What is asthma?

Asthma is a disease that affects the small airways in the lungs.

Children with asthma have sensitive airways. When they come into contact with things that trigger their asthma, this causes inflammation in their airways or makes existing inflammation worse. This inflammation causes the airways to narrow, which makes it hard for air to get into the lungs.

This causes breathing difficulties and other symptoms.

An asthma flare-up or attack is when asthma symptoms are worse than normal.

What are the symptoms of asthma in children?

Wheezing

An asthma wheeze can vary from mild to severe. It might sound like a high-pitched whistle, usually when your child breathes out.

Asthma wheezing is typically worse at night or in the early morning. It might also happen after your child has done some exercise or has been exposed to a trigger like smoke or cold air.

Coughing

Asthma coughing can vary from mild to severe.

You’re more likely to hear the cough at night, after your child has done some exercise, or when the weather is cold.

Sometimes your child might have a restless sleep or wake during the night because of the cough. Sometimes coughing, especially at night, or after exercise is the only sign that your child has asthma.

Chest tightness

Your child might feel like something is squeezing or constricting their chest.

Breathing difficulty or discomfort

As wheezing, coughing or chest tightness gets worse, your child might also have difficulty breathing.

Breathing difficulties might stop your child from doing things like sport or other physical activity.

The severity and frequency of asthma symptoms vary a lot. Some children wheeze or cough only a few times a year when they have a cold, whereas a few children have some asthma symptoms every day.

What to do if you think your child might have asthma

Take your child to see your GP if your child:

• has a wheeze, a cough or chest tightness that keeps coming back or gets worse, particularly when they exercise
• has difficulty breathing, which makes it hard for them to exercise or play as usual or to keep up with other children
• isn’t sleeping well because of wheezing or coughing.

How is asthma diagnosed?

Your GP might be able to diagnose asthma by asking how severe your child’s symptoms are and how often your child has them. They’ll also look at your child’s medical history and examine your child.

If your child is aged over 5 years, doctors might also use breathing tests to help in the diagnosis.

Allergy testing can also help.

Asthma tests are often arranged by a paediatrician or respiratory specialist.

You might hear your child’s doctor talk about allergic asthma, non-allergic asthma, exercise-induced asthma or thunderstorm asthma. These names refer to triggers that cause asthma symptoms.

Asthma action plans

Every child with asthma should have an individualised asthma action plan, regardless of how mild or severe their symptoms usually are and how old they are.

The aim of all asthma action plans is to prevent asthma flare-ups and attacks so that children can lead healthy, balanced lives. Asthma action plans also aim to make asthma attacks shorter and less severe.

How to get an asthma action plan for your child

You and your child will work with your child’s doctor to develop the asthma action plan.

It’s a good idea for your child to see their doctor or nurse regularly to monitor their asthma symptoms and treatment and to review the asthma action plan. If you’re not sure about any aspects of your child’s asthma action plan, check with your child’s doctor or nurse.

What your child’s asthma action plan will cover

• Steps to take if your child has a flare-up or attack
• Medicines your child needs and information about how to take them
• Triggers for your child’s asthma and how to avoid them

It’s important to give a copy of the asthma action plan to anyone who’s caring for your child. This includes family, carers, babysitters, sports coaches and school staff.

What to do if your child has an asthma attack

If your child has an asthma attack, follow the steps in their asthma action plan. The steps will probably look something like this.

Children aged 0-6 years

1. Remain calm, and sit your child down.
2. Give your child 2-6 puffs of reliever medicine from the inhaler (usually the blue one) through the spacer. Make sure you shake the puffer before inserting it into the spacer. Your child should take 4 normal breaths after each puff before getting the next puff.
3. Wait 4 minutes.

If there’s little or no improvement in symptoms or symptoms get worse, immediately call 000 for an ambulance. Say that your child is having an asthma attack. Follow steps 1-3 until the ambulance arrives.

If your child’s symptoms improve after treatment, watch your child throughout the day. If symptoms happen again, start treatment again.

If your child has had an asthma attack or is having symptoms that need treatment more than once every 3 hours, take your child to the GP as soon as possible.

Children aged over 6 years

1. Remain calm, and sit your child down.
2. Give your child 6-12 puffs of reliever medicine from the inhaler through the spacer. Make sure you shake the puffer before inserting it into the spacer. Your child should take 4 normal breaths after each puff before getting the next puff.
3. Wait 4 minutes.

If there’s little or no improvement in symptoms or symptoms get worse, immediately call 000 for an ambulance. Say that your child is having an asthma attack. Follow steps 1-3 until the ambulance arrives.

If your child’s symptoms improve after treatment, watch your child throughout the day. If symptoms happen again, start treatment again.

If your child has had an asthma attack or is having symptoms that need treatment more than once every 3 hours, take your child to the GP as soon as possible.

The symptoms of severe asthma and allergies are very similar. If your child has a history of anaphylaxis and is showing signs of severe asthma, use their adrenalin injector at the same time as starting inhaler treatment.

What types of asthma medicines will your child need?

Your child’s asthma action plan will include asthma medicines, which can help to relieve asthma symptoms or prevent asthma attacks.

Your doctor will tell you what medicines your child needs and how to use them. It’s important that your child uses the medicines listed in their asthma action plan.

Relievers

Relievers treat asthma symptoms.

They include short-acting beta-2 agonists like salbutamol (Ventolin, Asmol), which work quickly to relax the narrowed airways and make it easier for air to get through.

If your child is having a severe asthma attack, your child might be given corticosteroids (prednisolone) to reduce inflammation and swelling in their airways.

If your child is over 12 years old and doesn’t use a preventer, your child’s doctor might recommend an anti-inflammatory reliever. This is a combination medicine that contains formoterol (Symbicort), a long-acting beta-2 agonist that helps relax the narrowed airway passages, and budesonide (Pulmicort), a steroid medication that reduces inflammation.

Preventers

These medicines prevent asthma symptoms, so they’re very important.

They can reduce inflammation in the airway passages, relax the airway muscles for prolonged periods of time, or target the underlying factors that cause inflammation and allergies.

Asthma preventers include:

• inhaled corticosteroids like fluticasone (Flixotide), ciclesonide (Alvesco), beclomethasone (Qvar) and budesonide (Pulmicort)
• corticosteroid tablets or mixtures (prednisolone), which children take by mouth
• montelukast (Singulair), which is a tablet that can be taken alone or with inhaled corticosteroids
• combination inhalers, which combine inhaled corticosteroids and long-acting beta-2 agonists like fluticasone and salmeterol (Seretide), budesonide and formoterol (Symbicort), and flucticasone and vilanterol (Breo Ellipta)
• biologics like omalizumab and dupilumab (Xolair and Dupixent), which are given by injection every 2-4 weeks and are used for severe asthma not controlled by other preventers.

Safety and side effects of asthma medicines

Asthma medicines are generally very safe, especially inhaled medicines. But if you think your child is experiencing side effects, discuss this with your doctor.

Children who use corticosteroid inhalers might get oral thrush. There’s also a chance that children can damage their tooth enamel if they use an inhaler and don’t look after their teeth properly. Your child can avoid these side effects by rinsing out their mouth after using their corticosteroid inhaler. Also make sure your child’s teeth are cleaned twice a day with toothpaste – but allow 30-60 minutes after using an inhaler before brushing.

If your child uses an inhaler, learning how to use it is very important. You and your child’s health professionals might need to explain several times and show your child how to do it.

How to help your child avoid asthma triggers

Your child’s asthma action plan should include the things that trigger their asthma, along with information about how to avoid them, if possible.

The most common asthma trigger is a viral infection, usually the common cold. Other triggers might include:

• airway irritants like cigarette smoke and air pollution
• allergens like food, pollen, dust mites or animal dander
• exercise
• cold air and weather changes
• stress.

It’s impossible to avoid everything that might trigger your child’s asthma. But if you and your child know what triggers their asthma, you’ll know when to look for symptoms and be ready to manage them.

Living with asthma

Most children with asthma lead lives that have a healthy balance of physical and other activities.

If your child is diagnosed with asthma, keep encouraging your child to do sport and exercise. Your child might benefit from taking reliever medicine just before exercise to prevent a wheeze or a cough.

If your child has frequent asthma attacks or if symptoms stop your child from playing sport, sleeping at night or feeling healthy, it’s likely that your child is being undertreated or not taking their medicine properly. Talk to your doctor about this.

Children with asthma might not be able to judge the severity of their symptoms well. That’s why it’s important for your child to see their doctor regularly to check their asthma. You should also see the doctor if you have concerns about their symptoms.

What causes asthma?

Children who have parents with asthma might get genes from their parents that make it more likely that they’ll get asthma too. If you, your child’s other parent or other family members have asthma, eczema, hay fever or allergies, there’s an increased chance your child will have asthma.

Also, if children are exposed to cigarette smoke in pregnancy, they have an increased risk of developing asthma in childhood. And children who are born prematurely are more likely to have asthma symptoms in childhood.

Early in life, something switches on a child’s asthma for the first time. This might be:

• a viral infection
• an allergen like pollen, dust mites and animal dander
• something in the environment that irritates the child’s airways.

At this stage we don’t know how to stop asthma from developing.

Asthma is the most common chronic medical condition in children in Australia. It affects approximately 10% of Australian children aged 0-14 years.