Asthma - children

What is Asthma?

Asthma is a common chronic disease which inflames the airways. The airways are the small tubes that carry air in and out of the lungs. Asthma causes the airways to become over-sensitive and react to things they wouldn’t normally react to, such as colds and flus or dust mites – even family pets, these are called triggers.

When asthma symptoms are triggered the muscles around the wall of the airways tighten, making them narrow. The lining of the airways also swells and sticky mucus is produced, clogging up the already narrowed airways. With the airways narrow and clogged with mucus, it becomes difficult to breathe.

Asthma affects around one out of every five children in Ireland. Whilst it can’t be cured, asthma can be well controlled. Children whose asthma is well controlled can lead happy, healthy lives. Poorly controlled asthma can have a big impact on a child’s health, as well as their ability to play and learn. Uncontrolled asthma causes children to miss school, can lead to hospitalisation, and, although it is rare, in a small number of cases children can die from asthma.

In the Republic of Ireland:

  • Ireland has the fourth highest prevalence of asthma in the world
  • Asthma is the most common chronic disease in Ireland
  • More than 450,000 people have asthma in Ireland
  • Around 1 in every 5 children have asthma
  • Asthma cannot be cured but it can be controlled
  • 60% of people with asthma do not have their asthma under control
  • Asthma can be fatal if not controlled

Useful Links

http://www.asthma.ie/get-help/asthma-for-parents/asthma-your-child/asthma-your-child

For lots of useful documents and resources for parents visit http://www.asthma.ie/get-help/resources/publications-documents/resources-for-parents

Quit.ie

 Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.


 

The common symptoms of asthma include:

  • feeling breathless 
  • wheezing (there may be a whistling sound when your child breathes)
  • coughing, particularly at night
  • tightness in the chest

Symptoms vary between people and children may have one or more of these symptoms. If symptoms become worse during the night or with exercise, your child's asthma may not be well controlled. Take your child to see their doctor or asthma nurse.

When asthma gets worse

When symptoms of asthma get significantly worse, this may be the start of an asthma attack. The symptoms of a severe asthma attack sometimes develop slowly, taking 6-48 hours to become serious. For some people, asthma can get worse very quickly.

Be aware of any signs of worsening asthma in your child. These may include:

  • an increase in symptoms, such as your child becoming more wheezy, tight chested or breathless 
  • the reliever inhaler (usually blue) not helping as much as usual
  • a drop in peak expiratory flow rate (see the Asthma in children - diagnosis for more information).

If you notice your child's symptoms are getting worse, do not ignore them. Contact your GP or asthma clinic.

What to do in a severe asthma attack

1. take 2 puffs of the reliever inhaler immediately

2. sit the child upright and try to keep her/him calm

3. take slow steady breath

4. if no improvement take 6 puffs in 10 minutes for children under 6 years and 10 puffs for children over 6 years

5. if no improvement call 999 or 1112

 

Symptoms of a severe asthma attack include:

  • the reliever inhaler does not help symptoms at all 
  • the symptoms (wheezing, coughing, tight chest) will be severe and constant
  • breathing very fast and too breathless to complete a sentence in one breath or too breathless to talk or feed 
  • a racing pulse
  • feeling agitated or restless 
  • lips or finger nails may look blue

Call 999 for an ambulance if your child has severe symptoms of asthma.

You may be advised to give extra doses of the reliever inhaler while you are waiting for the ambulance.

What Causes Asthma?

The exact causes of asthma are still unknown but we do know that:

  • Asthma can run in families and children are more likely to have asthma if they have a parent or parents with asthma.
  • Asthma usually starts in early childhood, but can also sometimes develop at later stages in life.
  • Asthma is linked to other allergic diseases, and a child is more likely to develop asthma if they suffer from other allergic conditions such as eczema, hay fever or a food allergy.
  • Asthma is not infectious.
  • Modern lifestyles that have resulted in changes to housing, diet and the levels of air pollution may be contributing to the rise in asthma.
  • Smoking during pregnancy or exposing a child to tobacco smoke will increase their risk of developing asthma.
  • Being overweight increases the risk of developing asthma.
  • Viral respiratory infections can increase the risk of developing asthma.
  • Some children lose their symptoms as they grow older but asthma is a chronic disease so it never goes away and symptoms can come back later in life.

 

Medications to maintain asthma control have an important role because children are often less sensitive to risk factors when their asthma is under proper control.

Often it's not just one trigger that sets off an episode of asthma but a mixture of several triggers at about the same time.

The following is an incomplete list of triggers:

  • Colds and Viral Infections
  • House Dust Mite
  • Household Pets
  • Tobacco Smoke
  • Pollen
  • Mould
  • Changes in Weather
  • Chemicals
  • Exercise and Excitement
  • Food

http://www.asthma.ie/get-help/asthma-for-parents/asthma-your-child/asthma-your-child


 

Before you can be treated for asthma you must be diagnosedby a doctor. Your doctorwill check if you have asthma by askingyou questions, examining your chest and performing some t ests.

Questions Your Doctor Might Ask You:

  • How long has your child had asthma-like symptoms?
  • How often does s/he have symptoms?
  • How do the symptoms affect his/ her day to day life?
  • Has s/he  had an att ack or regular attacks of wheezing,coughing or shortnessof breath?
  • Does   s/he  cough at night and doesit disturb his/her   sleep?
  • Does  s/he   wheeze or coughafter exercise?
  • Does s/he wheeze or cough afters/he comes in contact with triggerssuch as pollen, pets, smoke, cold air, etc.?
  • Do colds go down to his / her   chest ?
  • Are symptoms improved by taking asthma treatments?
  • Is there a history of asthma in the family?

If you suspect that your child is suffering from asthma your G.P. will be able to give you a diagnosis based on: 

  • Whether there’s a family history of asthma;
  • The pattern of the symptoms;
  • A physical chest examination;
  • Peak flow/lung function test (child must be over 5 years old);
  • A trial of asthma treatment.

Before confirming or ruling out asthma, your doctor may also ask if there are any conditions, such as eczema or hay fever. You may also be asked to keep a diary of which symptoms your child has - and when you have them. The following tests may be performed by your doctor to confirm the correct diagnosis. 

Spirometry; a simple breathing test that gives measurements of lung function including a reversibility test that measures lung function before and after a dose of reliever to see if it has improved your lung function. This can be helpful with asthma diagnosis.

Peak Expiratory flow rate measurements (PEFR); another simple breathing test which may be measured over a period of time, when one has symptoms or even when symptom free, performed in a GP surgery, hospital or even at home.

 An exercise test to check if exercise worsens the symptoms

Children under 2

Asthma is difficult to diagnose in children under the age of two. This is because wheezing and respiratory infections, such as bronchiolitis, are common in young children and the symptoms are often very similar to asthma.

If your child is under two and the symptoms are bad or persistent, your doctor may decide to give them a trial of asthma medication to help make a diagnosis.

http://www.asthma.ie/get-help/asthma-for-parents/asthma-your-child/asthma-your-child

With the right asthma treatment children with asthma can live and full and active lives. When your child’s symptoms are worse, their doctor may increase their medication and decrease it when their asthma is under control.

The following are types of treatment which may be prescribed by your doctor:

Reliever Inhaler

Reliever medication relieves symptoms quickly by opening the airways wider and making it easier for your child to breathe. It usually comes in a blue inhaler.

Every child with asthma should have a reliever inhaler and should keep it with them at all times. Reliever medication can be taken before symptoms get worse, for example when a child is getting a cold.

If your child needs their reliever inhaler more than twice per week, for two weeks in a row, it means that their asthma is not controlled and they should see their doctor.

Examples of reliever medication:

  • Salbutamol (e.g. Ventolin, Salamol)
  • Terbutaline (e.g. Bricanyl)
  • Ipratropium bromide (e.g. Atrovent)

Possible Side Effects

Reliever medication can sometimes cause side effects, such as hyperactivity or increased heart rate, but these are temporary and shouldn’t cause concern.

Controller Inhaler (Inhaled Corticosteroids)

Controller medication reduces the inflammation of the airways over- time. It does not provide instant relief of symptoms, but builds up protection over a period of time. It usually comes in a brown inhaler.

Not every child with asthma will need controller medication. Your child may be prescribed controller medication if they have regular symptoms and/or use their reliever more than twice a week.

Controller medication must be taken every day as prescribed, even when your child is feeling well.

Examples of controller medication:

  • Beclomethasone (e.g. Becotide)
  • Budesonide (e.g. Pulmicort)
  • Fluticasone (e.g. Flixotide)

 

 

Possible Side Effects

Controller medication can occasionally cause hoarseness, sore throat or oral thrush. These side effects can be reduced by making sure children use their inhaler correctly, use a spacer device, and rinse their mouths and wipe their faces after taking their medication.

It is important to note that the steroids in controller inhalers are similar to those produced naturally in our bodies and should not be confused with anabolic steroids, which are sometimes used illegally to enhance sporting performance.

Leukotriene Receptor Antagonist (LTRA)

An LTRA may be used instead of or as well as another controller medication to help control a child’s asthma. They are particularly effective for children with exercise related symptoms or allergies. LTRA’s work by blocking one of the reactions in a child’s lungs that causes the airways to flare up when they come into contact with an asthma trigger. LTRA’s are taken once a day, even when a child is well and come as tablets, chewable tablets and granules which can be given in food for children under six months old.

Examples of LTRAs:

  • Montelukast (e.g. Singulair )

Possible Side Effects

The most common side effects caused by LTRAs are headache, dizziness, abdominal pain, nightmares sore throat and rhinitis. Speak to a doctor, nurse or pharmacist for more information on possible side effects.

Combination Inhalers

For children with poorly controlled asthma, another treatment option is a combination inhaler. Combination inhalers contain both a slow acting reliever medication and a controller medication, and are an easy way for children to take two medicines at one time. They should be taken every day as prescribed, even when a child is feeling well. Children using combination medication should be monitored by their doctor or nurse to make sure they are on the lowest dose of medication to manage their symptoms.

Examples of combination medication:

  • Fluticasone & Salmeterol (e.g. Seretide :used in children over 4 years)
  • Budesonide & Formoterol (e.g. Symbicourt: used in children over 6 years)
  • Flutiform (used in children over 12 years)

Possible Side Effects

Combination medication can occasionally cause hoarseness, sore throat or oral thrush. These side effects can be reduced by making sure children use their inhaler correctly, use a spacer device, and rinse their mouths and wipe their faces after taking their medication.

Oral Steroid Tablets

Oral steroid tablets (glucocorticosteroids) may be prescribed, in addition to regular medication, for a period of three to five days to regain control of a child’s asthma following an asthma attack. Steroid tablets are powerful and quickly reduce inflammation in the lungs that causes a child’s symptoms. If a child repeatedly needs oral steroids to keep their asthma under control then their doctor may refer them to a specialist paediatric respiratory doctor.

Examples of Oral Steroid Tablets:

  • Prednisolone
  • Prednisone
  • Prednesol

 

Possible Side Effects

A short course of steroids usually causes no long term side effects. These are more likely to occur of a child needs longer courses, or needs repeated short courses. Oral steroids can sometimes cause disturbed sleep, hyperactivity and increased appetite. Oral steroids may also reduce resistance to chickenpox. Speak to your doctor, nurse or pharmacist if you have any concerns.

Immunotherapy

Immunotherapy is used to treat asthma and allergies. Immunotherapy works by giving an allergen vaccine repeatedly over time to reduce a child’s sensitivity to a particular allergen e.g. pollen, dust mites and animal dander or hair.

Immunotherapy is given by a healthcare professional who specialises in asthma and can be given by injection, tablets or drops that are placed under a child’s tongue. This treatment is given gradually. If there is an improvement the treatment is given for at least three years, and continues working after the treatment is finished.

For more information on allergies visit http://www.asthma.ie/get-help/learn-about-asthma/asthma-triggers-a-z/allergies-and-asthmaand booklet Asthma and Allergic Rhinitis athttp://www.asthma.ie/document-bank/asthma-and-allergic-rhinitis

Complimentary or Alternative Treatments

Some people find that complimentary treatments help their asthma symptoms; however there is little scientific evidence that complimentary treatments are effective by themselves. Speak to a healthcare professional before trying your child on any complementary treatment and always continue with prescribed medication as well.

Important Points to Note about Asthma Medication

  • Always give your child their medication as it has been prescribed by their doctor.
  • If your child is using their reliever medication more than twice a week they should see their doctor or nurse.
  • Children should have access to their blue reliever at all times.
  • Children should have their inhaler technique checked at every visit to their doctor and pharmacist.

How to Take Asthma Medication

Asthma medication can be given to a child in a variety of ways. It is important that children have their inhaler and spacer technique checked by a doctor, nurse or pharmacist regularly. You can view demonstration videos on inhaler and spacer technique at http://www.asthma.ie/get-help/resources/videos

Inhalers

An inhaler is the most effective method of giving asthma medication as it ensures that the medication goes directly to the lungs where it is needed, and requires smaller dosages than tablets.

http://www.asthma.ie/get-help/asthma-for-parents/medicines-for-your-child/medicines-for-your-child

Spacers

A spacer device is a plastic container with a mouthpiece or mask at one end, and space to insert an inhaler at the other. Children should always use a spacer with their inhaler. Spacers have several advantages:

  • They make inhalers easier to use
  • They increase the amount of medication that reaches the airways
  • They reduce the risk of side effects from controller medication, such as oral thrush.
  • Always use a spacer with children under 4 years old.

There are several different brands of spacer device (e.g. Aerochamber, Volumatic, Babyhaler), with some available on prescription.

How to Use a Spacer with a Mask

  1. Shake the inhaler
  2. Insert the inhaler into the spacer
  3. Place the mask over the child’s mouth and nose, ensuring that there is a tight seal
  4. Press the inhaler once and allow the child to breath in and out slowly five times
  5. Some spacers have a valve which shows the breath going in and out. If so, you can watch this to make sure your child takes five breaths of their medication
  6. Repeat steps2-5 for each prescribed dose of medication.

 

How to Use a Spacer with a Mouthpiece

  1. Assemble the spacer if it comes in two halves
  2. Shake the inhaler
  3. Insert the inhaler into the spacer
  4. The child should grip the mouthpiece with their teeth and place their lips around it
  5. Press the inhaler once and allow the child to breath in and out slowly five times
  6. Some spacers have a valve which shows the breath going in and out. If so, you can watch this to make sure your child takes five breaths of their medication
  7. Repeat steps 3-6 for each prescribed dose of medication.

 

Remember

·        Only release one puff of medication into a spacer at a time.

·        Always follow the manufacturer’s instructions for care and replacement guidelines.

Tips for Using a Spacer with a Mask

Making sure children take their medication correctly is very important, but using a spacer can be difficult for young children.

  • Let your child play with their spacer before they use it so they get used to it.
  • Be positive- children will sense if you’re anxious.
  • Avoid giving children medication when they are upset as it may make things worse and reduce the amount of medication they breathe in.
  • Distract your child with music or videos.
  • It is better to give children their medication when they are awake.
  • Count out loud to six each time you give them a puff of inhaler so they know how long they have to breathe through the spacer, and remove the mask on the count of six.
  • Praise your child after they have taken their inhaler.
  • Always wipe your child’s face after they have taken their controller inhaler.

 

Tips for Using a Spacer with a Mouthpiece

Older children can use a spacer with a mouthpiece, but using it for the first time or transitioning from a spacer with a mask can be tricky.

  • Show your child how to use the inhaler and spacer without releasing a puff of medication.
  • Let them decorate their spacer with stickers.
  • Count out loud with each breath.
  • Let your child play with their spacer and practice with their teddy or doll before they need to take their medication.
  • Stick to a routine and give medication at the same time each day-usually before they brush their teeth.
  • Praise children for taking their medication or use a sticker chart to reward them.

 

Nebuliser Compressor

The Asthma Society of Ireland doesn’t recommend the use of nebuliser compressors in the home, unless you have been instructed to do so by a health care professional. Using an inhaler and spacer together are equally as affective as using a nebuliser, except in severe asthma attacks. Nebulisers deliver a fine mist of high doses of asthma medication to the lungs. Nebulisers are sometimes used in hospitals to treat asthma attacks or for children with uncontrolled asthma who find it difficult to use a spacer device.


Asthma Management

Giving your child their medication as prescribed by their doctor and using inhalers and spacers correctly are very important in keeping their asthma under control; but there are other things to consider and steps you can take to help children manage their asthma.

Peak Flow

Children over six years old can use a peak flow meter to help manage their asthma. A peak flow meter is a small plastic tube-like device that a child blows into. It shows how well their lungs are working by measuring how quickly they can blow air out. If readings vary greatly it may be an early warning sign that a child’s asthma is getting worse. Peak flow readings can be recorded in an asthma management plan and over time a pattern of when a child’s asthma control gets worse and better should become clear.

Asthma Management Plan

Every child should have an Asthma Management Plan to help monitor and control their asthma.

An Asthma Management Plan is tailored to each individual child. A healthcare professional can work with you to complete an Asthma Management Plan which will contain the following information:

  • Contact details for parents, guardians and doctors.
  • A list of medication that has been prescribed for your child.
  • How to recognise when asthma control is getting worse.
  • Steps to take to improve asthma control.
  • The 5 Step Rule - what to do in an asthma attack.

For help on how to control your child’s asthma visit http://www.asthma.ie/get-help/asthma-for-parents/controlling-your-childs-asthma/controlling-your-childs-asthma

And for a copy of the asthma management plan for children visithttp://www.asthma.ie/document-bank/my-asthma-plan

 

Vaccinations

Vaccinations are given to immunise children, or in other words to protect them against disease. Immunisation is very safe and effective. All children, including children with asthma, should be immunised according to the Primary Childhood Immunisation Schedule. Speak to a healthcare professional for more information. The annual flu vaccine is recommended for all children diagnosed with asthma. Speak to your health care professional for more information.

Breastfeeding

Mothers are encouraged to breastfeed exclusively for at least four to six months. Breastfeeding for the first four to nine months can reduce the risk of wheezing and developing asthma. This is likely because infants who are breastfed have fewer respiratory infections, which are a common cause of wheezing. 

If breast feeding is not possible and there is a family history of asthma or other associated conditions such as hay fever or eczema, speak to your healthcare professional about the best formula for your baby.

Diet

Changing a child’s diet will not reduce their changes of developing asthma, but it is important that children with asthma have a healthy, balanced diet. Obesity makes asthma control worse. Lung function is poorer and asthma is more difficult to control if children are obese. Use the Food Pyramid as a guide and give children portions that are appropriate to their age. Children should eat from all of the four major food groups-grains, fruit and vegetables, protein and dairy- and shouldn’t eat sweets, cakes and other food from the top of the Pyramid every day.

http://www.asthma.ie/get-help/asthma-for-parents/your-child-school/your-child-school

Managing Asthma in Childcare and at School

One in five children in Ireland has asthma and it is the leading cause of missed school days in the country. Take the following steps to make sure that your child’s asthma is well managed whilst in childcare of at school:

  • Teachers and childcare workers should be alerted if a child in their care has asthma, along with what their triggers are, if they have any allergies, and what to do during an asthma attack.
  • Keep an up to date Asthma Management Plan and make sure your child’s carer or teacher has a copy. This should include contact details for your child’s doctor.
  • Check what policy is in place for medication. Where their medication is stored and will children have access to it? Do teachers and childcare workers know when and how to give medication to smaller children? Are they happy to do so?
  • Clearly mark your child’s name on their medication.
  • Give the school or childcare facility a spare reliever inhaler and spacer for emergencies.
  • Make sure your child is cared for in a smoke and pet free environment.

For more information on managing asthma in school go to www.asthma.iefor a free copy of our Guidelines for Asthma in Schools booklet.

http://www.asthma.ie/document-bank/asthma-schools-guidelines


 

How to Help Manage Asthma

  • Understand medication: learn about the different types of medication that have been prescribed for your child and how they should be taken.
  • Taking medication as prescribed: it is very important that children take their medication as it is prescribed by their doctor.
  • Inhaler technique: children should have their inhaler technique checked regularly. Inhaler technique can be checked by a doctor, nurse or pharmacist.
  • Monitor symptoms: your child’s symptoms should be tracked in in their Asthma Management Plan.
  • Manage triggers:knowing your child’s triggers and how to avoid them is very important in keeping asthma under control. Triggers should be noted in a child’s Asthma Management Plan.
  • Asthma review:children should have their asthma reviewed by a doctor every six to twelve months, even when they are well.
  • Vaccinations:making sure vaccinations are up to date is very important in keeping children with asthma well.
  • Diet:eating a balanced diet and maintaining a healthy weight helps keep asthma under control.
  • Asthma in Childcare and at School: teachers and childcare workers should be well informed about your child’s asthma and kept up to date on their asthma management.

 

What to do in an Asthma Attack

How to recognise if your child’s asthma is getting worse

It is important to recognise when your child’s asthma is getting worse so you can take the necessary steps to stop them having an asthma attack. To make sure you act fast keep an eye out for the following signs:

  • Wheezing or coughing in the morning.
  • Wheezing after exercise or avoiding exercise altogether.
  • Waking at night because of asthma symptoms.
  • Needing to take reliever medication more often than normal.
  • Reliever medication isn’t helping to relieve symptoms.

 

If you notice any of these signs or are in doubt speak to a healthcare professional immediately.

 

If your child has recently had an asthma attack

There are important steps to take after a child has had an asthma attack:

  • Make an appointment with their doctor to have their asthma and medication reviewed.
  • Have their inhaler technique checked by a healthcare professional.
  • Make sure you know how to recognise if their asthma is getting worse and what to do if they have another attack.

If you are having an asthma attack immediately follow the 5 step Rule

  1. Take two puffs of reliever inhaler (usually blue), one puff at a time
  2. Sit up and stay calm
  3. Take slow steady breaths
  4. If there is no improvement, take one puff of reliever inhaler every minute:

·        Adults and children over six years can take up to ten puffs in ten minutes

·        Children under six years can take up to six puffs in ten minutes

  1. Call 999 or 112 if symptoms do not improve after ten minutes or you are worried. Repeat Step 4 if an ambulance does not arrive within ten minutes.

Remember, if you are having an asthma attack:

  • Extra puffs of reliever are safe
  • You should use a spacer if possible
  • Don’t lie down or let anyone put their arm around you.

http://www.asthma.ie/emergency

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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