Asthma

Here at Children’s Hospital Boston, we specialize in innovative, family-centered care. From your first visit, you’ll work with a team of professionals who are committed to supporting all of your family’s physical and psychosocial needs. We understand that you want to learn more about your child’s asthma to keep him safe and healthy.

What is asthma?

Asthma is an inflammatory disease affecting the lungs and airways that can be triggered by allergens, cold air, respiratory infections, air pollution, airborne irritants, exercise and other factors.

Will my child be OK?

Almost all children with asthma live normal, active lives if they comply with specific medication regiments, and are vigilant about reducing their exposure to irritants and triggers of asthma.

Is it curable?

There is no cure for asthma, however it can be controlled using certain medications. Children with asthma can still participate in sports if they are properly treated.

What happens during an asthma attack?

• The lining of the airways become swollen and inflamed.
• The muscles that surround the airways tighten.
• The production of mucus is increased, leading to mucus plugs.
• The airways narrow, making it difficult for air to go in and out of your child's lungs.

What are the different levels of severity?

• step 1: mild intermittent asthma
  • symptoms less than two times a week
  • no problems between flare-ups
  • short flare-ups from a few hours to a few days
  • nighttime symptoms less than two times a month
• step 2: mild persistent
  • symptoms more than two times a week, but no more than one time per day
  • nighttime symptoms more than twice a month
• step 3: moderate persistent
  • symptoms every day
  • use rescue medication every day
  • nighttime symptoms more than once a week
• step 4: severe persistent
  • symptoms constantly
  • decrease in physical activity
  • frequent flare-ups
  • nighttime symptoms frequently

With proper management of the asthma, such as avoiding triggers, taking prescribed medications, monitoring for warning signs and knowing what to do during an asthma attack, most children can leady a healthy and active lifestyle.

How common is asthma?

• Asthma is the most common chronic condition among children in the United States.
• At least 6.5 million children in the United States have asthma.
• Asthma is the third most common cause of childhood hospitalizations under the age of 15.
• More than 200,000 children with asthma experience symptoms that are more severe due to exposure to secondhand smoke.

Who is at risk for developing asthma?

• children who have respiratory or food allergies
• children with a family history of asthma
• children with a history of eczema
• boys are at higher risk because they have smaller airways than girls
• children who are exposed to irritants such as secondhand cigarette smoke
• African-American children

According to Centers for Disease Control and Prevention, African American children had the greatest increase in prevalence of pediatric asthma from 2001 to 2009, rising 50 percent.

Signs and symptoms

What are symptoms of asthma?

• cough or change in breathing
• shortness of breath during exercise
• frequent cough at night
• cough with laughter
• “colds” that persist for more than 2 weeks
• tightness in the chest
• wheezing
• lower peak flow numbers
• fatigue
• trouble sleeping
• dark circles under the eyes
• chin or throat itchiness
• anxiety

Some of these symptoms are also symptoms of heart failure, bronchitis and dysfunction of the vocal cords. Be sure to consult with a doctor for an accurate diagnosis.

Triggers of asthma

What triggers asthma?

Asthma and allergies are separate, but related conditions. About 80 percent of children with asthma also have allergies. Allergic reactions can make asthma worse by increasing the swelling in a child’s airways.

In addition to allergies, other triggers of asthma are:

• upper respiratory infections, colds and sinusitis: Infections can cause irritation of the airways, nose, throat, lungs and sinuses and worsens asthma.
• airborne irritants that irritate the nose, throat or airways such as
  • secondhand cigarette smoke
  • air pollution
  • pollen
• cold air
• physical expressions of emotion, such as crying, laughing or yelling
• emotional anxiety and nervous stress: Stress and anxiety can cause fatigue, which may affect the immune system and, in turn, bring on an attack.
• strong smells
• colds or other respiratory illnesses
• chemicals
• weather conditions
• pet dander
• dust mites
• mold and mildew
• cockroaches
• exercise:  Strenuous activities, such as running especially in cold or dry weather, are most likely to induce asthma. Swimming is the least likely.
• gastroesophageal reflux (GER), or acid reflux: Your child may experience heartburn, coughing, belching or spitting up.
• sensitivity to medications, such as aspirin, ibuprofen, indomethacin and naproxen
• sulfites used as preservatives in food and drinks

  Anxiety and asthma
  Asthma and anxiety are interconnected conditions. Your child may experience anxiety from the stress of managing asthma, and anxiety can contribute to asthma. For the visual learners out there, watch as Stuart Goldman, MD, Co-Director, Mood Disorder Program, literally draws a picture to explain anxiety and discuss how to manage it in Children’s  Pediatric Playbook.

FAQ

Q: What exactly is asthma?
A:Asthma is an inflammatory disease affecting the lungs and airways that can be triggered by allergens, cold air,respiratory infections, airborne irritants, exercise and other factors.

Q: What is an asthma “attack?”
A: An asthma attack is the body’s overreaction to an infection or to an irritant, such as second-hand smoke or an allergen. When an asthma attack occurs, the lining of the airways might become swollen and inflamed, the muscles that surround the airways might tighten and the production of mucus might increase, leading to mucus plugs, or the airways might narrow, making it difficult for air to get in and out of your child's lungs.

Q: What causes a child to have asthma?
A: There are many triggers of asthma, including allergies, cold air, upper respiratory infections, secondhand cigarette smoke and several other triggers. Exposure to allergens can trigger asthma symptoms in 70-80 percent of children with asthma.

Q: How serious is it?
A: An asthma attack can affect your child’s breathing, so it should be taken very seriously. However, if your child takes the proper medication and avoid irritants, he should still be able to take part in sports and other physical activities, and lead a healthy, normal life.

Q: What is treatment like?
A: Treatment options can usually be self-administered, and do not require hospitalization if administered correctly as recommended by a doctor or nurse practitioner. There is no cure for asthma, so your child may have to continue treatment for the rest of his life.

Q: Will my child ever outgrow asthma?                                          
A:For many children, asthma improves during their teenage years. For others, symptoms become more severe over time. About half of the children who have asthma at a young age appear to "outgrow" it, although symptoms may reappear later in life.

Q: Is there a cure for asthma?                                                                       
A:Currently there is no cure for asthma, but it can be controlled and managed with proper use of medication and vigilantly avoiding irritants.

Q: What is the connection between asthma and allergies?

A:Asthma and allergies are separate, but related conditions. About 80 percent of children with asthma have allergies. Allergies can make asthma worse by increasing the swelling in the child’s airways.

Q: If my child has asthma, are sports still safe?                                 
A:Exercise, such as running, may trigger an asthma attack, but aerobic exercise actually improves airway function by strengthening breathing muscles. With proper management, an adolescent with asthma can maintain full participation in most sports.

Q:How can I tell if my child needs emergency treatment?                                           
A:You should seek emergency treatment immediately if your child experiences any of the following:

• severe coughing
• shortness of breath
• difficulty talking
• breathing hard and fast
• nasal flaring
• hunched shoulders
• tightening in the chest and/or wheezing
• chest and neck muscles pull in when your child breathes
• lips or fingernails turn gray or blue

Questions to ask your doctor

After your child is diagnosed with asthma, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you.

Lots of parents find it helpful to jot down questions as they arise- that way, when you talk to your child’s doctors you can be sure that all of your questions are concerned. If your child is old enough, you may want to suggest that she writes down what he wants to ask her health care provider too.

Here are some questions to get you started:

• How did you arrive at this diagnosis?
• How could allergy medicines impact my child’s life, including academic performance?
• How could asthma medication interact with my child’s current medication regiments?
• Are there any dietary restrictions my child needs to follow while on asthma medications?
• What treatments and medications are covered by my insurer?
• What are some things I can do to minimize my child’s exposure to asthma triggers at home?
• How can I find out if any of the products, substances and foods around the house triggers my child’s asthma?
• How may asthma impact my child’s social life?
• What resources are available to help my child cope with stress of having asthma?
• How should I talk to my child about his asthma?
• How can you coordinate with my child’s school nurse to continue care at school?

  Children’s teams up with Kohl’s to help families manage asthma

  The Health Family Fun website is a project of Children’s Hospital Boston and Kohl’s Department Stores providing families with information on how to help their children with asthma to live healthy, active lives. Launched in May 2010, the Healthy Family Fun campaign recently expanded to Boston’s Jamaica Plain, Roxbury and Mission Hill neighborhoods in April, 2011. Learn more about the Healthy Family Fun website Neither Children’s Hospital Boston or the Asthma Program at Children’s unreservedly endorses the information found at other websites mentioned on our Web pages.