Asthma in children

Asthma is a chronic inflammatory condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. One in five Singaporean children suffers from bronchial asthma.

Asthma cannot be cured, but its symptoms can be controlled. Although asthma is a chronic condition, in many children, symptoms do improve with age. Frequency and intensity of asthma symptoms vary over time so it’s important to work with the doctor to track your child’s signs and symptoms and adjust treatment as needed.

Symptoms

Asthma symptoms vary from child to child.  Common symptoms include:

  • Shortness of breath
  • Chest tightness or pain
  • Wheezing
  • Coughing

Very young children may present just as tiredness, irritability or changes in mood.

Causes

Childhood asthma is caused by the interaction of a genetic tendency for asthma with the environment. The following environmental factors may be important:

  • Contracting some types of airway infections at a very young age e.g. RSV or Rhinovirus
  • Exposure to environmental factors, such as cigarette smoke, traffic pollution and smoke haze
  • Sensitisation to environmental allergens e.g. house dust mites

Asthma triggers

Triggers that result in asthma attacks may differ in each child, some common triggers include:

  • Viral infections, such as the common cold
  • Environmental allergens, such as dust mites, pollen, animal dander and mould
  • Changes in temperature or humidity
  • Irritants in the air, including traffic pollutants, cigarette smoke, and smoke haze
  • Exercise, especially in children with uncontrolled asthma
  • Negative reactions to medications such as painkillers e.g. aspirin, NSAIDS
  • Strong emotions and stress

Diagnosis

Several childhood conditions have similar symptoms and it is important to confirm the diagnosis of bronchial asthma before starting treatment if possible.

The following tests may be helpful in the evaluation of and to confirm the diagnosis of asthma:

  • Tests to measure lung function
  • Exhaled Nitric oxide test
  • Allergy testing
  • Exercise testing for exercise induced asthma
  • Chest X-Ray
  • Other special tests may be needed to rule out other possible causes

Treatment

Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking symptoms to make sure the daily asthma medications are keeping symptoms under control.

There are two main types of asthma medications:

Preventers: These work slowly to control the chronic inflammation, making airways less sensitive to triggers. Use these medicines / inhalers daily unless instructed to stop by the doctor – this is important in the control of asthma. Examples of preventers include steroid inhalers, combination inhalers and oral anti leukotrienes.

Relievers: These work rapidly to open the airway, providing quick relief of asthma symptoms. They should only be used when needed. Examples of relievers include Salbutamol inhalers.

Written asthma action plan

The written asthma action plan outlines in writing when to take certain medications or when to increase or decrease the dose of your medications based on your symptoms. Follow your written asthma action plan and check in with the doctor when in doubt.

An asthma  flare-up

Signs of an asthma flare up include:

  • Worsening of shortness of breath or wheezing
  • Persistent coughing
  • Inability to feed well, sleep or play

Consult the doctor when your child:

  • Has persistent breathlessness and cough despite activating the written asthma action plan
  • Is unable to feed and take fluids well
  • Is unable to speak in complete sentences
  • Is drowsy, lethargic or irritable and difficult to calm

Though bronchial asthma is a chronic disease, symptoms can be controlled and most children achieve a normal quality of life.  Understanding the disease, active participating in the care plan and compliance with the prescribed medications and regular review is key to successful treatment of the condition.

See the doctor

  • If you think your child has asthma. Treating asthma early may prevent long-term lung damage and help keep the condition from worsening over time.
  • To monitor your child’s asthma and keep it under good control. Good long-term control allows your child to participate in all activities as desired and have a good quality  of life. Good control of asthma  can prevent a life-threatening asthma flare-up
  • If the asthma flare-up cannot be controlled with the written asthma action plan. An early review by the doctor may be life saving in a severe flare up.
  • To review your treatment. Asthma is a chronic disease and symptoms often change over time. Regular review is necessary to make any needed treatment adjustments.

Dr Jenny Tang
Paediatrician,
Asthma, Lung, Sleep & Allergy
SBCC Asthma, Lung, Sleep & Allergy

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