Signs & Symptoms
Symptoms of asthma can appear suddenly (attacks) or be chronically present (persistent). Symptoms include cough (especially chronic cough and dry cough at night or after exercise), wheeze (whistling noise in the chest), shortness of breath and tightness of chest.
Symptoms differ for different people. In some patients, coughing, especially at night, may be the only symptom of asthma, while in others, asthma may present itself as wheezing, breathlessness or chest tightness.
The most typical presentation of asthma is the so-called asthma attack during which the child experience sudden wheezing, coughing and shortness of breathe.
These attacks can be mild or severe, and may need emergency treatment.
What causes it
Triggers can cause an asthma attack or make your asthma worse. Controlling your asthma involves recognizing your own triggers. Allergy tests can help in identifying these triggers. Work towards avoiding or controlling these triggers.
The common triggers include:
- Infections - especially upper respirator tract infections (colds or flu)
- Dust and dust mite allergens
- Animal dander (dogs, cats and birds)
- Cold air (However, most children can sleep in air-conditioned rooms without any problems)
- Weather changes, including the haze
- Cigarette smoke
- Exercise (All children with asthmas should exercise as it is good for their general health and for their asthma. However, if the asthma is not well-controlled, they may not be able to exercise and will need to see their doctor for further treatment. Children who have Exercise-Induced Asthma (EIA) can still exercise with proper medications.
Food (including cold drinks, ice-cream and chocolates) are usually NOT asthma triggers.
About the condition
Asthma is a chronic (long term) disease of the lower airways in the lungs.
The most important feature of asthma is the increased sensitivity of the airways to many factors in the environment.
These, though variable from patient to patient, include allergens (e.g. house dust mites, pollen, pets), pollution and viral infection of the airways (such as common colds).
The major consequence of the hypersensitivity of the airways is that they become swollen and narrowed. This is described as inflammation.
Asthma is therefore considered to be a condition of chronic inflammation of the airways induced and maintained by different environmental triggers.
This inflammation and swelling reduces the amount of air that can pass through the airways, making breathing difficult and noisy (wheezing).
Asthma can appear at any age. However the trigger factors can vary according to age. In young children (under the age of 3 years), asthma is usually triggered or induced by viral infection, while in older children, allergy becomes a more important trigger for asthma.
When the child wheeze or cough when he/she exercise, he/she may be suffering from Exercise-Induced Asthma (EIA).
Children with EIA have airways that are very sensitive to changes in temperature and humidity, especially when breathing cold, dry air. When children with EIA exercise, there is abnormal narrowing of the airways resulting in symptoms, such as wheezing and coughing minutes after exercise. These symptoms usually reach its peak 5-10 minutes after stopping the activity.
Diagnosis and Treatment Options
Our paediatrician is usually able to diagnose asthma based on a good history and clinical examination. Special tests may be needed to help in the further evaluation or management of your asthmatic child.
Spirometry is a lung function test that measures airflow obstruction in asthma. It can be used to support the diagnosis of asthma, assess severity and assess response to treatment. Children above 6 years old are usually able to perform this test reliably.
Oscillometry is a special lung function test that requires minimal patient cooperation. Even children between 2 to 6 years can perform this test reliably.
3) Exhaled Nitric Oxide
Exhaled Nitric Oxide measurements are used to determine the severity of lung inflammation in asthma and to titrate the dose of preventer medication required.
4) Exercise Challenge Tests
Exercise Induced Asthma (EIA) is suspected when there is a suggestive history. EIA is then confirmed with an Exercise Challenge Test. The child exercises for 6-8 minutes on a tread-mill machine. The child's lung function is assessed before exercise and at various intervals after exercise. A decrease of at least 12-15% in lung function parameters measured is diagnostic of EIA. Children above 5-6 years old are usually able to perform the test reliably.
5) Allergy Tests
Allergy tests are useful in detecting the allergens to which your child may be sensitive to. Commonly used allergy test in asthma include skin prick tests and blood tests. Children of any age (including babies) can undergo allergy testing. Knowing and avoiding the allergens that trigger your child's asthma will help in its control.
Goals of Asthma Treatment
- Control all asthma symptoms
- Prevent asthma attacks
- Allow the child to lead a healthy, normal life
Control of Asthma
- reduce and control the chronic inflammation of the airways
- Avoid environmental triggers
- Proper understanding of the condition and its management
Preventors or Anti-inflammatory agents:
- Reduce the chronic inflammation of the airways
- Required for long term control of asthma and should be taken on a daily basis when prescribed by the doctor
- Usually in the form of inhaled cortocosteroids (e.g. Beclometasone, Fluticasone, Budesonide) which are the treatment of choice for most asthmatics
- Inhaled long acting beta agonists (e.g. Salmeterol and Formeterol) are also used in the treatment.
- Other forms of preventors (Leukotriene Modifiers such as Monteleukast and Zafilukast) may be taken orally.
The dosage of some of these medications may be increased during an asthma attack as instructed by your doctor.
Used when your child has asthma symptoms or during an asthma attack:
- Short acting beta agonists are be inhaled (Salbutamol or Ventolin, Terbutaline) or taken orally - (Salbutamol or Terbutaline).
- Anti-cholinergics (e.g Ipratropium Bromide) can be inhaled.
- Cortocosteroids (e.g. Prednisolone, hydrocortisone) can be taken orally or injected.
NB: Formoterol, a long acting Beta agonist, has a fast onset of activity and can also be used as a reliever medication.
Please click here for Children's Asthma Care Plan
Managing Exercise Induced Asthma
Swimming is often considered the sport of choice for children with asthma because of the many positive factors like incorporating deep breathing exercises and also being least likely to trigger asthma symptoms.
Although some sports are better for Exercise Induced Asthma (EIA), children with EIA can and should participate in all physical activities (e.g. badminton, basketball, soccer, and long distance running) with proper control and medications.
A warm-up period of activity before exercise and a warm-down period after exercise can also prevent or lessen EIA symptoms.
Inhaled medications taken prior to exercise are also helpful in preventing and controlling EIA. The medication of choice in preventing EIA symptoms is a short acting bronchodilator inhaler (e.g. salbutamol or ventolin, used 15 minutes before exercise. These medications can also be used to relieve EIA symptoms after they occur.
Exercise is a vital part of every growing child. With proper asthma management, all children with EIA can and should exercise and participate in sports like every other child. They can even excel. Some of our national athletes have asthma. They include Dr Benedict Tan (Asian Games gold medalist in Sailing), as well as national swimmers, like Leslie Kwok, Gerald Koh and Nicolette Teo (SEA Games medalists).