Menu
eMediHealth Logo
Subscribe
No Result
View All Result
eMediHealth Logo
Subscribe
No Result
View All Result

Home > Child Health > Conditions and Symptoms > Childhood Asthma: Causes, Symptoms, and Treatment

Childhood Asthma: Causes, Symptoms, and Treatment

June 24, 2021 - Updated on August 30, 2021
9 min read
By Powen Hsueh, DO, FAAP, CBS | Pediatrician

In this article:

  • Childhood Asthma Versus Adult Asthma
  • Causes of Asthma in Children
  • Common Signs and Symptoms of Asthma in Children
  • Medical Treatment for Asthma in Children
  • Alternative Treatments for Asthma
  • Diagnosing Asthma in Children
  • Tips to Manage Asthma in Children
  • Asthma Triggers
  • Lifestyle Changes Recommended for Children With Asthma
  • Emergency Care for Children
  • Major Risk Factors Associated With Asthma in Children
  • Final Word

Childhood asthma is defined as episodic and reversible airway constriction and inflammation in response to a variety of triggers, which include, but are not limited to, various physical, chemical, or emotional irritants, household or environmental allergens, and viral and bacterial infections/illnesses.

asthma in children

Childhood asthma is an extremely heterogeneous disease with a lot of different presentations among different asthmatic patients. Each one of them has different triggers.

A child with asthma can present a wide range of symptoms from mild once-in-a-while night cough to severe airway closure with bronchospasm that requires intensive care unit admission. (1)

Childhood Asthma Versus Adult Asthma

The underlying etiologies of child and adult asthma are similar in nature, in that both are reversible airway constriction and inflammation.

Advertisements

However, there is a common misconception that a child tends to grow out of their asthma. In most cases, the inflammation and reversible airway constriction process generally does get better, but, as the child grows, their airway grows in proportion as well.

With the same amount of inflammation and constriction to the airway, the end effect is much smaller in the larger airway. This results in fewer respiratory symptoms from the exacerbation.

Resistance is inversely proportional to the diameter of the airway (to the 4th power), so the larger the airway, the less the resistance. (2)

Causes of Asthma in Children

Asthma is an extremely heterogeneous disease with causes ranging from dysregulations of the immune system to nonspecific inflammatory responses.

All of the dysregulations result in chronic inflammation, which eventually leads to remodeling or destruction of the lung cell structure. This can lead to a more permanent injury to a child’s respiratory system.

Common Signs and Symptoms of Asthma in Children

signs and symptoms of childhood asthma

Symptoms of asthma in children include:

Advertisements
  • Coughing (tends to take place at nighttime)
  • Persistent wheezing (high-pitched noise from the lung)
  • Shortness of breath or labored breathing (dyspnea) – Due to the labored breathing, the child may speak in short sentences or is unable to make any sound. (3)
  • Fast respiratory rate – This is age dependent: under 3 months, 60 bpm (breath per minute); under 1 year, 40 bpm; 1–3 years, 30 bpm; 3–4 years, 25 bpm; and 4 years and older, 20 bpm.
  • Use of accessory muscles during respiration – In many children, the rib cage may be seen during resting breathing and neck tugging.

Medical Treatment for Asthma in Children

Unfortunately, there is no cure for asthma. In the extreme case where a child has very severe asthma, sometimes the pulmonologist may resort to bronchial thermoplasty (burn and permanently dilate the airway) or immunomodulation as a more permanent method to control the symptoms.

For most cases, the physician will prescribe therapy generally with inhaled corticosteroids. (4)(5) The effectiveness of corticosteroids for chronic asthma control has been demonstrated both clinically and by multiple trials such as the START study. (6)(7)

Alternative Treatments for Asthma

In general, the main method of asthma control is to adhere to the physician’s prescribed treatments, although some alternative modalities may help to alleviate the symptoms.

For example, honey helps to reduce the incidence of coughing spells. (8) However, honey consumption is not safe for children under the age of 1 due to the risk of botulism.

In a small study, agave syrup has shown similar efficacy to honey. (9) So, for younger patients, agave syrup may be a better alternative to honey for cough relief.

Diagnosing Asthma in Children

The gold standard test for asthma is a pulmonary function test (PFT). Since asthma is a reversible illness, a normal PFT does not rule out asthma diagnosis.

Advertisements

In addition, the patient needs to be able to follow directions in order to perform a proper PFT. A child generally has to be 5 or older for the test to be conducted correctly. There are also other more advanced techniques such as the measurement of FeNO. This method can track the disease progression, but it is not widely used in general pediatric offices.

Otherwise, for younger patients or for a patient with normal PFT with the inability to trigger symptoms in the clinic, the physician would diagnose asthma clinically. The physician would take into account the child’s medical history and assess their overall clinical symptoms.

Depending on the clinical symptoms, history, and results of the clinical examination, the physician can determine the severity of asthma and accordingly prescribe the proper medications to manage it. (4)

Tips to Manage Asthma in Children

tips to manage asthma in children

Here are some useful guidelines to keep your child’s asthma under control:

  • Adhere to your physician’s prescribed treatments and for the most part the steroid inhaler or steroid plus beta agonist.
  • Use the proper techniques and spacer before using any inhalation medication.
  • Adhere to your trigger control medications such as nasal steroids and allergy medications.
  • Have a comprehensive asthma action plan. Formulate it with your physician and follow them closely.
  • Obtain the annual flu shot and practice good hand hygiene to reduce the transmission of respiratory illness.
  • Adhere to trigger prevention (see the asthma triggers below).

Asthma Triggers

Asthma triggers vary from patient to patient. While some triggers are easily avoidable, others can be everywhere. What you can do as parents is to decrease the level of exposure. For any child with asthma and associated allergies, the advice is to ask the parent to help the child avoid the triggers.

For easily preventable triggers such as exercise or emotional triggers, you can pretreat the child with short-acting beta agonist inhaling agents to prevent the attack. Things such as dust mites, animal dendrites, and pollen can be hard to avoid, but there are always steps that you can take to decrease the exposure.

Advertisements

In my clinic, I generally advise parents to:

  • Vacuum and clean out the house often.
  • Wash the child’s bedsheet, clothes, and dolls in 140°F water at least every 2 weeks.
  • Close the window as much you can to prevent the inflow of outdoor pollen.
  • Replace your central air conditioning filter with an HEPA-grade filter.
  • Replace all bedsheets, pillowcases, and blankets with a hypoallergenic material if the child can tolerate it.
  • If you decide to have pets in your household, all pets’ movement should be restricted to non-carpeted regions only. Pets should not be allowed in the child’s room.

Lifestyle Changes Recommended for Children With Asthma

The following measures can help curb the intensity and frequency of asthma flare-ups in children:

1. Vitamin D intake

increasing vitamin D intake can help prevent asthma

Vitamin D is known to have anti-inflammatory properties. One of the underlying causes of childhood asthma is airway edema and inflammation, so it is natural to assume that increasing vitamin D intake can improve a child’s asthma. A lot of studies have been done on the effectiveness of vitamin D in both adults and children, and they yielded similar results.

Advertisements

A 2016 Cochrane review article indicated that the effectiveness of vitamin D on asthma management is still unclear, and more studies are required before more concrete conclusions can be obtained. (10) While this Cochrane review is inconclusive, another more recent systemic review study showed some improvement in asthma with increased vitamin D intake. (11)

In practice, since vitamin D is a relatively benign supplement (as long as you are getting it from reputable sources) and an increasingly sedentary lifestyle with decreased sunlight exposure makes many children vitamin D deficient, regular supplementation vitamin D with the recommended dose of 400 IU for younger children and 600 IU for older children via a multivitamin is considered part of well-rounded nutrition.

If a child has a more poorly controlled asthma with a comorbidity of vitamin D deficiency, it would be a good idea to treat the deficiency and asthma concurrently.

2. Regular exercise, balanced diet, and relaxation techniques

Regular exercise increases lung capacity and reduces obesity, both of which will help asthmatic children to grow bigger, healthier respiratory systems. In addition, a balanced diet is essential to help a child to develop a healthy lung, and nutrients like vitamin D may be playing a role in regulating inflammation.

So, a well-balanced diet and regular exercise will help a child to have a more robust lung growth and in return will decrease the likelihood of disease progression. Relaxation techniques can be very helpful with emotion-induced or anxiety-induced triggers for asthma.

3. Air quality

check air quality of your surroundings to prevent allergies

It is very important that air quality be checked for children with environmentally induced allergies. Many of these patients have routine allergy shots for allergy symptoms control.

As a parent of these children, it is vital that you monitor the air quality index and pollen index on AirNow (airnow.gov) and other local agents to check whether allergens are high or not. If the allergens are in excess, it would be best for the child to stay home to prevent another attack.

Emergency Care for Children

Every child who is diagnosed with asthma should always have an asthma action plan, and all the child’s controlled medication should be spelled out all as emergency medication in the action plan.

The action plan will also guide parents and other caretakers regarding the amount of short-acting beta agonist that should be provided during the attack outside of the hospital setting. If the child is not responding to the initial rescue using the inhaler beta agonist, it would be time to take the child to the emergency room for further evaluation.

It is paramount for the child’s caretaker to continue the treatment with a rescue inhaler on the way to the emergency room. Sometimes, rescue inhalers can be lifesaving during a severe attack. Depriving the child of the necessary inhaler treatments can be detrimental to their life.

Major Risk Factors Associated With Asthma in Children

risk factors associated with childhood asthma

These factors can make your child more prone to asthma:

  • Family history of asthma
  • Personal history of atopic disease (e.g., eczema, allergic rhinitis)
  • Secondhand smoking
  • Small for gestational age at birth
  • Living in an environment with poor air quality
  • Growing up in the lower socioeconomic strata

Final Word

Avoiding triggers is the best way to prevent asthma attacks. So, the first step is to identify all the triggers that flare up your child’s asthma and then do your best to keep your child away from them.

Things such as getting rid of pets, scheduling outdoor activity depending on air quality, and many more may be very cumbersome for both the child and the rest of the family, but these sacrifices help improve the child’s quality of life and sometimes even save it by preventing frequent or severe asthma attacks.

References
  1. Patel SJ, Teach SJ. Asthma. American Academy of Pediatrics. https://pedsinreview.aappublications.org/content/40/11/549. Published November 1, 2019.
  2. Elsevier. Pediatric Allergy: Principles and Practice. Pediatric Allergy: Principles and Practice – 2nd Edition. https://www.elsevier.com/books/pediatric-allergy-principles-and-practice/9781437702712. Published October 12, 2010.
  3. CM; MDKKNR. Pediatric asthma severity score is associated with critical care interventions. World journal of clinical pediatrics. https://pubmed.ncbi.nlm.nih.gov/28224093/. Published 2017.
  4. Horak F, Doberer D, Eber E, et al. Diagnosis and management of asthma – Statement on the 2015 GINA Guidelines. Wiener klinische Wochenschrift. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010591/. Published August 2016.
  5. PMC E. Europe PMC. http://europepmc.org/articles/PMC6110874. Published 2018.
  6. Kaplan A, Price D. Treatment Adherence in Adolescents with Asthma. Journal of asthma and allergy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969681/. Published January 14, 2020.
  7. Reddel HK; Busse WW; Pedersen S; Tan WC; Chen YZ; Jorup C; Lythgoe D; O’Byrne PM; Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study. Lancet (London, England). https://pubmed.ncbi.nlm.nih.gov/27912982/. Published 2017.
  8. Cohen HA; Rozen J; Kristal H; Laks Y; Berkovitch M; Uziel Y; Kozer E; Pomeranz A; Efrat H; Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics. https://pubmed.ncbi.nlm.nih.gov/22869830/. Published 2012.
  9. Paul IM; Beiler JS; Vallati JR; Duda LM; King TS; Placebo effect in the treatment of acute cough in infants and toddlers: a randomized clinical trial. JAMA pediatrics. https://pubmed.ncbi.nlm.nih.gov/25347696/. Published 2014.
  10. Martineau AR, Cates CJ, Urashima M, et al. Vitamin D for the management of asthma. The Cochrane database of systematic reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457769/. Published September 5, 2016.
  11. Erick Forno MD. Effect of Vitamin D3 on Severe Asthma Exacerbations in Children With Asthma and Low Vitamin D Levels. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2769724. Published August 25, 2020.
  • Was this article helpful?
  • YES, THANKS!NOT REALLY
Spread the Love❤️
Advertisements
Advertisements
Advertisements
Advertisements

Newsletter

Get our BEST updates delivered to your inbox:



This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Categories

  • Nutrition
  • Wellness
  • Oral Care
  • Eye Care
  • Heart Health
  • Skin & Beauty
  • Women’s Health
  • Ear, Nose & Throat
  • Respiratory Health

Links

  • Home
  • About Us
  • Contact
  • Privacy Policy
  • Terms and Conditions
  • Cookie Policy
  • Editorial Policy
  • Advertising Policy
  • Subscribe to Newsletter
eMediHealth

This site provides content for informational purposes only. The information provided is not intended for use as medical advice, diagnosis, or treatment. In case of a medical concern or emergency, please consult your healthcare provider.

This website is certified by Health On the Net Foundation.

Our Network: Little Extra

© 2019 eMediHealth. All rights reserved.

No Result
View All Result
  • Nutrition
  • Skin & Beauty
  • Wellness
  • Yoga & Meditation
  • Women’s Health
  • Heart Health
  • Allergy & Immunology
  • Bones & Joints
  • Child Health
  • Digestive
  • Ear, Nose & Throat
  • Eye Care
  • Glands & Hormones
  • Health News
  • Infectious Diseases
  • Mental Health
  • Nervous System
  • Oral Care
  • Pain Management
  • Respiratory Health
  • Sleep Disorders
  • Urological Health

© 2019 eMediHealth. All rights reserved.