Asthma in Children

Overview

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This topic provides information about asthma in children. If you are looking for information about asthma in teens and adults, see the topic Asthma in Teens and Adults.

What is asthma?

Asthma makes it hard for your child to breathe. It causes swelling and inflammation in the airways that lead to the lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for your child to breathe. These flare ups are also called asthma attacks or exacerbations.

Asthma affects children in different ways. Some children only have asthma attacks during allergy season, when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.

Even if your child has few asthma attacks, you still need to treat the asthma. If the swelling and irritation in your child’s airways isn't controlled, asthma could lower your child's quality of life, prevent your child from exercising, and increase your child's risk of going to the hospital.

Even though asthma is a lifelong disease, treatment can control it and keep your child healthy. Many children with asthma play sports and live healthy, active lives.

What causes asthma?

Experts do not know exactly what causes asthma. But there are some things we do know:

• Asthma runs in families.
• Asthma is much more common in people with allergies, though not everyone with allergies gets asthma. And not everyone with asthma has allergies.
• Pollution may cause asthma or make it worse.

What are the symptoms?

Symptoms of asthma can be mild or severe. When your child has asthma, he or she may:

• Wheeze, making a loud or soft whistling noise that occurs when the airways narrow.
• Cough a lot.
• Feel tightness in the chest.
• Feel short of breath.
• Have trouble sleeping because of coughing and wheezing.
• Quickly get tired during exercise.

Many children with asthma have symptoms that are worse at night.

How is asthma diagnosed?

Along with doing a physical exam and asking about your child’s symptoms, your doctor may order tests such as:

• Spirometry. Doctors use this test to diagnose and keep track of asthma in children age 5 and older. It measures how quickly your child can move air in and out of the lungs and how much air is moved. Spirometry is not used with babies and small children. In those cases, the doctor usually will listen for wheezing and will ask how often the child wheezes or coughs.
• Peak expiratory flow (PEF). This shows how fast your child can breathe out when trying his or her hardest.
• A chest X-ray to see if another disease is causing your child’s symptoms.
• Allergy tests, if your doctor thinks your child’s symptoms may be caused by allergies.

Your child needs routine checkups so your doctor can keep track of the asthma and decide on treatment.

How is it treated?

There are two parts to treating asthma, and they are outlined in the asthma action plan. The goals are to:

• Control asthma over the long term. The asthma action plan tells you which medicine your child needs to take. It also helps you track your child’s symptoms and know how well the treatment is working. Many children take controller medicine—usually an inhaled corticosteroid—every day. Taking controller medicine every day helps reduce the swelling of the airways and helps prevent attacks.
• Treat asthma attacks when they occur. The asthma action plan tells you what to do when your child has an asthma attack. It helps you identify triggers that can cause your child’s attacks. Your child will use quick-relief medicine, such as albuterol, during an attack.

Using an inhaler with a spacer is the best way to get the most medicine to your child’s lungs. But your child has to use the inhaler correctly for it to work well. If you are not sure how to use the inhaler the right way, ask your doctor to show you how.

If your child needs to use the quick-relief inhaler more often than usual, talk to your doctor. This is a sign that your child’s asthma is not controlled and can cause problems.

Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your child’s asthma action plan.

What else can you do to help your child's asthma?

You can prevent some asthma attacks by helping your child avoid those things that cause them. These are called triggers. A trigger can be:

• Irritants in the air, such as cigarette smoke or other air pollution. Try not to expose your child to tobacco smoke.
• Things your child is allergic to, such as pet dander, dust mites, cockroaches, or pollen. Taking certain types of allergy medicines may help your child.
• Exercise. Ask your doctor about using an inhaler before exercise if this is a trigger for your child’s asthma.
• Other things like dry, cold air; an infection; or some medicines, such as aspirin. Try not to have your child exercise outside when it is cold and dry. Talk to your doctor about vaccines to prevent some infections. And ask about what medicines your child should avoid.

It can be scary when your child has an asthma attack. You may feel helpless, but having an asthma action plan will help you know what to do during an attack. An asthma attack may be severe enough to need urgent medical care, but in most cases you can take care of symptoms at home if you have a good asthma action plan.

Health Tools 

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Allergies: Should I take allergy shots?
	Actionsets are designed to help people take an active role in managing a health condition.
	Asthma in children: Helping a child use a metered-dose inhaler and mask spacer
	Asthma: Identifying your triggers
	Asthma: Measuring peak flow
	Asthma: Taking charge of your asthma
	Asthma: Using an asthma action plan
	Breathing problems: Using a dry powder inhaler
	Breathing problems: Using a metered-dose inhaler

Frequently Asked Questions

Cause

The cause of asthma is unknown. Health experts believe that inherited, environmental, and immune system factors combine to cause inflammation of the bronchial tubes, which carry air to the lungs. This can lead to asthma symptoms and asthma attacks.

• Asthma may run in families (inherited). If this is the case in your family, your child may be more likely than other children to develop long-lasting (chronic) inflammation in the bronchial tubes.
• In some children, immune system cells release chemicals that cause inflammation in response to certain substances (allergens) that cause allergic reactions. Studies show that exposure to allergens such as dust mites, cockroaches, and animal dander may influence asthma’s development.¹ Asthma is much more common in children with allergies (atopic children), though not all children with allergies develop asthma. And not all children with asthma have allergies.
• Environmental factors and today's germ-conscious lifestyle may play a role in the development of asthma. Some experts believe there are more cases of asthma because of pollution and less exposure to certain types of harmful bacteria and other "germs."² As a result, children's immune systems may develop in a way that makes it more likely they will also develop allergies and asthma.

Symptoms

Symptoms of asthma can be mild or severe. Your child may have no symptoms; severe, daily symptoms; or something in between. How often your child has symptoms can also change. Symptoms of asthma may include:

• Wheezing, a whistling noise of varying loudness that occurs when the airways of the lungs (bronchial tubes) narrow.
• Coughing, which is the only symptom for some children.
• Chest tightness.
• Shortness of breath, which is rapid, shallow breathing or difficulty breathing.
• Sleep disturbance.
• Tiring quickly during exercise.

If your child has only one or two of these symptoms, it does not necessarily mean he or she has asthma. The more of these symptoms your child has, the more likely it is that he or she has asthma.

An asthma attack occurs when your child's symptoms suddenly increase. Factors that can lead to an asthma attack or make one worse include:

• Having a cold or another type of respiratory illness, especially one caused by a virus, such as influenza.
• Exercising (exercise-induced asthma), especially if the air is cold and dry.
• Exposure to triggers, such as cigarette smoke, air pollution, dust mites, or animal dander.
• Changes in hormones, such as during the start of a girl's menstrual blood flow at puberty.
• Taking medicines, such as aspirin (aspirin-induced asthma) or nonsteroidal anti-inflammatory drugs.

Most asthma attacks result from a failure to successfully control asthma with medicines. By strictly following the doctor's recommendations and taking all medicines correctly, it is possible in most cases to prevent these attacks from occurring. While some asthma attacks occur very suddenly, many get worse gradually over a period of several days.

Many children have symptoms that become worse at night (nocturnal asthma). In all people, lung function changes throughout the day and night. In children with asthma, this often is very noticeable, especially at night, and nighttime cough and shortness of breath occur frequently. In general, waking at night because of shortness of breath or cough indicates poorly controlled asthma.

It can be difficult to know how severe your child's asthma attack is. Symptoms are used to classify asthma by severity. Talk with your doctor about how to evaluate your child's symptoms.

Symptoms are also used along with peak expiratory flow to help define the green, yellow, and red zones of your child's asthma action plan. You use this to decide on treatment during an asthma attack.

Other conditions with symptoms similar to asthma include sinusitis and vocal cord dysfunction.

What Happens

Asthma often begins during childhood or the teen years and may last throughout your child's life.

At times, the inflammation found in asthma causes your child's airways to narrow and produce mucus, resulting in asthma symptoms such as shortness of breath.

The airways narrow when they overreact to certain substances. These are known as asthma triggers and may include:

• Substances your child is allergic to (allergens, such as dust mites or animal dander). Allergens cause long-term (chronic) inflammation and may cause asthma symptoms.
• Environmental factors, such as smoke or cold air. Environmental factors may lead to a tightening of the muscles that line the bronchial tubes (bronchospasm), which can trigger asthma symptoms.

What triggers asthma symptoms varies from child to child. When asthma is triggered by an allergen, it is known as allergic asthma.

When asthma symptoms suddenly occur, it is known as an asthma attack (also called an acute episode, flare-up, or exacerbation). Asthma attacks can occur rarely or frequently and be mild to severe.

It can be difficult to know how severe your child's asthma attack is. Knowing this is important, because severe attacks may require emergency treatment. But in most cases you can take care of your child's symptoms at home with an asthma action plan, which is a written plan that tells you which medicine your child needs to use and when you should call a doctor or seek emergency treatment.

Asthma is classified as intermittent, mild persistent, moderate persistent, and severe persistent. Children with:

• Intermittent, mild persistent, and frequently, moderate persistent asthma often have symptoms only after being around a trigger.
• Intermittent asthma usually need medicines only during an asthma attack. In intermittent asthma, the child is well and without symptoms in between infrequent attacks with symptoms.
• Mild persistent or moderate persistent asthma need to take medicines daily to control the long-term inflammation in their airways. These children are at risk of asthma attacks that may become severe.
• Severe persistent asthma have symptoms almost all of the time. Their symptoms need to be treated daily. These children are at increased risk for severe, life-threatening asthma attacks known as status asthmaticus.

Asthma can have a great impact on your child's life. Even mild asthma may result in changes to the airway system (airway remodeling) and speed up and make worse the natural decrease in lung function that occurs as we age.³ Loss of lung function in asthma appears to start early in childhood.⁴ Asthma also may increase the risk of a partial collapse of lung tissue (atelectasis) or a collapsed lung (pneumothorax).

Sometimes asthma does not respond to treatment because children are not taking their medicines, not taking them correctly, not avoiding triggers, and otherwise not following their asthma action plan. It is very important that you and other caregivers make sure your child is following his or her action plan to keep asthma from getting worse and to prevent an increased risk of death.

By following asthma plans, most children with asthma can live a healthy, full life.

What Increases Your Risk

Many factors may increase the risk of a child developing asthma. Some of these are not within your control; others you can control.

Asthma risk factors that you cannot control

• Gender. Among children, boys have asthma more often than girls.
• Race. Asthma is more common in black children than in white children.⁵
• Inherited tendency (genetic predisposition) to overreaction of the bronchial tubes. Children who inherit a tendency of the bronchial tubes (which carry air to the lungs) to overreact often develop asthma.
• A history of allergies. Children with an allergy are more likely than other children to develop asthma. Most children with asthma have allergic rhinitis, atopic dermatitis, or both. Studies show that 40% to 50% of children with atopic dermatitis develop asthma. Having atopic dermatitis as a child may also increase the risk of a person having more severe and persistent asthma as an adult.⁶
• A family history of allergies and asthma. Children who have an allergy and asthma usually have a family history of allergies or asthma.
• Respiratory syncytial virus (RSV) and wheezing at a young age. Early infection with respiratory syncytial virus (RSV) that causes a lower respiratory infection is a risk factor for wheezing.⁷ Young children who wheeze have a greater risk of developing asthma than children who do not wheeze.

Asthma risk factors that you can control

You may be able to change some factors to reduce your child's risk of developing asthma or of making the condition worse.

• Cigarette smoking. Children who smoke are more likely to develop asthma when they become teenagers. A large study found that children who smoked at least 300 cigarettes in a year were almost 4 times more likely to get asthma.⁸
• Cigarette smoking during pregnancy. Women who smoke during pregnancy increase the risk of wheezing (a symptom of asthma) in their babies. Babies whose mothers smoked during pregnancy also have worse lung function than babies whose mothers did not smoke.⁹
• Exposure to secondhand cigarette smoke. Children who are exposed to secondhand cigarette smoke are at increased risk for developing asthma.⁹ If children already have the disease, exposure to secondhand smoke increases the severity of their symptoms.
• Obesity. Studies have found a link between obesity in children and a higher-than-average asthma prevalence. But the reason for the link is unclear. Experts don't know whether one condition contributes to the other or whether some unknown mechanism contributes to both.⁵ Also, symptoms caused by obesity are sometimes thought to be asthma symptoms.
• Dust mites. Exposure to dust mites may increase your child's risk for developing asthma.⁹
• Cockroaches. In one study, children who had a high level of cockroach droppings in their home were 4 times more likely to have a new diagnosis of asthma than children whose homes have a low level.⁹

No one is sure if breast-feeding affects a child's risk of getting asthma. Some studies show that breast-feeding protects a child from getting asthma.^{10, 11} Other studies show that breast-feeding, especially when mothers with asthma breast-feed, may actually increase a child's risk of getting asthma.¹² Two large studies found that breast-feeding had no effect on the development of asthma.^{13, 14} Mothers are still encouraged to breast-feed their children for all the other proven health benefits that come from breast-feeding.

Experts are also not sure about the effect that pets in the home have on getting asthma. Some research shows that having cats or dogs in the home increases an adult's risk of getting asthma.¹⁵ But other research has seemed to show that being around pets early in life might protect a child against getting asthma.¹⁶ If your child already has asthma and allergies to pets, having a pet in the home may make his or her asthma worse.

Risk factors that may make asthma worse and may lead to asthma attacks

Your child may be at increased risk for severe asthma attacks if he or she:

• Is an infant.
• Has a history of severe symptoms, such as asthma attacks that get worse quickly and frequent nighttime symptoms.
• Has had to go to the hospital or emergency room in the past because of an asthma attack.
• Has difficulty taking medicines or often has to use short-acting beta2-agonists.
• Has frequent changes in peak expiratory flow.
• Has symptoms that last for a long time.
• Does not use oral corticosteroids quickly enough during an attack.
• Does not have good support from families and friends.

Triggers that may make asthma worse and may lead to asthma attacks in your child include:

• Infections, such as severe upper respiratory infections (URI), sinusitis, and influenza (flu).¹⁷
• Allergens, such as dust mites, mold, or pet dander.⁹

When to Call a Doctor

If your child has been diagnosed with asthma and has an asthma action plan (which tells you what medicines to take during an asthma attack), do the following.

Call 911 or other emergency services immediately if your child has severe asthma symptoms (in the red zone of the asthma action plan) and you have followed the plan, but:

• Your child is still having severe difficulty breathing.
• 20 to 30 minutes after taking the extra quick-relief medicine, your child does not feel better and/or his or her peak expiratory flow (PEF) is still less than 50% of the personal best measurement.

Call your doctor immediately if your child:

• Has asthma symptoms that get worse and you feel there is nothing else you can do at home.
• Has had an asthma attack in the red zone, and 6 hours after taking the extra medicine the following are true:
  • The child still requires inhaler medicine every 1 to 3 hours.
  • The peak expiratory flow is below 70% of the personal best measurement.
• Is in the yellow zone of the asthma action plan and continues to have a peak expiratory flow below 70% of the personal best measurement in spite of home treatment using the asthma action plan.
• Is having a first attack of asthma symptoms, and they include wheezing, chest tightness, and moderate difficulty breathing.
• Is coughing up yellow, dark brown, or bloody mucus.

Call your doctor if your child:

• Has asthma symptoms, you do not have an action plan, and the symptoms are mild (chest tightness, cough, and slight shortness of breath or tiring easily during exercise).
• Is having symptoms in the yellow zone almost every day, but inhaler medicine is providing quick relief.
• Has asthma and his or her PEF has been getting worse for 2 to 3 days.

If your child has not been diagnosed with asthma but has asthma symptoms, call your doctor and make an appointment for an evaluation. Many children and teens with frequent wheezing have asthma but are not diagnosed with the disease. Children and teens who are less likely to be diagnosed with asthma include:¹⁸

• Girls, especially teenage girls.
• Smokers or those exposed to household cigarette smoke.
• Those with low socioeconomic status.
• Those who have allergies.
• African Americans, Native Americans, or Mexican Americans.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your child's symptoms or condition without using medical treatment.

If you think your child has asthma, watchful waiting is not appropriate. See your doctor.

If your child has been getting treatment for 1 to 3 months and is not improving, ask your doctor whether the child needs to see a specialist (allergist or pulmonologist).

Watchful waiting may be appropriate if your child follows his or her asthma action plan and stays within the green zone. Monitor your child's symptoms, and continue to avoid asthma triggers.

Who to See

Health professionals who can diagnose and treat asthma include:

• Pediatricians.
• Family medicine physicians.
• Nurse practitioners.
• Physician assistants.
• Internists.

Your child may need to see a specialist (an allergist or pulmonologist) if he or she:

• Has moderate persistent to severe persistent asthma.
• Has other medical conditions that make it hard to treat asthma.
• Needs more education or has difficulty following the asthma action plan.
• Is not meeting the goals of treatment after several months of therapy.
• Has had a life-threatening asthma attack.
• Needs skin testing for allergies or may get allergy shots.

Exams and Tests

Diagnosis of asthma is based on medical history, a physical exam, and simple lung function tests such as spirometry.

Diagnosing asthma in babies and toddlers is often very difficult. Symptoms may be the same as those of other diseases, such as infection with respiratory syncytial virus (RSV) or inflammation of the lungs (pneumonia), sinuses (sinusitis), and small airways (bronchiolitis). If you have a very young child, spirometry is not practical. So the diagnosis is made based on your report of symptoms.

Repeated wheezing is the key symptom in children with asthma. But asthma is not the most common cause of wheezing. Still, if your child wheezes frequently, he or she should be checked for asthma, especially if cough and shortness of breath are also present. Many children and teens who wheeze often may have asthma but are not diagnosed with the disease.

To make a diagnosis of asthma in your child, the doctor may look for factors associated with asthma:

• Wheezing, which is a high-pitched whistling sound when breathing out.
• Coughing, especially if it gets worse at night.
• Problems breathing, especially if they occur often.
• Symptoms that occur or get worse when a possible asthma trigger is present. Some common asthma triggers include animal fur, pollen, weather changes, and strong emotions.
• A parent with asthma.

In an older child, lung function tests can diagnose asthma, determine its severity, and check for complications.

• Spirometry is the most common test to diagnose asthma in older children. It measures how quickly a child can move air in and out of the lungs and how much air is moved. The test helps your doctor decide whether airflow is decreased because of inflamed bronchial tubes and whether the tubes can return to their usual size in a short time after using medicine. The test is recommended at least every 1 to 2 years after asthma treatment has begun.
• Testing of daytime changes in peak expiratory flow (PEF) is done over 1 to 2 weeks. This test is needed when your child has symptoms off and on but has normal spirometry test results.
• An exercise or inhalation challenge may be used if the spirometry test results have been normal or near normal but asthma is still suspected. These tests measure how quickly your child can breathe in and out after exercise or after using a medicine. An inhalation challenge also may be done using a specific irritant or allergen.
• A bronchoscopy involves using a flexible scope called a bronchoscope to examine the airways. Sometimes airway problems such as tumors or foreign bodies will create symptoms that mimic those of asthma. The test might be done if there is unequal wheezing in the lungs or a poor response to asthma therapy. Biopsies of the airways can be done to look for changes that point to asthma.

A newer test to monitor asthma is the NIOX nitric oxide test system. This test measures nitric oxide in exhaled air. A decrease in nitric oxide suggests that treatment may be reducing inflammation caused by asthma. But some experts believe that this test is not useful for monitoring asthma.¹⁹

Regular checkups

You need to monitor your child's condition and have regular checkups to keep asthma under control and to review and possibly update your child's asthma action plan. The frequency of checkups depends on how your child's asthma is classified. Checkups are recommended:

• About every 6 to 12 months for children with intermittent or mild persistent asthma that has been under control for at least 3 months.
• Every 3 to 4 months for children with moderate persistent asthma.
• Every 1 to 2 months for children with uncontrolled or severe persistent asthma.

During checkups, your doctor will ask you and your child whether symptoms and peak expiratory flow have held steady, improved, or become worse. He or she will also ask about asthma attacks during exercise, at night, or after laughing or crying hard. You and your child track this information in an asthma diary. Your child may be asked to bring the peak expiratory flow meter and inhaler to an appointment so your doctor can see how he or she uses them. Based on the results, your child's asthma category may change. And your doctor may change the medicines your child uses or how much medicine he or she uses.

Tests for other diseases

Asthma sometimes is hard to diagnose because symptoms vary widely from child to child and within each child over time. Symptoms may be the same as those of other conditions, such as influenza or other viral respiratory infections. Tests that may be done to determine whether diseases other than asthma are causing your child's symptoms include:

• A chest X-ray. A chest X-ray may be used to see whether something else, such as a foreign object, is causing symptoms.
• A sweat test, which measures the amount of salt in sweat. This test may be used to see whether cystic fibrosis is causing symptoms.

Tests to identify triggers

If your child has persistent asthma and takes medicine every day, your doctor may ask about his or her exposure to substances (allergens) that cause an allergic reaction. For more information about the following tests, see the topic Allergic Rhinitis.

Allergy tests include:

• Skin tests. The skin on the back or arms is pricked with one or more small doses of allergens that might cause an allergy. The amount of swelling and redness at the sites of the skin pricks is measured to see which allergens cause a reaction. Skin tests are quick, simple, and relatively safe. Skin tests are necessary if you feel your child may need allergy shots (immunotherapy).
• Enzyme-linked immunosorbent assay (ELISA). A blood sample is taken from a vein and tested for immunoglobulin E (IgE) antibodies, which are produced in response to particular allergens.

Other tests may be done to see whether other conditions such as sinusitis, nasal polyps, or gastroesophageal reflux disease are present.

Treatment Overview

Although your child's asthma cannot be cured, you can manage the symptoms with medicines, especially inhaled corticosteroids and beta2-agonists. You and your child will usually work with your doctor to make an asthma action plan. This plan will help you and your child meet treatment goals:

• Increase lung function by treating the inflammation in the lungs.
• Decrease the severity, frequency, and duration of asthma attacks by avoiding triggers.
• Treat acute attacks as they occur.
• Use quick-relief medicine less (ideally on not more than 2 days a week).
• Have a full quality of life—the ability to participate in all daily activities, including school, exercise, and recreation—by preventing and managing symptoms.
• Sleep through the night undisturbed by asthma symptoms.

For more information, see:

Asthma: Taking charge of your asthma.

Babies and small children need early treatment for asthma symptoms to prevent severe breathing problems. They may have more serious problems than adults because their bronchial tubes are smaller. Although it may appear that occasional treatment with medicines for children who have mild asthma is enough, one review has noted that one-third of fatal asthma attacks occurred in children who had mild asthma.²⁰ Even if your child's asthma does not appear severe, work with your doctor to make the right plan for your child.

The National Asthma Education and Prevention Program (NAEPP) recommends treatment with long-term medicines for infants and young children who:²¹

• Consistently need treatment for symptoms on more than 2 days a week for longer than 4 weeks.
• Have severe attacks more than once every 6 weeks.
• Have had wheezing 4 or more times in the past year lasting longer than 1 day and affecting sleep and who have atopic dermatitis or a parent with asthma.
• Have had wheezing 4 or more times in the past year lasting longer than 1 day and affecting sleep and two of the following four symptoms:
  • Wheezing not associated with colds.
  • Allergic rhinitis.
  • Evidence of sensitivity to some foods.
  • A high eosinophil count. Eosinophils are a type of white blood cell often present in allergic reactions.

Emergency treatment

If your child has a severe asthma attack (the red zone of the asthma action plan), give him or her medicine based on the action plan, and talk with a doctor immediately about what to do next. This is especially important if your child's peak expiratory flow (PEF) does not return to the green zone or stays within the yellow zone after he or she takes medicine. Your child may have to be admitted to the hospital or go to the emergency room for treatment.

At the hospital, your child will probably receive inhaled beta2-agonists and corticosteroids. He or she may be given oxygen therapy. Doctors will assess your child's lung function and condition. Depending on the response, further treatment in the emergency room or a stay in the hospital may be needed.

Medical checkups

Your child needs to monitor his or her asthma and have regular checkups to keep asthma under control and to ensure the right treatment. The frequency of checkups depends on how your child's asthma is classified. Checkups are recommended:

• About every 6 to 12 months for children who have intermittent or mild persistent asthma that has been under control for at least 3 months.
• Every 3 to 4 months for children who have moderate persistent asthma.
• Every 1 to 2 months for children who have uncontrolled or severe persistent asthma.

During checkups, your doctor will check to see that all your goals are being met. He or she will ask you and your child whether symptoms and peak expiratory flow have held steady, improved, or become worse. He or she will also ask about asthma attacks during exercise, at night, or after laughing or crying hard. You track this information in an asthma diary. Your child may be asked to bring his or her inhaler and peak expiratory flow meter to an appointment so your doctor can see if they are being used correctly.

Initial treatment

There are many components to managing asthma. Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, no one plan will be effective for all children. After your child's diagnosis, your doctor may only discuss the components you need to know immediately. These include:

• Oral or injected corticosteroids (systemic corticosteroids). These medicines may be used to get your child's asthma under control before he or she starts taking daily medicine. In the future, your child also may take oral or injected corticosteroids to treat any sudden and severe symptoms, such as shortness of breath (asthma attacks). Oral corticosteroids are used more than injected corticosteroids. Systemic corticosteroids include prednisone and dexamethasone.
• Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. They reduce the inflammation of your child's airways and are taken every day to keep asthma under control and to prevent asthma attacks. Inhaled corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
• Short-acting beta2-agonists. These medicines are used for asthma attacks. They relax the airways, allowing your child to breathe easier. Short-acting beta2-agonists include albuterol and pirbuterol.
• Basic education about asthma. The more you and your child know about asthma, the more likely it is you will control symptoms and reduce the risk of asthma attack. Keep in mind that even severe asthma can be controlled, and cases where the condition cannot be controlled are unusual.
• Instruction on how to use a metered-dose inhaler (MDI) or dry powder inhaler (DPI). An MDI delivers inhaled medicines directly to the lungs. If your child uses the inhaler correctly, he or she can control the symptoms and avoid asthma attacks that can result in emergency care. Most doctors recommend using a spacer with an MDI. A DPI medicine is a dry powder. Your child breathes in sharply to inhale the medicine. How well the DPI works may depend on how well your child inhales. A dry powder inhaler should not be used with a spacer. For more information, see:

  Asthma: Using a metered-dose inhaler.

  Asthma: Using a dry powder inhaler.

The short-term goal is to control your child's current symptoms. The long-term goal is to prevent your child's symptoms so that asthma does not impact your child's daily activities.

Special things to think about in treating asthma include:

• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you and your child can take to reduce the risk of this include using medicine immediately before exercising.
• Managing asthma before surgery. Children with moderate to severe asthma are at higher risk of having problems during and after surgery than children who do not have asthma.

Ongoing treatment

After your child's initial treatment for asthma, it is important for you and your child to learn more about the condition and make an overall plan to manage the disease. You, your child, and your doctor will work together to do this. Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, no one management plan is effective for everyone.

Asthma management consists of:

• An asthma action plan. An asthma action plan tells you which medicines your child takes every day and how to treat asthma attacks. It may also include an asthma diary where your child records peak expiratory flow (PEF), symptoms, triggers, and quick-relief medicine used for asthma symptoms. This helps you identify triggers that can be changed or avoided, be aware of your child's symptoms, and know how to make quick decisions about medicine and treatment. For more information, see:

  Asthma: Using an asthma action plan.

  An example of an asthma action plan (What is a PDF document?).

• Monitoring peak expiratory flow. It is easy to underestimate the severity of your child's symptoms. You may not notice them until his or her lungs are functioning at 50% of the personal best peak expiratory flow (PEF). Measuring PEF is a way to keep track of asthma symptoms at home. It can help you and your child know when lung function is becoming worse before it drops to a dangerously low level. This is done with a peak flow meter. For more information, see:

  Asthma: Measuring peak flow.

• A plan to deal with factors that can make asthma worse (triggers). Being around triggers increases symptoms. Try to avoid situations that expose your child to irritants (such as smoke or air pollution) or substances (such as animal dander) to which he or she may be allergic. See information on:

  Asthma: Identifying your triggers.

• A plan to treat other health problems. If your child also has other health problems, such as inflammation and infection of the sinuses (sinusitis) or gastroesophageal reflux disease (GERD), he or she will need treatment for those conditions.
• Using the prescribed medicines correctly. Your doctor may adjust your child's medicines depending on how well your child's asthma is controlled. Medicines include:
  • Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. Inhaled corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
  • Long-acting beta2-agonists (such as salmeterol and formoterol), which are always used with inhaled corticosteroids.
  • Oral or injected corticosteroids (systemic corticosteroids) to treat any sudden and severe symptoms, such as shortness of breath (asthma attacks). Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and dexamethasone.
  • Quick-relief medicine, such as short-acting beta2-agonists and anticholinergics (ipratropium) for asthma attacks. If your child is using quick-relief medicine on more than 2 days a week (other than to prevent exercise-induced asthma), he or she probably needs more long-term treatment. Overuse of quick-relief medicine can be harmful.
• Education. Continue to learn about asthma. This questionnaire can help you and your child determine what you already know about asthma and what you may need to discuss with your doctor.

If your child has persistent asthma and reacts to allergens, he or she may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful. For more information, see:

Should I take allergy shots (immunotherapy) for allergic rhinitis and allergic asthma?

Your child can expect to live a normal life if he or she controls symptoms by following his or her asthma action plan. Asthma symptoms that are not controlled can limit your child's activities and lower his or her quality of life.

Special things to think about in treating asthma include:

• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medicine immediately before exercising.
• Managing asthma before surgery. People with moderate to severe asthma are at a higher risk than people who do not have asthma of having problems during and after surgery.

Treatment if the condition gets worse

If your child's asthma is not improving, talk with your doctor and:

• Review your child's asthma diary to see if he or she has a new or previously unidentified trigger, such as animal dander. Talk to your doctor about how best to avoid triggers.
• Review your child's medicines, to be sure he or she is using the right ones and using them correctly.
• Review your child's asthma action plan, to be sure it is still suitable for his or her condition.
• Find out whether your child has a condition with symptoms similar to asthma, such as sinusitis.

If your child's medicine is not working to control airway inflammation, your doctor will first check to see whether your child is using the inhaler correctly. If your child is using it correctly, your doctor may increase the dosage, switch to another medicine, or add a medicine to the existing treatment. You can work with your doctor to educate your child about the importance of taking medicines correctly and to encourage your child's teachers, babysitters, and other adults to help your child follow his or her plan.

Your doctor may suggest other medicines, such as leukotriene pathway modifiers (zafirlukast, zileuton, or montelukast). Less commonly, your doctor may recommend a mast cell stabilizer (cromolyn) or theophylline (such as Uniphyl).

If your child's asthma does not improve with treatment, he or she may require more intensive treatment, including larger doses of corticosteroids or other medicines. An asthma specialist generally prescribes these medicines.

If your child has persistent asthma and reacts to allergens, he or she may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful.

What to think about

If your child has been diagnosed with asthma, it is important that you treat it. He or she may feel good most of the time—so much so that it may be hard to believe your child has a long-lasting condition. But all asthma—even mild asthma—may result in changes to the airways that speed up and make worse the natural decrease in lung function that occurs as we age.³

Prevention

While there is no certain way to prevent asthma, you can take steps to reduce your child's airway inflammation and the likelihood of asthma attacks.

No one is sure if breast-feeding affects a child's risk of getting asthma. Some studies show that breast-feeding protects a child from getting asthma.^{10, 11} Other studies show that breast-feeding, especially when mothers with asthma breast-feed, may increase a child's risk of getting asthma.¹² Two large studies found that breast-feeding had no effect on the development of asthma.^{13, 14} Mothers are still encouraged to breast-feed their children for all the other proven health benefits that come from breast-feeding.

Preventing asthma attacks

The main focus of prevention is on reducing the number, length, and severity of asthma attacks. The best way to prevent asthma attacks in your child is to follow your doctor's recommendations and make sure your child takes asthma control medicines as directed. By doing this, it is possible, in most cases, to prevent asthma attacks. Also, by avoiding triggers, your child may be able to prevent or reduce the severity of symptoms. For more information on identifying your child's triggers, see:

Asthma: Identifying your triggers.

Controlling symptoms at night

Coughing and wheezing can wake your child who has asthma. Special problems that might cause night symptoms include:

• Delayed allergic reactions. Sometimes allergens that get in the airway can cause problems up to 8 hours later. This is called a late allergic response (LAR). Talk to your doctor about treating allergies that affect your child at night. To prevent LAR, you may be able to change your child’s medicine or the time your child takes it.
• Medicine that wears off in early morning. If your child’s controller medicine wears off during sleep, asthma symptoms may cause your child to wake up. If this is a problem, the doctor may be able to change your child’s dosage or medicine to make sure it lasts through the night. Adjusting the dose or timing of medicine your child takes for other problems also may help. Treating a sinus infection, cold, or allergies can keep your child’s symptoms from occurring at night.

Talk to your doctor before giving your child any other medicine. You need to be sure that the medicines your child takes are not harmful together.

Upper respiratory infections

Upper respiratory infections, including the common cold, cause 85% of asthma attacks in young children.²² Basic preventive measures include the following:

• Avoid contact with other people who are ill. If there is an ill child in the home, separate him or her from other children, if possible. Put the child in a room alone to sleep.
• If you have a respiratory infection, such as a cold or the flu, or if you are caring for someone with a respiratory infection, wash your hands before caring for your child. Hand-washing eliminates the germs on your hands and the spread of germs to your child when you touch your child or touch an object he or she might touch.
• Do not smoke. Secondhand smoke irritates the mucous membranes in your child's nose, sinuses, and lungs and increases his or her risk for respiratory infections.
• Children with asthma and their family members should have a flu shot (influenza vaccine (What is a PDF document?)) every year.

Irritants in the air

Common irritants in the air, such as tobacco smoke and air pollution, can trigger asthma symptoms in some children.

Controlling tobacco smoke is important because it is a major cause of asthma symptoms in children and adults. If your child has asthma, try to avoid being around others who are smoking. And ask people not to smoke in your house.

• Pregnant women who smoke cigarettes during pregnancy increase the risk for wheezing in their newborn babies.
• Exposing young children to secondhand tobacco smoke makes it more likely that the children will develop asthma and makes symptoms more severe if the children already have the disease.

Consider keeping your child inside when air pollution levels are high. Other irritants in the air (such as fumes from gas, oil, or kerosene, or wood-burning stoves) can sometimes irritate the bronchial tubes. Avoiding these may reduce asthma symptoms.

Allergens

Your child may be allergic to certain substances (allergens). You may reduce your child's asthma symptoms by limiting exposure to those substances.

To help reduce your child's exposure to allergens:

• Control cockroaches, especially if you and your child live in an inner-city area or the southern part of the United States.
• Control dust mites. House dust mites have been linked with the asthma in children.¹
• Control animal dander and pet allergens. If your pet is a known trigger for your child, you may need to think about giving your pet away. If that is too hard, taking steps such as keeping your pet out of your child's bedroom and dusting and vacuuming often may help your child's asthma.
• Control indoor mold, especially if you live in an area with high humidity.

It also may be necessary to avoid exposure to other types of triggers that cause asthma symptoms.

• Control your child's exposure to pollens in the air. Watch local weather reports or read the local newspaper for pollen counts in your area.
• Limit your child's exercise outdoors in cold weather. The air may irritate airways. Have your child wear a scarf around his or her face and breathe through the nose.
• Have your child avoid foods that may cause asthma symptoms. Some children have symptoms after eating processed potatoes, shrimp, or dried fruit. These foods and liquids contain sulfites, which may cause asthma symptoms.
• Consider using acetaminophen (such as Tylenol) for pain relief instead of similar medicines such as ibuprofen if they increase asthma symptoms. (Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome.)

Some research shows that children who have older siblings or who attend day care may receive some protection from developing asthma.²³ One theory as to the increasing prevalence of asthma suggests that low exposure to some bacteria and infections may prevent children's immune systems from forming the cells necessary to protect against asthma.

Living With Asthma

You can control the impact asthma has on your child's life by following your asthma action plan consistently. A management plan can reduce inflammation to prevent long-term damage to your child's lungs and reduce the severity, frequency, and duration of asthma attacks. Your child may have difficulty following the plan because of its many parts.

To help you and your child remain consistent in following the asthma action plan:

• Educate yourself and your child about asthma. By doing so, you can learn to control symptoms and reduce the risk of your child having asthma attacks. This questionnaire can help you and your child see what you already know about asthma and what you may need to discuss with your doctor.
• Understand your child's barriers and solutions. What may prevent your child from following his or her plan? These may be physical barriers, such as living far from your doctor or pharmacy. Or your child may have emotional barriers, such as having undiscussed fears about the condition or unrealistic expectations. Talk with the doctor about your child's barriers, and work to find solutions.
• Set goals that relate to your child's quality of life. Being able to measure success gives your child greater motivation to follow asthma plans consistently. Decide together what you want to be able to do. Have symptom-free nights? Be able to exercise on a regular basis? Feel secure in knowing you both can deal with an asthma attack? Work with your doctor to make sure your child's goals are realistic and your child knows how to reach them.

In general your child's asthma treatment will consist of the following:

• Seeing your child's doctor regularly to monitor the asthma. The frequency of checkups depends on how your child's asthma is classified. Doctors recommend checkups about every 6 to 12 months for intermittent or mild persistent asthma that has been under control for at least 3 months, every 3 to 4 months for moderate persistent asthma, and every 1 to 2 months for uncontrolled or severe persistent asthma. Bring your asthma plan to each appointment.
• Following your child's asthma action plan. The plan helps you minimize the long-term effects of asthma and describes which medicines to take every day. The action plan also contains the steps to handle asthma attacks at home. It helps you better control your child's asthma attacks by being aware of symptoms and knowing how to make quick decisions about medicines and treatment. See an example of an asthma action plan (What is a PDF document?). Your child also may have an asthma diary where you or your child records peak expiratory flows, symptoms, and triggers of asthma attacks. This valuable tool can help your doctor manage your child's asthma.

For more information on how to monitor and treat asthma, see:

Asthma: Taking charge of your asthma.

Asthma: Using an asthma action plan.

To effectively manage your child's asthma and use his or her asthma action plan, you will have to know how to monitor peak airflow and identify asthma triggers and see that your child takes his or her asthma medicine correctly.

Monitoring peak expiratory flow

It is easy to underestimate the severity of asthma symptoms. You and your child may not notice symptoms until your child's lungs are functioning at 50% of their personal best measurement. Measuring peak expiratory flow (PEF) is a way to keep track of asthma symptoms at home and to know when your child's lung function is getting worse before it drops to a dangerously low level. You can do this with a peak flow meter. This test can easily be done (with practice) by most children age 5 and older. For more information, see:

Asthma: Measuring peak flow.

Identifying asthma triggers

A trigger is anything that can lead to an asthma attack. A trigger can be:

• Irritants in the air, such as tobacco smoke or air pollution.
• Substances to which your child is allergic (allergens), such as pollen or animal dander.
• Other factors, such as a viral infection, exercise, stress, or dry, cold air.

If your child can avoid triggers, he or she may reduce the chance of having an asthma attack. And, in the case of allergens, avoiding triggers will help control inflammation in the bronchial tubes. For more information, see:

Asthma: Identifying your triggers.

If your child has asthma triggered by an allergen, taking antihistamine medicine may help him or her manage the allergy and thus limit its effect on asthma.

Taking asthma medicine

Taking medicines is an important part of asthma treatment. But because your child may need to take more than one medicine, it can be hard to remember to take them. To help you and your child remember, understand the reasons people don't take their asthma medicines. And then find ways to overcome those obstacles, such as taping notes on the bathroom mirror.

Most medicines for asthma are inhaled. With inhaled medicines, a specific dose of the medicine can be given directly to the bronchial tubes, avoiding or decreasing the effects of the medicine on the rest of the body. Delivery systems for inhaled medicines include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler (MDI) is used most often.

Many doctors recommend that every child who uses a metered-dose inhaler (MDI) also use a spacer, which is attached to the MDI. A spacer may deliver the medicine to your child's lungs better than an inhaler alone. And for many people, a spacer is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and result in less use of oral corticosteroids.

If your child is younger than 3, he or she may not be able to use an MDI alone but, with assistance, may be able to use an MDI with a mask spacer. Most school-age children can use an MDI. If your child is having a hard time using an MDI with a spacer, he or she can use a nebulizer. Work with your doctor to find the best delivery system for your child.

It is important to keep track of the inhaler doses and discard the inhaler when your child has used the number of doses indicated on the package labeling. This not only prevents your child from having an empty inhaler when he or she might need medicine, but it also prevents your child from inhaling only propellant after the medicine has run out. For more information, see:

Asthma: Using a metered-dose inhaler.

Asthma in children: Helping a child use a metered-dose inhaler and mask spacer.

Asthma: Using a dry powder inhaler.

More tips for managing your child's asthma

To manage your child's asthma:

• Maintain a daily routine. Make treatment part of normal, daily activities to help your child adjust to the condition and take responsibility for managing treatment. Your child could, for example, get used to taking medicine before brushing his or her teeth.
• Check your child's symptoms. If your child is old enough to understand the process, teach him or her what symptoms to watch for and how to check the peak expiratory flow. Help your child understand how to follow his or her asthma action plan.
• Inform others in your child's life about asthma. Inform the principal, school nurse, teachers, and coaches at your child's school that your child has asthma. Give the staff a copy of your child's asthma action plan so that they can help your child to take his or her medicine and will know what to do during an asthma attack. Encourage your child to participate in exercise and sports. Asthma, when well controlled, should not prevent your child from participating in sports and other physical activities.

It is important to treat your child's asthma attacks quickly. If your child does not improve soon after treating an attack, talk with a doctor.

• During attacks, stay calm and soothe your child. This may help your child relax and breathe more easily.
• Don't underestimate or overestimate how severe your child's asthma is. It is often hard to know how much breathing difficulty a baby or small child is having. Seek medical care early for babies and small children with asthma symptoms.

Medications

Medicine does not cure asthma. But it is an important part of managing the condition. Medicines for asthma treatment are used to:

• Prevent and control the airway inflammation to minimize long-term lung damage.
• Decrease the severity, frequency, and duration of asthma attacks.
• Treat the attacks as they occur.

Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks. Most children with persistent asthma need to use long-term medicines daily. Quick-relief medicines are used as needed and provide rapid relief of symptoms during asthma attacks.

Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, different medicines and doses of medicines may be used. Special consideration may be necessary before and during exercise and before surgery.

Medicine delivery

Most medicines for asthma are inhaled. Inhaled medicines are used because a specific dose of the medicine can be given directly to the bronchial tubes. Different types of delivery systems may be used to do this, and one type may be more suitable for certain people or age groups than another. Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.

Many doctors recommend that every child who uses a metered-dose inhaler (MDI) also use a spacer, which is attached to the MDI. A spacer may deliver the medicine to your child's lungs better than an inhaler alone. And for many people a spacer is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and result in less use of oral corticosteroids.

If your child is younger than 3, he or she may not be able to use an MDI alone but, with assistance, may be able to use an MDI with a mask spacer. Most school-age children can use an MDI. If your child is having a hard time using an MDI with a spacer, he or she can use a nebulizer. Work with your doctor to find the best delivery system for your child.

It is important to keep track of the inhaler doses and discard the inhaler when your child has used the number of doses shown on the package label. This not only prevents your child from having an empty inhaler when he or she might need medicine, but it also prevents your child from inhaling only propellant after the medicine has run out. Some newer inhalers have built-in counters to keep track of doses left. For more information on using an inhaler, see:

Asthma: Using a metered-dose inhaler.

Asthma in children: Helping a child use a metered-dose inhaler and mask spacer.

Asthma: Using a dry powder inhaler.

Medication choices

The most important asthma medicines are:

• Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. They reduce inflammation of your child's airways and are taken every day to keep asthma under control and to prevent sudden and severe symptoms (asthma attacks). Inhaled corticosteroids include beclomethasone, triamcinolone, fluticasone, budesonide, and flunisolide.
• Oral or injected corticosteroids (systemic corticosteroids) to get your child's asthma under control before he or she starts taking daily medicine. Your child may also need these medicines to treat asthma attacks. Oral corticosteroids include prednisone and dexamethasone.
• Short-acting beta2-agonists for asthma attacks. They relax the airways, allowing your child to breathe easier. These medicines include albuterol and pirbuterol.

Long-term medicines sometimes used alone or with other medicines for daily treatment include:

• Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
• Long-acting beta2-agonists (such as salmeterol and formoterol). They are always used with an inhaled corticosteroid.
• Less commonly, your doctor may recommend a mast cell stabilizer (such as cromolyn) or theophylline (such as Uniphyl).

Other medicines may be given in some cases.

• Anticholinergics (such as ipratropium) are usually used for severe asthma attacks.
• Other medicine such as omalizumab or magnesium sulfate may be used if asthma does not improve with treatment. An asthma specialist generally prescribes this medicine.

Medicine treatment for asthma depends on your child’s age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.

• Children up to age 4 are usually treated a little differently than those 5 to 11 years old.
• The least amount of medicine that controls your child’s symptoms is used.
• The amount of medicine and number of medicines are increased in steps. So if your child’s asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
• If your child’s asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control your child’s asthma.
• Quick-relief medicine is used to treat asthma attacks. But if your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.

Your child’s doctor will work with you and your child to help find the number and dose of medicines that work best.

What to Think About

Medicines are usually added one at a time to keep the number of medicines low. The dosage of each medicine should correspond to the severity of the child's asthma. In general, your doctor will start your child at a higher dose within an asthma classification so that the inflammation is immediately controlled. After symptoms have been under control for a period of time, the dose of the last medicine added may be reduced to the lowest possible dose for maintenance. This is known as step-down care. Step-down care is believed to be a better way to control inflammation in the bronchial tubes than starting at lower doses of medicine and increasing the medicine if the dose is not enough.

Because quick-relief medicine quickly reduces symptoms, children sometimes overuse these medicines instead of adding the slower-acting, long-term medicines. But overuse of quick-relief medicines may have harmful effects, such as decreasing the future effectiveness of these medicines.²⁴ Overuse of quick-relief medicine is also an indication that asthma symptoms are not being controlled. You should talk with your doctor immediately.

Research indicates that the most important factor in reducing the severity and length of an asthma attack in children is giving a corticosteroid pill early in a severe attack. The corticosteroid pill works best when it is given at the first sign of symptoms.²⁵ If your child needs oral corticosteroid according to his or her action plan, you should start that treatment right away.

There has been some worry that children who use inhaled corticosteroids may not grow as tall as other children. In the studies done so far, there was a very small difference in height and growth in children using inhaled corticosteroids compared to children not using them. When these children stopped using inhaled corticosteroids, their growth increased. It is expected that even though using inhaled corticosteroids may slow growth at first, children will still grow to a normal height.^{26, 27} But no study has gone on long enough for experts to be sure. The difference in height is very small and this effect is rare. But children using inhaled corticosteroids should have their height checked once or twice a year.

Your child may have to take more than one medicine daily to manage his or her asthma. It can be difficult to remember when your child needs to take medicine and which medicine to take. To help you and your child remember, understand the reasons people don't take their asthma medicines, and then find ways to overcome those obstacles, such as taping notes to the refrigerator.

Some children only have symptoms during certain times of the year (seasonal asthma). If you know when your child will most likely have symptoms, your doctor may have him or her start using a medicine to decrease inflammation before the symptoms start.

Try to avoid giving your child an inhaled medicine when he or she is crying, because not as much medicine is delivered to the lungs.

Other Treatment

Allergy shots (immunotherapy) may be recommended for children who have asthma symptoms when they are around substances to which they are allergic (allergens). Allergy shots have been shown to reduce asthma symptoms and the need for medicines in some people.²⁸ But allergy shots are not equally effective for all allergens. Allergy shots should not be given when asthma is poorly controlled. For more information, see:

Should I take allergy shots (immunotherapy) for allergic rhinitis and allergic asthma?

Allergy shots are similar to vaccinations because they contain small doses of one or more substances to which your child is allergic so that the body can become less responsive to them over time.

Research has shown that (in addition to taking medicine) family therapy, such as counseling, may be helpful to children who have asthma.²⁹ In one small study, peak expiratory flow and daytime wheezing improved in children who had therapy compared with those who didn't. Another small study found that children showed overall improvement from therapy.

A review of complementary and alternative treatments for treating asthma in children concluded that none have been proved to improve asthma symptoms and some may have harmful side effects.³⁰ The therapies reviewed included:

• Herbal products such as ivy leaf, butterbur, and Tylophora indica (T. indica).
• Dietary supplements such as fatty acids and probiotics.
• Homeopathy.
• Procedures such as acupuncture, massage therapy, chiropractic, osteopathy, hypnosis, and biofeedback.

Talk to your doctor before your child tries a complementary or alternative treatment.

Other Places To Get Help

Organizations

Related Information

• Allergic Rhinitis
• Asthma in Teens and Adults
• Atopic Dermatitis

References

Citations

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2. McGeady SJ (2004). Immunocompetence and allergy. Pediatrics, 113(4): 1107–1113.
3. Jarjour NN, Kelly EAB (2002). Pathogenesis of asthma. Medical Clinics of North America, 86(3): 926–936.
4. Martinez FD (2002). Development of wheezing disorders and asthma in preschool children. Pediatrics, 109(2): 362–367.
5. Rodriguez MA, et al. (2002). Identification of population subgroups of children and adolescents with high asthma prevalence: Findings from the third National Health and Nutrition Examination. Archives of Pediatrics and Adolescent Medicine, 156(3): 269–275.
6. Eichenfield LF, et al. (2003). Atopic dermatitis and asthma: Parallels in the evolution of treatment. Pediatrics, 111(3): 608–616.
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8. Gilliland FD, et al. (2006). Regular smoking and asthma incidence in adolescents. American Journal of Respiratory and Critical Care Medicine, 174(10): 1094–1100.
9. Etzel RA (2003). How environmental exposures influence the development and exacerbation of asthma. Pediatrics, 112(1): 233–239.
10. Oddy WH (2004). A review of the effects of breastfeeding on respiratory infections, atopy, and childhood asthma. Journal of Asthma, 41(6): 605–621.
11. Kull I (2004). Breast-feeding reduces the risk of asthma during the first 4 years of life. Journal of Allergy and Clinical Immunology, 114(4): 755–760.
12. Sears MR, et al. (2002). Long-term relation between breast-feeding and development of atopy and asthma in children and young adults: A longitudinal study. Lancet, 360(9337): 901–907.
13. Burgess SW, et al. (2006). Breastfeeding does not increase the risk of asthma at 14 years. Pediatrics, 117(4): 787–792.
14. Kramer MS, et al. (2007). Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: Cluster randomised trial. BMJ. Published online September 11, 2007 (doi: 10.1136/bmj.39304.464016.AE).
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16. Ownby DR, et al. (2002). Exposure to dogs and cats in the first year of life and risk of allergic sensitization at 6 to 7 years of age. JAMA, 288(8): 963–972.
17. Sutherland ER, Martin RJ (2002). Is infection important in the pathogenesis and clinical expression of asthma? In SL Johnston, ST Holgate, eds., Asthma: Critical Debates, pp. 69–84. London: Blackwell Science.
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19. Szefler SJ, et al. (2008). Management of asthma based on exhaled nitric acid in addition to guideline-based treatment for inner-city adolescents and young adults: A randomised controlled trial. Lancet, 372(9643): 1065–1072.
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21. National Institutes of Health (2007). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08–5846). Available online: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.
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25. Rachelefsky G (2003). Treating exacerbations of asthma in children: The role of systemic corticosteroids. Pediatrics, 112(2): 382–397.
26. Guilbert TW, et al. (2006). Long-term inhaled corticosteroids in preschool children at high risk for asthma. New England Journal of Medicine, 354(19): 1985–1997.
27. Childhood Asthma Management Program Research Group (2000). Long-term effects of budesonide or nedocromil in children with asthma. New England Journal of Medicine, 353(15): 1054–1063.
28. Abramson MJ, et al. (2003). Allergen immunotherapy for asthma. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.
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30. Bukutu C, et al. (2008). Asthma: A review of complementary and alternative therapies. Pediatrics in Review, 29(8): e44–e49.

Other Works Consulted

• Bisgaard H, et al. (2006). Intermittent inhaled corticosteroids in infants with episodic wheezing. New England Journal of Medicine, 354(19): 1998–2005.
• Gold DR, Fuhlbrigge AL (2006). Inhaled corticosteroids for young children with wheezing. Editorial. New England Journal of Medicine, 354(19): 2058–2060.
• Gotzsche PC, Johansen HK (2008). House dust mite control measures for asthma. Cochrane Database of Systematic Reviews (2).
• Joint Task Force on Practice Parameters (2005). Attaining optimal asthma control: A practice parameter. Journal of Allergy and Clinical Immunology, 116(5): S3–S11. Available online: http://www.jcaai.org/pp/Attaining_Optimal_Asthma_Control.pdf.

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