Asthma (Children)

Asthma is a common long-term condition affecting the airways (breathing tubes) in the lungs. In children with asthma, the airways can become inflamed, swollen, and narrowed, making breathing difficult. 

Children with asthma may have: 

• Wheezing (a whistling sound when breathing) 
  
• Coughing 
  
• Shortness of breath 
  
• Tightness in the chest 
  

Symptoms may occur from time to time, with the child appearing well in between, or may be more frequent, including at night or early in the morning. Asthma symptoms can develop in young children as well as school-age children and adolescents. 

Sometimes symptoms suddenly worsen, leading to an asthma attack. Attacks can range from mild to severe and may require urgent medical care. 

Common symptoms of asthma include: 

• Recurrent cough (especially at night or with exercise) 
• Wheeze 
  
• Shortness of breath 
  
• Tightness in the chest 
  

Symptoms may be triggered by: 

• Viral infections such as the common cold 
  
• Exercise 
  
• Cold air 
  
• Tobacco smoke (including second-hand smoke) 
  
• Air pollution 
  
• Allergens such as house dust mites, pet dander, mould, and pollen 

Asthma is diagnosed using a combination of: 

• Your child’s symptoms and medical history 
  
• Family history of asthma or allergies 
  
• Physical examination 
  
• Lung function and inflammation tests, where appropriate 

Tests that may be used: 

Spirometry 

A breathing test that measures airflow and response to treatment. It is usually suitable for children 6 years and older. 

Oscillometry 

A gentle breathing test for younger children (approximately 2-6 years) who cannot perform spirometry. 

Exhaled nitric oxide measurements 

A breath test that helps assess airway inflammation and may support diagnosis and treatment decisions. 

Allergy testing 

Skin prick tests or blood tests can identify allergens that may trigger asthma symptoms. These tests can be done at any age, including in babies. 

The aim of asthma treatment is to: 

• Control daytime and nighttime symptoms  
  
• Prevent asthma attacks 
  
• Reduce emergency visits and hospital admissions 
  
• Allow children to live active, healthy lives 
  

With the right treatment, most children can achieve good asthma control. 

Asthma Medications 

Reliever medicines 

Relievers are used to quickly ease symptoms during an asthma attack. The most commonly used reliever is salbutamol. Relievers in the form of metered-dose inhalers work best when inhaled using an inhaler with a spacer. Frequent need for reliever medication should prompt medical review. 

Preventer (controller) medicines 

Preventer medicines reduce inflammation in the airways and help prevent asthma attacks. Inhaled corticosteroids are the most effective preventers. Examples include: 

• Fluticasone 
  
• Beclomethasone 
  
• Budesonide 
  

Some children, particularly older children, may need combination inhalers that contain both an inhaled corticosteroid and a long-acting bronchodilator. Preventer medicines are taken every day, even when your child feels well. They are not needed for all children – treatment is tailored to each child. Your child’s doctor will regularly review treatment to ensure the lowest effective dose is used. 

Identification and avoidance of triggers 

Your healthcare team will help identify factors that worsen your child’s asthma. Recommendations may include: 

• Avoiding exposure to tobacco smoke 
  
• Managing allergies when relevant 
  
• Reducing indoor allergens where appropriate 
  
• Treating viral infections early 
  

Avoidance strategies are individualised and balanced with maintaining a normal lifestyle. 

Exercise-Induced Asthma 

Some children develop asthma symptoms during or after exercise. 

Management: 

• Good overall asthma control reduces exercise-related symptoms 
  
• A reliever inhaler may be used 10-15 minutes before exercise 
  
• Warming up before exercise and cooling down afterwards can help 
  
• Swimming is often well tolerated 
  

Children with asthma should be encouraged to take part in sports and physical activities. 

Take your child to the Children's Emergency Department if: 

• Breathing is very difficult or rapid 
  
• Your child cannot speak in full sentences 
  
• Reliever medication is not helping or is needed very frequently 
  
• Your child becomes very tired, drowsy, or distressed 
  
• You are worried that your child is seriously unwell