Does your little one have asthma? Let's learn everything about childhood asthma!

Does your little one cough often? Does he wheeze while playing? Or does he wake up at night and say he has trouble breathing? These could be signs of asthma in children. Don't worry , we'll talk about this today. If you understand this properly and follow the doctor's instructions, your child can also stay healthy.

What is Childhood Asthma?

Simply put, asthma is a chronic lung disease . It affects your airways, the tubes that carry air into and out of your lungs. In someone with asthma, these airways become swollen and narrow, making it difficult for your lungs to get enough air.

Imagine that when you squeeze a water pipe, it is difficult for the water to flow. This makes it difficult to breathe, and you may also experience wheezing, coughing, and a feeling of tightness in your chest. Certain things (we call them `Triggers`) can cause these symptoms to suddenly increase, or an asthma attack can occur. This attack can come on slowly or quickly, and sometimes it can be life-threatening .

Although asthma can start at any age, it often begins in childhood, when a child's immune system is still developing. Most children with asthma show their first symptoms by the age of 5. Asthma can keep your child from going to school and may even require hospitalization. Therefore, it is very important to have a proper asthma treatment plan to help control your child's condition.

How common is asthma in young children?

In fact, asthma is one of the most common chronic diseases of childhood. In the United States alone, it affects about 7.5 million children. The prevalence of this disease among children is increasing. It is also a major reason why children are unable to go to school and parents are unable to go to work.

Why are more children developing asthma these days?

Researchers believe that there are several reasons why children are more likely to develop asthma. Some of these include:

• Frequent exposure to allergens like dust, air pollution, and cigarette smoke.
• Insufficient exposure to certain childhood illnesses that strengthen the immune system .
• Decreased breastfeeding . This reduces the baby's ability to receive important nutrients for its immune system.

What are the symptoms of asthma in a young child?

Not all children show the same symptoms of asthma. Also, symptoms can vary from one child to another. Some of the symptoms that can be seen in childhood asthma are:

• Frequent coughing . This cough may occur when the child is playing or laughing. Coughing while sleeping at night or upon waking up in the morning can sometimes be the only symptom of asthma.
• Getting tired more quickly than usual while playing.
• Rapid breathing, feeling like you are suffocating (Dyspnea) .
• The child says that the chest is constricted and that the chest "hurts."
• Wheezing is a whistling sound heard when breathing in and out.
• Retractions are when the chest between the ribs and the neck area appear to be going inward . This means that the baby is trying very hard to breathe.
• Feeling lifeless and tired .
• Irritability .
• Difficulty breastfeeding and eating (this can especially affect very young babies).

If your child is experiencing one or more of these symptoms frequently, it is very important to see a doctor for advice.

How do you know if your asthma is worsening and is an emergency?

When a child has an asthma attack (Asthma Exacerbation), the symptoms can be very severe. This attack can come on slowly or suddenly. Sometimes it can be life-threatening (Status Asthmaticus). If your child shows any of the following symptoms of a severe asthma attack, you should seek medical help immediately :

• Very loud coughing .
• Difficulty breathing or wheezing that gets worse quickly .
• It's very difficult to breathe .
• Increased breathing rate even when just standing still.
• The child's face, lips, and/or fingernails turn pale or blue .
• Difficulty speaking , inability to complete a sentence, or inability to speak at all.

What causes asthma in children?

Researchers don't know exactly what causes asthma. But it often begins during childhood, when a child's immune system is still developing. There are several factors that affect how a child's lungs develop and how well the body fights off disease. These include:

• Genetics : If someone in the family, especially a parent, has asthma.
• Allergens: Things that the child is allergic to, such as dust, pet dander, and cigarette smoke.
• Viral infections in childhood: Infections that affect the respiratory system, such as the common cold .

Is asthma a contagious disease?

No, asthma is not a contagious disease. It is not caused by germs, that is, bacteria or viruses. Therefore, it cannot be transmitted from one person to another.

What are the risk factors for developing asthma in childhood?

There are several risk factors that contribute to the development of asthma in childhood:

• Having allergies .
• A family history of asthma and/or allergies .
• Frequent respiratory infections during childhood.
• Being born with low birth weight .
• Exposure to cigarette smoke before and after birth.
• Being a boy (statistically, boys are more likely to be affected in early childhood).
• Belonging to certain ethnic groups (this may not be particularly relevant to Sri Lanka).
• Living in an urban area with high air pollution .

What complications can occur if asthma is not managed properly?

If asthma is not properly controlled, a variety of problems and complications can occur. Some of them include:

• Having a severe asthma attack .
• Having to miss school or other activities.
• Frequent hospitalizations and/or emergency room visits.
• Permanent damage to the lungs .

How to diagnose asthma in young children?

In fact, it is a little difficult to diagnose asthma in young children, especially children under 6 years of age. This is because the symptoms can be similar to those of other diseases. Also, some children do not always show symptoms of asthma, so they can be mistaken for another respiratory disease. In addition, pulmonary function tests used to diagnose asthma may not be accurate in young children.

Your child's pediatrician can diagnose the condition after reviewing your child's medical history, symptoms, and a physical exam. The doctor will ask you if your child has ever had trouble breathing. He or she will also ask if anyone in your family has asthma, allergies, or other lung conditions. Be sure to describe your child's symptoms in detail, including when they occur and how often they occur.

Your doctor may also refer your child to a specialist, such as a pediatric pulmonologist or a pediatric allergist.

What tests are done to check for asthma?

If possible, your doctor may order several tests to diagnose asthma. These include:

• Lung function tests: These tests measure how much air your child's lungs can hold and how quickly they can exhale it. The results can help the doctor determine how severe your child's asthma is.
• Allergy skin testing and blood tests: These help identify what allergens are stimulating the child's immune system.
• Chest X-ray: Your doctor can use imaging tests like this to confirm that it is not asthma but some other medical condition.

Lung function tests are usually difficult for very young children. Therefore, the doctor may suggest giving the child some asthma medication to see how he or she responds.

How to treat asthma in young children?

When treating childhood asthma, it is important to work with your child's doctor to create an "Asthma Action Plan." This plan describes how to manage your child's symptoms and prevent asthma attacks. The plan also includes:

• When and how to use your child's asthma medication .
• What to do if your child's asthma gets worse .
• When does a child need emergency treatment ?

Make sure you understand this plan, and ask your doctor any questions you may have. This asthma action plan is very important for the success of your child's asthma management. Keep it handy to remind yourself of your child's daily asthma management plan and to have it handy when your child has asthma symptoms. Also, give a copy of this plan to your child's school staff and other caregivers.

In addition to following your asthma action plan, limit your exposure to things that make your asthma worse (asthma triggers) as much as possible (and avoid them altogether if possible). Your doctor can help you with strategies to avoid these triggers.

Medications for childhood asthma

The medications given to children with asthma are the same as those given to adults and young children, but the dosage and method of administration may be different. When giving inhaled medications, a different delivery device may be used depending on the child's age and ability.

Depending on the severity of your child's condition, you may need to take medication only when needed, or you may need to take medication every day. Some medications help prevent or relieve the symptoms of an asthma attack. Other medications work to control or prevent swelling in your child's airways.

Quick-relief medicines

These medications help prevent or relieve asthma symptoms. If your child has mild asthma, or if their asthma flares up only with physical activity, these quick-relief medications may be enough. This type of medication comes with an inhaler that your child should keep with them at all times.

Medications that provide immediate relief:

• Short-acting beta2-agonists (SABAs): For example, albuterol. These quickly open your child's airways and allow air to flow during an asthma attack. They also help prevent attacks that are triggered by physical activity. While they used to be called "reliever" or "inhaler," doctors now prefer to use the term "quick-relief." This is because these medications can and should be used for any asthma symptom, not just an asthma attack.
• Short-acting anticholinergics: For example, Ipratropium bromide. This is also a bronchodilator that quickly opens the airways. Anticholinergics may not be as effective as SABAs. However, since some children have side effects from SABAs, anticholinergics are a good option.
• Systemic corticosteroids: Corticosteroids can reduce the inflammation in your child's airways that causes asthma symptoms. These medications can be given to your child either orally or by injection. They can also help your child recover more quickly after an asthma attack.

Long-term control medicines

Your doctor may also prescribe daily medications for your child to help prevent asthma attacks and control symptoms. These medications help prevent your child's airways from narrowing and reduce swelling.

Long-term control medications:

• Corticosteroids: These are anti-inflammatory medications that reduce swelling. Although they can be given orally, doctors prefer to give them by inhalation. These medications can be given as a liquid (used in a nebulizer), through a metered dose inhaler (MDI), or through a dry powder inhaler (DPI). When using an MDI, your child must use a valved holding chamber, which is a spacer.
• Leukotriene modifiers: These medications help reduce swelling in your child's airways and keep them open. Your doctor may prescribe these alone or with corticosteroids. Leukotriene modifiers work by reducing the effects of a chemical called leukotriene in your child's body.
• Long-acting beta2-agonists (LABAs): LABAs help relax the muscles around your child's airways and prevent them from narrowing. Your doctor will often prescribe these with a corticosteroid. A LABA may be recommended when your child's daily symptoms are not controlled with a regular dose of an inhaled steroid. A LABA should always be used with an inhaled steroid (this is called combination therapy).

Are there any side effects of the treatment?

Most people tolerate asthma medications well. Doctors say that the benefits of the medications far outweigh the risks. However, like all medications, there is a chance that some side effects may occur. Asthma medications can cause side effects such as:

• Skin irritation or swelling.
• Oral thrush.
• Increased heart rate.
• Restlessness, agitation.
• Weight gain.
• Headache.

If your child experiences severe side effects, you can talk to your doctor and change the dosage or switch medications.

If my child has asthma, what should I expect?

Asthma is not a completely curable disease. However, most children can manage their asthma well with proper treatment and prevention strategies . Untreated asthma can cause long-term complications, such as permanent lung damage.

How do you know if your child's asthma is well controlled?

You can know that your child's asthma is well controlled if, while taking medication, they:

• If you live an active, normal life .
• If there are very few bothersome symptoms.
• If you are not missing school due to symptoms.
• If you can do your daily tasks without any difficulty .
• Unless there are emergency visits to the pediatrician, emergency room, or hospital.
• If the medication has fewer side effects, or none at all .

Does childhood asthma go away as you grow older?

Once a person's airways become sensitive, that sensitivity lasts a lifetime. For about half of children with asthma, symptoms decrease significantly by the time they reach adolescence. Therefore, they may seem to have outgrown their childhood asthma.

However, childhood asthma can come back. About half of children who seem to have gone away from their asthma will experience a return of asthma symptoms in their 30s or 40s. Unfortunately, there is no way to predict who will have their symptoms go away in their younger years and who will have a return later in life.

Can childhood asthma be prevented?

Childhood asthma cannot be prevented because the exact cause of the disease is unknown. Also, asthma can develop because your child's immune system is still developing.

How can I reduce my child's risk of developing asthma?

Although childhood asthma cannot be prevented, there are several things you can do to reduce your child's risk of developing it:

• Keep your home free of mold and moisture .
• Avoid air pollution as much as possible.
• Help your child maintain a healthy weight .

When should my child see a doctor?

If your child has asthma symptoms along with any of these risk factors, you should see a doctor:

• If you have been hospitalized due to asthma within the past year.
• If you have previously had a life-threatening asthma attack .
• If you have recently had to take oral corticosteroids to treat asthma.
• If you use more than one canister of `SABA` medicine that lasts for more than a month.
• If you have a mental health condition or substance abuse problem .
• If you have a food allergy .

What to do if your child has an asthma attack?

If your child is showing symptoms of an asthma attack:

1. Give your child's asthma action plan as a quick-relief medicine .

2. Wait 15 minutes . If the symptoms disappear, the child should be able to return to the activity he was doing.

3. If symptoms persist, follow the asthma action plan for further treatment .

4. If your child's condition does not improve, or if you are unsure of what to do, call your child's doctor .

When should I take my child to the Emergency Treatment Unit (ETU) ?

If your child shows any of these warning signs of an asthma attack, you should call 911 or take your child to the nearest emergency room:

• If there is a severe whistling sound (Wheezing) .
• If you have a severe cough .
• If you have difficulty walking and/or talking .
• If the skin, lips and/or nails turn blue .

Finally, what to remember

So, being aware of your child's asthma is a big step in managing it. It's important to work with your doctor to identify and avoid triggers, use medications correctly, and learn how to administer them properly. Don't forget that with proper treatment, your child can live a normal, healthy life without asthma symptoms. We all wish you and your child the strength to continue this journey!