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This topic provides
information about asthma in children. If you are looking for information about
asthma in teens and adults, see the topic
Asthma in Teens and Adults.
Asthma makes it hard for your
child to breathe. It causes
swelling and inflammation in the airways that lead to the lungs. When asthma
flares up, the airways tighten and become narrower. This keeps the air from
passing through easily and makes it hard for your child to breathe. These flare-ups are also called asthma attacks or exacerbations.
affects children in different ways. Some children only have
asthma attacks during allergy season, when they
breathe in cold air, or when they exercise. Others have many bad attacks that
send them to the doctor often.
Even if your child has few asthma
attacks, you still need to treat the asthma. If the swelling and irritation in
your child's airways isn't controlled, asthma could lower your child's quality
of life, prevent your child from exercising, and increase your child's risk of
going to the hospital.
Even though asthma is a lifelong disease,
treatment can control it and keep your child healthy. Many children with asthma
play sports and live healthy, active lives.
Experts do not know exactly
what causes asthma. But there are some things we do know:
Symptoms of asthma can be
mild or severe. When your child has asthma, he or she may:
Many children with asthma have symptoms that are worse at
Along with doing a
physical exam and asking about your child's symptoms, your doctor may order
tests such as:
Your child needs routine checkups so your doctor can keep
track of the asthma and decide on treatment.
There are two parts to treating
asthma, and they are outlined in the asthma action plan. The goals are
If your child needs to use quick-relief medicine on more than 2 days a week, talk to your doctor. This is a sign that your child's asthma
is not controlled and can cause problems.
Asthma attacks can be
life-threatening, but you may be able to prevent them if you follow a plan.
Your doctor can teach you the skills you need to use your child's asthma action
You can prevent some asthma attacks by helping your child avoid those
things that cause them. These are called triggers. A trigger can be:
It can be scary when your child has an asthma attack. You
may feel helpless, but having an asthma action plan will help you know what to
do during an attack. An asthma attack may be bad enough to need urgent
medical care. But in most cases you can take care of symptoms at home if you
have a good asthma action plan.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about asthma:
Living with asthma:
The cause of
asthma is unknown. Health experts believe that
inherited, environmental, and
immune system factors combine to cause
inflammation of the bronchial tubes, which carry air
to the lungs. This can lead to asthma symptoms and
asthma can be mild or severe. Your child may have no
symptoms; severe, daily symptoms; or something in between. How often your child
has symptoms can also change.
Symptoms of asthma may include:
If your child has only one or two of these symptoms, it
does not necessarily mean he or she has asthma. The more of these symptoms your
child has, the more likely it is that he or she has asthma.
Many children have symptoms that become worse at night (nocturnal
asthma). In all people, lung function changes throughout the day and night. In
children with asthma, this often is very noticeable, especially at night. Nighttime cough and shortness of breath occur frequently. In general, waking at
night because of shortness of breath or cough indicates poorly controlled
It can be hard to know
how severe your child's asthma attack is. Knowing this is important, because
severe attacks may require emergency treatment. But in most cases you can take
care of your child's symptoms at home with an
asthma action plan, which is a written plan that tells
you which medicine your child needs to use and when you should call a doctor or
seek emergency treatment.
begins during childhood or the teen years and may last
throughout your child's life.
classified as intermittent, mild persistent, moderate
persistent, and severe persistent.
asthma attack occurs when your child's symptoms
suddenly increase. While some asthma attacks occur
very suddenly, many get worse over a period of several days.
Things that can lead to an asthma attack or make one worse
Most asthma attacks result from a failure to control asthma with medicines. When your child strictly follows his or her asthma action plan and takes all medicines correctly, it is possible to prevent attacks.
At times, the
inflammation of the airways in asthma causes your child's
airways to narrow and produce
mucus, resulting in asthma symptoms such as shortness
Loss of lung function in asthma appears to start early in
childhood. Asthma also may increase the risk of a
partial collapse of lung tissue (atelectasis) or a collapsed lung (pneumothorax).
Sometimes asthma does not
respond to treatment because children are not taking their medicines or are not taking them correctly, are not avoiding triggers, and are otherwise not following their
asthma action plan. It is very important that you and other caregivers make
sure your child is following his or her action plan to keep asthma from getting
worse and to reduce the
risk of death from asthma.
asthma plans, most children who have asthma can live a healthy, full life.
Many things can increase
a child's risk for
asthma. Some of these are not within your control;
others you can control.
also not sure about the effect that pets in the home have on getting asthma.
An analysis of several studies found that having a pet cat appeared to protect against asthma. Having a pet dog slightly increased the risk for asthma. The effect of other furry pets on the risk of asthma was not clear.7
If your child already has asthma and
allergies to pets, having a pet in the home may make his or her asthma
Your child may be at increased risk for severe asthma
attacks if he or she:
Triggers also may make asthma worse and may lead to
Call 911 or other emergency services immediately if:
Call your doctor now or seek immediate medical care if:
Call your doctor if:
If your child has not been diagnosed with asthma but has
asthma symptoms, call your doctor and make an appointment for an evaluation.
Watchful waiting is a period of
time during which you and your doctor observe your child's symptoms or
condition without using medical treatment.
If you think your child
has asthma, watchful waiting is not appropriate. See your doctor.
If your child has been getting treatment for 1 to 3 months and is not
improving, ask your doctor whether the child needs to see a specialist (allergist or
Watchful waiting may be
appropriate if your child follows his or her
asthma action plan and stays within the
green zone. Monitor your child's symptoms, and
continue to avoid
Health professionals who can diagnose
and treat asthma include:
Your child may need to see a specialist (an
pulmonologist) if he or she:
asthma is based on
medical history, a
physical exam, and simple lung function tests such as
Diagnosing asthma in babies
and toddlers is often very difficult. Symptoms may be the same as those of
other diseases, such as infection with
respiratory syncytial virus (RSV) or inflammation of
the lungs (pneumonia), sinuses (sinusitis), and
small airways (bronchiolitis). If you have a very young child,
spirometry is not practical. So the diagnosis is made based on your report of
In an older child,
lung function tests can diagnose asthma, determine its
severity, and check for complications.
A newer test to monitor asthma is the NIOX nitric oxide
test system. This test measures nitric oxide in exhaled air. A decrease in
nitric oxide suggests that treatment may be reducing inflammation caused by
asthma. But some experts believe that this test is not useful for monitoring
Asthma sometimes is hard
to diagnose because symptoms vary widely from child to child and within each
child over time. Symptoms may be the same as those of other conditions, such as
influenza or other viral respiratory infections. Tests
that may be done to determine whether diseases other than asthma are causing
your child's symptoms include:
Other tests may be done to see whether your child has health problems such as
nasal polyps, or
gastroesophageal reflux disease.
You need to
monitor your child's condition and have regular
checkups to keep asthma under control and to review and possibly update your
asthma action plan. The frequency of checkups depends
on how your child's asthma is
classified. Checkups are recommended:
During checkups, your doctor will ask you and your child
whether symptoms and
peak expiratory flow have held steady, improved, or
become worse. He or she will also ask about asthma attacks during exercise, at
night, or after laughing or crying hard. You and your child track this
information in an
Your child may be asked to bring the
peak expiratory flow meter and inhaler to an
appointment so your doctor can see how he or she uses them. Based on the
results, your child's asthma category may change. And your doctor may change
the medicines your child uses or how much medicine he or she uses.
If your child has
persistent asthma and takes medicine every day, your doctor may ask about his
or her exposure to substances (allergens) that cause an allergic
reaction. For more information about tests for allergies, see the topic
Although your child's
asthma cannot be cured, you can manage the symptoms
with medicines and other measures.
It's very important to treat your child's asthma. Although he or she may feel
good most of the time, even mild asthma may cause changes
to the airways that speed up and make worse the natural decrease in lung
function that occurs as we age.
Your child can expect to live a normal life by following his or her asthma action plan. Asthma symptoms
that are not controlled can limit your child's activities and lower his or her
quality of life.
By following your child's treatment plan, you can help your child meet these
Babies and small children need early treatment for asthma
symptoms to prevent severe breathing problems. They may have more serious
problems than adults because their bronchial tubes are smaller.
An asthma action plan tells you which medicines your
child takes every day and how to treat
asthma attacks. It may also include an
asthma diary where your child records
peak expiratory flow (PEF), symptoms, triggers, and
quick-relief medicine used for asthma symptoms. This helps you to identify
triggers that can be changed or avoided and to be aware of your child's symptoms. A plan also helps you make quick decisions about medicine and treatment.
See an example of an asthma action plan(What is a PDF document?).
Your child will take several types of medicines to control his or her asthma and to prevent attacks. These include:
You and your child will learn how to use a metered-dose
inhaler (MDI) or dry powder inhaler (DPI). An MDI
delivers inhaled medicines directly to the lungs. Most doctors recommend using a
spacer with an MDI.
Your child needs to
monitor his or her asthma and have regular checkups to
keep asthma under control and to ensure the right treatment. The frequency of
checkups depends on how your child's asthma is
It is easy to underestimate the severity of your child's symptoms.
You may not notice them until his or her lungs are functioning at 50% of the
personal best peak expiratory flow (PEF).
PEF is a way to keep track of asthma symptoms at home. It can help you and your
child know when lung function is becoming worse before it drops to a
dangerously low level. This is done with a
peak flow meter.
triggers increases symptoms. Try to avoid situations
that expose your child to irritants (such as smoke or air pollution) or
substances (such as
animal dander) to which he or she may be allergic. Using an air filter machine in your house reduces smoke and other particles in the air, which can help prevent asthma symptoms in children.9
things to think about in treating asthma include:
asthma is not improving, talk with your doctor
If your child's medicine is not working to control airway
inflammation, your doctor will first check to see whether your child is using
inhaler correctly. If your child is using it
correctly, your doctor may increase the dosage, switch to another medicine, or
add a medicine to the existing treatment.
child's asthma does not improve with treatment, he or she may require more treatment, including larger doses of corticosteroids or other
medicines. An asthma specialist typically prescribes these medicines.
If your child has a severe
asthma attack (the
red zone of the asthma action plan), give him or her medicine based on the
action plan. Talk with a doctor right away about
what to do next. This is especially important if your child's
peak expiratory flow (PEF) does not return to the
green zone or stays within the
yellow zone after he or she takes medicine.
may have to go to the emergency room for
At the hospital, your child will probably receive
inhaled beta2-agonists and
corticosteroids. He or she may be given
oxygen therapy. Doctors will assess your child's lung
function and condition. Depending on the response, further treatment in the
emergency room or a stay in the hospital may be needed.
While there is no certain way to prevent
asthma, experts continue to look at things that may reduce a child's chance of getting asthma.
Common irritants in the air,
such as tobacco smoke and air pollution, can cause asthma symptoms in some
Controlling tobacco smoke is important because it is a
major cause of asthma symptoms in children and adults. If your child has
asthma, try to avoid being around others who are smoking. And ask people not to
smoke in your house.
Consider keeping your child inside when air pollution
levels are high. Other irritants in the air (such as fumes from gas, oil, or
kerosene, or wood-burning stoves) can sometimes irritate the bronchial tubes.
Avoiding these may reduce asthma symptoms.
You may also want to use an air filter machine in your house to reduce the amount of dust and other pollutants.
No one is sure if
breast-feeding affects a child's risk of getting asthma. A large study following children until 14 years of age found
that breast-feeding was not linked to asthma.10 Mothers are encouraged to
breast-feed their children for all the other proven health benefits that come
You can limit the impact
asthma has on your child's life by learning about asthma and learning how you can help your child follow his or her treatment plan.
It is easy to
underestimate the severity of asthma. Measuring
peak expiratory flow (PEF) is a way to keep track of
asthma symptoms at home and to know when your child's lung function is getting
worse before it drops to a dangerously low level.
trigger is anything that can lead to an asthma attack. If your child can avoid triggers, he or she may reduce
the chance of having an asthma attack.
Your child may be allergic to certain
substances (allergens). You may reduce your child's asthma
symptoms by limiting exposure to those substances.
It also may be necessary to avoid exposure to other types
of triggers that cause asthma symptoms.
Coughing and wheezing
can wake your child. Special problems that might cause night
Treating a sinus infection,
cold, or allergies can keep your child's symptoms from occurring at
Upper respiratory infections, including the common cold, cause 85 out of 100 asthma attacks in
young children.11 Basic preventive measures include the
Taking medicines is an
important part of asthma treatment. But it can be hard to remember to take them. To help you
and your child remember, understand the reasons people don't take their asthma
medicines. And then find
ways to overcome those obstacles, such as taping notes
on the bathroom mirror.
Most medicines for asthma are inhaled.
With inhaled medicines, a specific dose of the medicine can be given directly
to the bronchial tubes, avoiding or reducing the effects of the medicine on
the rest of the body.
Delivery systems for inhaled medicines include
metered-dose and dry powder
nebulizers. A metered-dose inhaler (MDI) is usually used by older children, and nebulizers are used most often with infants.
manage your child's asthma:
It is important to treat your child's asthma
attacks quickly. If your child does not improve soon after treating an attack,
talk with a doctor.
Medicine does not cure
asthma. But it is an important part of managing the
condition. Medicines for asthma treatment are used to:
Asthma medicines are divided into two groups: those for
prevention and long-term control of inflammation and those that provide quick
relief for asthma attacks. Most children with persistent asthma need to use
long-term medicines daily. Quick-relief medicines are used as needed and
provide rapid relief of symptoms during asthma attacks.
Most medicines for asthma are
inhaled, because a specific dose of the medicine can
be given directly to the bronchial tubes. Delivery systems include metered-dose and dry powder
nebulizers. A metered-dose inhaler is used most
Most doctors recommend that every child who uses a
metered-dose inhaler (MDI) also use a
spacer, which is attached to the MDI. A spacer may
deliver the medicine to your child's lungs better than an inhaler alone. And
for many people a spacer is easier to use than an MDI alone. Using a spacer
corticosteroids can help reduce their side effects and
the need for oral corticosteroids.
The most important asthma
Long-term medicines sometimes used alone or with other
medicines for daily treatment include:
Other medicines may be given in some cases.
Medicine treatment for asthma depends on your child's
age, his or her type of asthma, and how well the treatment is controlling
Your child's doctor will work with you and your child to
help find the number and dose of medicines that work best.
Some parents worry that children who use inhaled
corticosteroids may not grow as tall as other children. A very small difference in height and growth was found in children using
inhaled corticosteroids compared to children not using them.12 And one study showed a very small difference in height [about 0.5 in. (1.3 cm)] in adults who used inhaled corticosteroids as children compared to adults who did not use inhaled corticosteroids.13 But the use of inhaled corticosteroids has important health benefits for children who have asthma. If you are worried about the effects of asthma medicines on your child, talk with your doctor.
(immunotherapy) may be recommended for children who have
asthma symptoms when they are around substances to
which they are allergic (allergens). Allergy shots have been
shown to reduce asthma symptoms and the need for medicines in some
people.16 But allergy shots are not equally effective
for all allergens. Allergy shots should not be given when asthma is poorly
Research has shown that (in addition to taking medicine) family therapy,
such as counseling, may be helpful to children who have asthma.17 In one small study,
peak expiratory flow and daytime wheezing improved in
children who had therapy compared with those who didn't. Another small study
found that children showed overall improvement from therapy.
review of complementary and alternative treatments for asthma in
children concluded that none have been proved to improve asthma symptoms and
some may have harmful side effects.18 The therapies
Talk to your doctor before your child tries a complementary
or alternative treatment.
This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.
The American Academy of Allergy, Asthma, and Immunology
publishes an excellent series of pamphlets on allergies, asthma, and related
information. It also provides physician referrals.
The Asthma and Allergy Foundation of America (AAFA)
provides information and support for people who have allergies or asthma. The
AAFA has local chapters and support groups. And its Web site has online
resources, such as fact sheets, brochures, and newsletters, both free and for
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
McGeady SJ (2004). Immunocompetence and allergy.
Pediatrics, 113(4): 1107–1113.
Rodriguez MA, et al. (2002). Identification of
population subgroups of children and adolescents with high asthma prevalence:
Findings from the third National Health and Nutrition Examination.
Archives of Pediatrics and Adolescent Medicine, 156(3):
Eichenfield LF, et al. (2003). Atopic dermatitis and
asthma: Parallels in the evolution of treatment. Pediatrics, 111(3): 608–616.
Guilbert T, Krawiec M (2003). Natural history of
asthma. Pediatric Clinics of North America, 50(3):
Etzel RA (2003). How environmental exposures influence
the development and exacerbation of asthma. Pediatrics,
Gilliland FD, et al. (2006). Regular smoking and
asthma incidence in adolescents. American Journal of Respiratory and Critical Care Medicine, 174(10): 1094–1100.
Takkouche B, et al. (2008). Exposure to furry pets and the risk of asthma and allergic rhinitis:
A meta-analysis. Allergy, 63(7): 857–864.
Szefler SJ, et al. (2008). Management of asthma based
on exhaled nitric acid in addition to guideline-based treatment for inner-city
adolescents and young adults: A randomised controlled trial. Lancet, 372(9643): 1065–1072.
Butz AM, et al. (2011). A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure. Archives of Pediatrics and Adolescent Medicine, 165(8): 741–748.
Burgess SW, et al. (2006). Breastfeeding does not increase the risk of asthma at 14 years. Pediatrics, 117(4): 787–792.
Lemanske RF Jr (2003). Viruses and asthma: Inception,
exacerbations, and possible prevention. Proceedings from the Consensus
Conference on Treatment of Viral Respiratory Infection-Induced Asthma in
Children. Journal of Pediatrics, 142(2, Suppl): S3–S7.
Guilbert TW, et al. (2006). Long-term inhaled
corticosteroids in preschool children at high risk for asthma. New England Journal of Medicine, 354(19):
Kelly HW, et al. (2012). Effect of inhaled glucocorticoids in childhood on adult height. New England Journal of Medicine, 367(10): 904–912.
Salpeter SR, et al. (2004). Meta-analysis: Respiratory
tolerance to regular beta2-agonist use in patients with
asthma. Annals of Internal Medicine, 140(10): 802–813.
Rachelefsky G (2003). Treating exacerbations of asthma
in children: The role of systemic corticosteroids. Pediatrics, 112(2): 382–397.
Abramson MJ, et al. (2010). Injection allergen immunotherapy for
asthma. Cochrane Database of Systematic Reviews (8).
Oxford: Update Software.
Yorke J, Shuldham C (2005). Family therapy for asthma in children. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
Bukutu C, et al. (2008). Asthma: A review of
complementary and alternative therapies. Pediatrics in Review, 29(8): e44–e49.
Other Works Consulted
Bisgaard H, et al. (2006). Intermittent inhaled
corticosteroids in infants with episodic wheezing. New England Journal of Medicine, 354(19): 1998–2005.
Global Initiative for Asthma (GINA) (2011). Global strategy for asthma management and prevention. Available online: http://www.ginasthma.org/guidelines-gina-report-global-strategy-for-asthma.html.
Gold DR, Fuhlbrigge AL (2006). Inhaled corticosteroids
for young children with wheezing. Editorial. New England Journal of Medicine, 354(19): 2058–2060.
Gotzsche PC, Johansen HK (2008). House dust mite
control measures for asthma. Cochrane Database of Systematic Reviews (2).
Joint Task Force on Practice Parameters (2005).
Attaining optimal asthma control: A practice parameter. Journal of Allergy and Clinical Immunology, 116(5): S3–S11. Available online:
Kolski GB (2011). Asthma in children. In ET Bope, et al., eds., Conn's Current Therapy 2011, pp. 786–796. Philadelphia: Saunders.
Malveaux FJ, et al., eds. (2009). State of childhood asthma and future directions: Strategies for implementing best practices. Pediatrics, 123(Suppl 3).
August 16, 2013
John Pope, MD - Pediatrics & Lora J. Stewart, MD - Allergy and Immunology
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