation down, we call this their ‘controller’ medicine. For children who have more frequent or what we call ‘persistent’ asthma, it is important that they take their controller medication every day, even when they are not sick, to prevent asthma flares. When children have asthma flare ups, we may need to use oral steroids to calm down the inflammation. Oral steroids are the ‘big guns’ in asthma treatment. They are very effective and work fast, but they have more side effects than inhaled steroids if they are used too long or too often, so we usually only use them for 3-5 days. If your child is needing frequent treatment with oral steroids (more than 1-2 times per year), this is a sign that their asthma is not well controlled and they may need to change their asthma plan.
Most asthma is managed by general pediatricians and nurse practitioners. Some children with more severe asthma (for example, asthma requiring frequent ER visits/hospitalizations) may also see a pediatric pulmonologist – a doctor that specializes in lung disease. Children who have a lot of allergies contributing to their asthma may benefit from seeing an allergist.
Managing asthma can be challenging, and it is very scary when your child is having trouble breathing. We are here to help! Please do not hesitate to ask your pediatrician or nurse practitioner about any questions or concerns you have about your child’s asthma.