The goal of asthma management is to make breathing easy—so kids can be kids.
According to the Centers for Disease Control and Prevention, there are currently 6.2 million U.S. children living with asthma. If your child has a cough that never goes away, wheezes or whistles when running, or can’t breathe well during colds, asthma could be the reason. Asthma is a syndrome related to swelling (inflammation) inside bronchial tubes together with twitchiness of airway smooth muscle (bronchospasm).
Asthma can limit your child’s activities because inflammation and bronchospasm can obstruct airflow and make running and playing difficult. In addition to a nagging cough or wheezing during the day, asthma symptoms can lead to restless nights from constant coughing. Asthma exacerbations (formerly called “asthma attacks”) can be severe. The sudden increase in inflammation and bronchospasm limits airflow, which can be a medical emergency. If your child ever has severe breathing difficulties, can’t speak, or has changes in color or level of alertness, call 911 and get to the hospital right away.
Not all children have regular symptoms of asthma. Some kids only have coughing, wheezing, or trouble breathing with colds. The common cold (known as the human rhinovirus) is one of the most frequent causes of worsening asthma.
The goal of management is to make sure you control asthma—not the other way around! Albuterol is an important “rescue” medicine because it treats bronchospasm and makes breathing easier. But albuterol doesn’t treat airway swelling or inflammation. Addressing long-term asthma inflammation requires allergy testing to identify triggers. Many patients benefit from prescribed anti-inflammatory asthma controller medications, which improve daily symptoms and reduce the risk of asthma exacerbations. Inhaled corticosteroids (ICS) are the most common asthma controller medications and reduce inflammation within two weeks to two months. Treating airway inflammation takes time, so it is important to continue using these medications even as asthma symptoms improve. In addition to ICS controller-type medicines, there are new strategies that target the inflammatory molecules that cause airway swelling and can be very effective in controlling asthma. Children with asthma should always get a flu shot, and avoid tobacco smoke and known allergen triggers.
Asthma is often classified using the “Rule of Two.” This means if a child has wheezing, coughing and/or shortness of breath more than two times per week, an asthma controller (like an ICS) would be worth trying for a few months. Your child would also meet the “Rule of Two” if they have a night-time cough that wakes them up more than two times per month. If asthma meets the “Rule of Two” we call it persistent (versus intermittent) asthma, and if it’s persistent, an asthma controller is needed.
Can your child outgrow asthma?
Children without other allergy risk factors, who tend to wheeze only a few times with colds, and do not have daily symptoms apart from colds are more likely to outgrow asthma. Asthma is more stubborn in kids with eczema, food allergies, environmental allergies or if family members have asthma.
Work the plan
Families should work closely with their providers to develop an asthma action plan, which uses a “traffic-light” system to manage asthma by identifying worsening symptoms and treatment changes.
The “green light” indicates daily management, including ICS dosage recommendations. The “yellow light” stands for the onset of cold symptoms, allergies, or wheezing and includes the use of a rescue treatment (like albuterol). The “red light” means an emergency requiring medical care. Emergency providers will administer corticosteroids to reduce airway swelling and bronchodilators like Albuterol. Because corticosteroids can take several hours to work, it’s better to seek emergency care as soon as possible.
Clear symptoms of the red zone include hard and fast breathing, needing rescue Albuterol treatments more often than every four hours, “pulling for breaths” (muscles between their ribs show or their nostrils flare out) or difficulty speaking in complete sentences. If you are worried or the plan is not working, it is important to get help.
The goal of asthma management is to make breathing easy—so kids can be kids. Most of the time, a few simple steps can effectively control symptoms, giving your child more valuable time spent in school, sports and activities, and play.
Marcus Shaker, MD, MS, FAAAAI, FAAP, is a doctor in Allergy, Asthma, and Clinical Immunology at the Children's Hospital at Dartmouth-Hitchcock (CHaD).