How to manage asthma in children

Asthma is one of the most common chronic childhood illnesses, responsible for many admissions, and accounting for more school absences than any other chronic illness in children.

It causes inflammation of the lung airways, making them sensitive to various triggers, and causing them to over-secrete mucus. The airway muscles may also contract, a reaction known as bronchospasm.

These two reactions lead to narrowing of the airways, making it difficult for the child to breathe out from the lungs. This resistance to breathing out is what typically leads to the typical symptoms of asthma.

In many cases, asthma is life-long. However, some children seem to outgrow it, while others remain symptom-free by managing the triggers that seem to exacerbate attacks.

Early and proper asthma management is likely to lead to a better prognosis than when it is not properly managed.

Causes of Asthma

Asthma seems to be on the rise due to air pollution, as well as exposure to indoor allergens, making the airways more sensitive to these triggers. The risk factors for asthma include allergic rhinitis (hay fever), and allergies such as eczema.

Patients with many allergies are said to be atopic, and asthma can present as one of the many allergic diseases an atopic child may have.

Asthma runs in families, but environmental factors such as pollution and living conditions also play a major role in the occurrence and severity of symptoms. Most patients with asthma have their own different sets of triggers.

Common triggers include; exposure to tobacco or wood smoke, breathing in irritants such as strong perfumes and chemicals, breathing in moulds, dust, or animal dander.

Many others get asthmatic attacks during an upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis, exposure to cold, dust, emotional excitement or stress, physical exertion and exercise.

Symptoms of asthma

The most common symptoms of asthma include; wheezing (a whistling or hissing sound commonly heard during exhalation), breathlessness, especially after a cough or with speech, chest tightness, cough especially at night, and difficulty speaking. Other symptoms may include refusal or difficulty in feeding in infants.

Not all wheezing is due to asthma, and not all asthmatics wheeze. In severe forms of asthma, due to absolute lack of air passage through the airways, wheezing may be very little or none at all.

Other symptoms of severe asthma include; tightness in neck muscles, slight grey or bluish colour in the lips and fingernail beds, a ‘sucked in’ appearance in the skin around the rib cage, as well as a ‘silent chest’.

Diagnosis of asthma

Asthma may occasionally be difficult to diagnose because different children may present with different symptoms. Some may have a nocturnal cough while they have no symptoms during the day, while others will have overt wheezing.

Others seem to have a ‘cold’ that never goes away. Doctors will usually ask questions about family history, as well as allergy symptoms. In addition, tests may be carried out to rule out other causes of the symptoms such as cough, breathless and refusal to feed.