Community Asthma Initiative

A: Asthma is a chronic lung disease characterized by inflammation and spasm of the airways. This causes breathing problems such as coughing, wheezing and shortness of breath. Asthma can be triggered by environmental factors, infections, allergies, exercise, temperature changes or other airway irritants.

Q: What causes childhood asthma?

A: The majority of children with asthma have allergies, such as allergies to mold, pollen, dust, dust mites, pet fur or feathers and rodents and cockroaches. Even exposure to low-grade allergens (those that do not cause significant allergic reactions) may increase the severity of the asthma. In addition, allergies may play a role in undiagnosed asthma cases.

Not all children with asthma, however, have allergies. They can have other asthma triggers that may include the following:

• environmental factors like cleaning products and strong odors
• exercise
• upper respiratory infections (i.e., colds)
• inhaled irritants, such as secondhand smoke
• temperature changes and certain weather conditions, such as cold air
• physical expressions of emotion, such as crying, laughing or yelling

However, 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, an individual with asthma can conduct a healthy and active lifestyle.

Q: What are the symptoms of asthma?

A: Common asthma symptoms include:

• coughing (for some children coughing is the only symptom)
• shortness of breath
• tightness in the chest
• wheezing

Asthma symptoms signal that an asthma episode is occurring. Action should be taken to treat these symptoms before they get worse. Follow your asthma management plan or call your child's doctor or nurse with any questions.

Q: What are the early warning signs of asthma?

A: Some early clues that asthma may be developing are:

• breathing changes or cough
• feeling tired
• trouble sleeping
• less energy for exercise
• chin or throat itchiness
• lower peak flow numbers

Each person's symptoms are different, but do not ignore the early warning signs of asthma. Early warning signs are important to learn about and watch for so you know that an asthma episode may be developing.

Q: What are the different levels of asthma?

As determined by the National Institutes of Health (NIH), the following is a guideline used by physicians to help determine the extent of asthma in your child. It is classified as "steps," because each child may step up or step down to different levels at any time.

The steps are as follows:

• Step 1 or mild intermittent asthma - This group of children has symptoms less than two times a week, does not have problems in-between flare-ups and only has short flare-ups from a few hours to a few days. Nighttime symptoms occur less than two times a month.
• Step 2 or mild persistent - This group of children has symptoms more than two times a week, but no more than one time per day and may have activity levels affected by the flare-ups. Nighttime symptoms occur greater than two times a month.
• Step 3 or moderate persistent - This group of children has symptoms every day, use their rescue medication every day, may have activity levels affected by the flare-ups and have exacerbations greater than or equal to two times a week. Nighttime symptoms occur greater than one time a week.

• Step 4 or severe persistent - This group of children has symptoms constantly, have a decrease in their physical activity and have frequent flare-ups. Nighttime symptoms occur frequently.

A: Severe asthma symptoms require immediate attention and can be a life threatening emergency. You should seek emergency treatment immediately.

Some examples of severe symptoms are:

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

Q: Who is at risk for developing asthma?

A: Although anyone may have asthma, it most commonly occurs in:

• children by the age of five
• children with a family history of asthma
• children who have allergies
• children who have exposure to secondhand tobacco smoke

Q: What happens during an asthma attack or asthma exacerbation?

A: Children with asthma have acute episodes when the air passages in their lungs become narrower and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways.

The lungs and airways overreact to certain triggers causing:

• the lining of the airways to become inflamed and swollen
• tightening of the muscles that surround the airways
• an increased production of mucus
• breathing to become harder and may hurt

If a child does not receive treatment immediately during an asthma attack, respiratory failure may occur.

Q: How is asthma diagnosed?

A: To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, physical examination and laboratory tests, which may include:

• peak flow monitoring (PFM) - a device used to measure the amount of air a person can blow out of the lungs. During an asthma or other respiratory flare up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.
• allergy tests

A: Some triggers can include:

• cigarette smoke
• mold
• rodents and cockroaches
• colds and flu
• dust and dust mites
• strong odors
• cleaning products
• pollen
• pets with fur or feathers
• exercise
• cold air and changes in weather

A: How asthma will affect a child throughout their lifetime varies, depending on the child. For some children, asthma improves during the teenage years, while others have symptoms that become more severe over time. About one-third of children with asthma will outgrow it and about one-third of children with asthma will have fewer episodes as they get older.

Q: If my child has asthma, can they participate in sports?

A: Exercise, such as running, may trigger an asthma attack in the majority of children and teens with asthma. However, with proper management, your child with asthma can maintain full participation in most sports. Aerobic exercise actually improves airway function by strengthening breathing muscles.

Some tips for exercising with asthma include the following:

• Make sure your child stretches before and after exercising, breathing through the nose and not the mouth to warm and humidify the air before it enters the airways.
• Make sure your child is compliant with all medication before exercising, as recommended by their physician.
• Make sure your child carries a "reliever" or "reserve" medications, just in case of an asthma attack.
• During cold weather, make sure your child wears a scarf over the mouth and nose, so that the air breathed in is warm and easier to inhale.

Q: How can my child control their asthma at school?

A: Some children with asthma may need to take their medications during school hours. It is important that the child, family, physician and school staff all work together toward meeting the asthma treatment goals.

To ensure optimal asthma care during school hours, the American Academy of Allergy, Asthma, and Immunology recommends the following:

• Meet with teachers, the school nurse and other relevant school staff to inform them about your child's condition and special needs.
• Provide the school nurse with a copy of your child's Asthma Action Plan to be put on file. This will explain what steps should be taken if your the child has an asthma attack in school.
• Educate school personnel on your child's asthma medications and how to assist during an asthma attack.
• Ask school staff to treat your child "normally" when the asthma is under control.
• Before your child starts a physical education class or team sport, educate that teacher or coach on exercise-induced asthma.
• Check indoor air quality, allergens, and irritants in the school.
• Take steps to prevent asthma symptoms from starting that could hamper your child's energy level.
• Ensure your child's emotional well-being by reassuring him/her that asthma does not have to slow him/her down or make him/her different from others.

A: It is very important to be honest with your child about their condition, the severity of the condition and the use of medications. Always remember that achieving independence is an important goal for a child. They do not want to be different, yet they will need guidance and supervision on any restrictions they might have. An Asthma Action Plan created by your child's health care provider will help you control your child's asthma.

By age:

Toddlers - This age group relies completely on the parents. They understand little about the disease. The most important factor with this age group is to try to make medication time a fun one, while stressing the importance of taking the medications. Let them assist in any way possible.

School-aged - This group has an increased ability to understand their disease and its impact. They should be taught about their medications, how to exercise restriction and how to avoid their triggers. They should be allowed to play with peers and monitor their own symptoms.

Adolescents - Generally, adolescents resist having to take chronic medications, do not like having restrictions on their life and do not want to be different. It is crucial to involve your adolescent in every aspect of the management of their asthma. They should help with goal setting and help decide which medications work best for them. Asthma "contracts" can be given to your adolescent child in order that they may have some control of their asthma, yet continue to allow overall parental supervision of their condition.

Having asthma does not have to mean having less fun than other adolescents. It is important for your adolescent child to tell their friends and dates what triggers the asthma, such as cigarette smoke or even perfumes or after-shaves, depending on their sensitivity.

In addition, your adolescent child should continue taking the asthma medication as prescribed. If your adolescent child has exercise-induced asthma, they may need to take a preventive medicine before participating in any physical activities, such as dancing. Always consult your child's physician if you have questions.