Asthma: symptoms

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When to see your doctor

See your doctor if: 

• your child’s wheezing, cough or shortness of breath persist or become worse despite medication
• inhalations are needed more often than every three or four hours
• one or two inhalations do not immediately make your child better
• your child can’t exercise or play normally, or cannot keep up with other children
• your child’s sleep is disturbed because of coughing or wheezing
• your child needs more and more medication
• your child needs medication immediately upon waking in the morning or cannot wait until after breakfast
• you do not have a clear asthma management plan for your child.

An asthma wheeze may vary from mild to severe, and it can often be easily heard by parents. Sometimes, however, the child may appear to be breathing normally and quietly, but the doctor will hear signs of airway narrowing by listening to the child’s chest with a stethoscope. The wheeze may be particularly evident when the child is breathing out or exhaling. The wheeze may be present all the time, during a viral infection, or after exercise. It is often worse in the early morning or at night.

Coughing is just as much part of the clinical spectrum of asthma as is wheezing. Depending on the age of the child, the cough often sounds ‘fruity’, and older children may even cough up thick yellow sputum. The cough is particularly evident at night and after physical exertion. Sometimes the cough results in restless sleep, and the child may wake frequently during the night. Often the cough gets in the way of them participating in sporting activities at school. A child does not have to have an audible wheeze to be suffering from acute or chronic asthma – sometimes the cough is the only sign.

On other occasions, there may be neither a cough nor a wheeze, but the child may complain of tightness in the chest, of feeling tired or ‘off colour’, or may lose their appetite. The symptoms of asthma can be vague, and it is only after treatment that parents may notice the difference to their child’s general wellbeing.

There is also a wide spectrum in the severity and frequency of asthma. Some children wheeze or cough only several times a year, in association with a cold, while others (a small minority) may experience some symptoms every day. Your child’s doctor will want to take a very careful history of the frequency and severity of the symptoms, for the treatment plan will depend on these two factors.

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