The most common cause of asthma in children is that both or one of the parents suffer from asthma. Most children with asthma will experience their first symptoms before the age of five, often in connection with an infection. It is sometimes difficult to know if small children have asthma or not, since asthma symptoms may look like symptoms of other diseases common among children. Many small children get a wheezing breath when they are affected by a cold or an infection of the airways. This may not be caused by asthma, but that the child has small airways that shrink when infected. It may also be a sign of viral-induced asthma, a type of asthma mostly affecting children under the age of two years old. In any case it is important for you not to ignore the problems. The earlier you can treat a child with asthma, the smaller the risk is of chronically damaged airways.
Asthma is caused by an inflammation of the respiratory tract, which makes it hard to breath. Just like in adults, asthma in children will appear in different ways and in different situations. Some experience problems when it is cold or damp, or from physical exertion (exercise-induced asthma), others when they have an infection or come into contact with substances they are hypersensitive to. It may be a perfume, a mould infected room, a friend's cat, a parent who smokes or if there is a lot of pollen in the air. These are called trigger factors and can initiate problematic symptoms if the underlying asthma is untreated or insufficiently treated. Pay special attention to symptoms in babies who are unable to tell you if something is wrong. As a parent it is a good idea for you to learn as much as possible about asthma, so that you can to talk to your child and explain what is happening in their body when the asthma strikes.
In small children and babies with asthma the symptoms can often be acute, for example, if the child wakes up from severe dyspnoea (difficult or laboured breathing) in the middle of the night. Should this be the case, try to stay as calm as possible and go to the nearest emergency department where the child will receive help.
Children under the age of five years old, it is difficult to perform lung function tests like spirometry and the doctor may then choose to do a physical examination instead and ask questions about symptoms and medical history in order to establish a diagnosis. If the child is old enough, the doctor will usually perform a lung function test with a spirometer, measuring the flow of air during maximum exhaling, using a peak flow meter. It should be possible to take the peak flow meter home in order to measure the results during a longer period of time. If the doctor suspects that allergies may be causing the asthma, a skin prick test or blood test is performed in order to test the sensitivity to certain allergens, for example, pollen, dust mites, pets or some foods. An exercise test or an airway provocation test may be performed where the child will inhale an irritating substance. If the child has reached school age he / she may even get to go through a nitric oxide measuring of the exhaled air. Regardless of which tests the doctor orders, it may be good for your child to know that an asthma examination neither hurts, nor is unpleasant.
Asthma in children is treated just like asthma in adults by using two types of asthma medications: bronchodilating medication that quickly widens the airways, and inflammation inhibiting medication that decreases the inflammation of the respiratory tract over time. Fast-acting bronchodilators with short effect duration work within 1-3 minutes and last up to six hours. They are used for acute problems or before exercise. Long-acting bronchodilators work within 20 minutes and last for at least 12 hours. They are often used as a complement to the inflammation inhibiting medication, when only using the latter is not sufficient. There are also fast-acting preventative bronchodilators with a long duration of effect that are usually used in combination with the preventive medicine. Make sure to always have fast-acting bronchodilators available for your child in case of an emergency.
Many people with asthma need to, in addition to the bronchodilators, take inflammation-inhibiting medicines to keep the disease away and to remain free of symptoms. The most common option is corticosteroid, inhaled through an asthma inhaler device. This is the best way for the medication to directly end up in the lower respiratory tract, where the inflammation is located. In case of milder asthma, leukotriene inhibitors in the form of tablets or a dry powder may be an alternative to cortisone. Leukotriene inhibitors are sometimes given as an additional treatment when the inhaled corticosteroid treatment is not sufficient.
The goal of the treatment is for the child to be able to live an everyday life without problems. There is no reason for the child not to be able to participate in his or her favourite activity, whether it's football, swimming or just playing with friends.
UK/GEN/15/0056 Date of preparation: December 2015
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