Asthma in Children

What are the signs and symptoms of asthma in children?

The signs and symptoms of asthma in children include:

• Frequent cough
• Wheezing
• Difficulty breathing with exercise
• Coughing during the night
• Shortness of breath or difficulty breathing
• Frequent respiratory illnesses or pneumonia

If your child has any of these symptoms on a regular basis, you should see your healthcare provider.

Signs of an asthma attack that require immediate emergency care include:

• Difficulty breathing while walking or talking
• A change in skin, fingernail or lip color to gray or blue
• Inward movement of the muscles in the neck, chest or ribs or flaring of the nostrils
• Failure of medications to reverse or control worsening symptoms
• Declining peak flow meter readings in spite of medication use (Aa peak flow meter measures how fast a child can blow air out of their lungs)

How do we diagnose asthma?

To diagnose asthma in children, our pediatric asthma experts will ask questions about your child's symptoms, medical history and your family medical history, and then perform a physical exam. The most common test used to diagnose asthma is called spirometry. If your child has allergies, your healthcare provider may conduct allergy skin testing as well.

What tests are used to diagnose asthma in children?

Our pediatric asthma specialists use a variety of pulmonary function tests to diagnose and treat asthma in kids.

Spirometry for asthma testing in children

During a spirometry test, your child takes a deep breath and blows out the air as fast as possible. A child-friendly computer and our respiratory therapist coaches your child on how to do the test. This is a painless test that children find fun and provides valuable information for parents and the healthcare provider.

In general, children starting at age 5 can perform spirometry. The test results show the total volume of air they breathe out. This shows whether your child's flow of air from the large and small airways is normal. If the results are low, a provider may give your child an inhaled medication called albuterol. Then your child repeats the spirometry test 15 minutes later to see if the results improve. This test can help diagnose asthma as well as other lung conditions.

Exercise-induced bronchoconstriction (EIB) test and the methacholine challenge asthma testing

Depending on your child and their symptoms, our providers might use other tests to diagnose asthma, including the exercise-induced bronchoconstriction (EIB) test and the methacholine challenge.

• The EIB test is a series of spirometry tests kids perform before and after exercising on a treadmill. It measures airway reactivity to exercise.
• The methacholine challenge uses a gas called methacholine to determine airway reactivity. Your child breathes the gas and then does a series of spirometry tests.

How is asthma treated?

Asthma medications help relieve and prevent symptoms by decreasing inflammation and bronchoconstriction (swelling and spasm in the lungs). All medications may have side effects. Be aware of potential side effects and notify your child's healthcare provider if side effects develop. To effectively manage asthma, it is very important for your child to regularly take prescribed medications and take them as instructed by the doctor.

Asthma treatment options for kids

• Quick-relief medication provides fast relief of asthma symptoms like coughing, wheezing or difficulty breathing by relaxing the muscles in and around the airways. This type of medication is known as a bronchodilator.
• Controller medication is used on a daily basis to avoid asthma symptoms by preventing inflammation or swelling inside the airways. This medication is usually an inhaled corticosteroid. Another type of controller medication is combination therapy. This is a combination of an inhaled steroid and a long-acting bronchodilator medication. A controller medication will not provide quick-relief for asthma symptoms. Your child should not take it to relieve acute asthma symptoms.
• A steroid burst is a course of oral steroids, usually prescribed for a few days when a child is having an asthma exacerbation, to help relieve airway inflammation.
• An asthma action plan details the prescribed asthma controller medication, relief mediations, triggers to avoid and when to step up therapy. We provide asthma action plans at each clinic visit. Download an Asthma Action Plan in English (.pdf) or Asthma Action Plan in Spanish (.pdf) to help guide your child's asthma care.

How to use an inhaler

We have resources to help you and your child learn how to best use the inhaler your doctor prescribes, including videos and instructions on the following in both English and Spanish:

• How to use a Diskus inhaler
• How to use a Flexhaler
• How to use a metered dose inhaler (MDI)
• How to use a Pari nebulizer
• How to use a Twisthaler
• How to use an Acorn nebulizer
• How to use a peak flow meter

How to manage your child's asthma

• Allergies: Children with allergy-induced asthma should avoid the allergens that trigger their asthma when possible. Allergists can perform lab tests to help parents determine what environmental allergens their children should avoid. Minimizing your child's contact with these allergens will lower their risk for asthmatic reactions.
• Exercise: Exercise can also trigger asthma symptoms. Children with asthma symptoms triggered by exercise should remember to treat themselves with their quick-relief medication (bronchodilator) 15 minutes before exercise. Children with asthma should not have to limit their activity in any way. If your child is having trouble with exercise, you should see a doctor to adjust their asthma care.
• Preventing the flu: It is important for all children with asthma to receive a flu vaccine every fall. The flu can make a child with asthma very sick because the virus attacks the lungs and can cause breathing problems, making asthma worse.
• School/camp information: Make sure to share your child's asthma action plan with school and camp. This will help guide those caring for your child in case they have problems with their asthma.
• Tracking medication doses: It is important to keep track of how many doses of asthma medication remain in the device. For the medication devices that do not have a dose counter on them, mark the device with a piece of masking tape and keep track of how many doses you use. Also check medication expiration dates.
• Vacation planning: Your child should always have their quick-relief medication available in case they start wheezing, coughing persistently or have difficulty breathing. When planning for a vacation, remember to check that you will have enough controller medication to last throughout the trip, and that quick-relief medication (for example: albuterol) is easily accessible during travel.

Tips for organizing your child's asthma care

• Provide your child’s school with a school asthma action plan in case symptoms occur at school.
• Keep a copy of your child's asthma action plan at home in a visible place in the house, such as a refrigerator.
• Store all asthma medications and devices in one place, such as a duffle bag or plastic container. Make this storage container easily accessible for you and your child.
• Place a handout for cleaning asthma devices in a commonly used area, such as on the refrigerator, to help remind you about cleaning the devices on a regular basis.
• Coordinate taking controller medications before teeth-brushing in the morning and at night to reduce the chance of forgetting to take the medicine and decrease the possibility of thrush, a fungal infection, in and around the mouth.

Common asthma terms to know

Here are some asthma terms you may hear during a visit to Children's Colorado Asthma Program:

• Asthma exacerbation refers to a period in time when your child experiences asthma symptoms often during the day and night and needs quick-relief medication at least every four hours. Another name for this is an acute asthma attack.
• Bronchospasm is the tightening or spasm of the muscles around the airways, which makes them narrower and more difficult to get air into and out of the lungs.
• Inflammation is irritation, redness and swelling of the airways.
• A peak flow meter is a small device that shows how well your child is able to force air out of the lungs. Peak flow meter readings are specific to each child. They show how your child's asthma is doing on a day-to-day basis.
• A trigger is anything that causes your child to have asthma symptoms.
• Zones refer to your child's asthma action plan. There are green, yellow and red zones, which are categorized by symptoms and peak flow readings. This information helps your child’s healthcare provider determine how bad your child's asthma is at that time.

Why choose Children's Colorado for your child's asthma?

Our Asthma Program sees more children with asthma than any other hospital in Colorado. We provide comprehensive evaluation, asthma management, allergy testing and education. Our multidisciplinary team includes pulmonologists, allergists, nurse practitioners, physician assistants, registered nurses, respiratory therapists, a dietitian and a social worker. Many of our staff members are certified asthma educators.

At Children's Colorado, parents and families are valued members of their child's healthcare team. We take time to answer questions, address your concerns and provide the education and tools you need to manage your child's asthma on a day-to-day basis and during asthma attacks.

Helpful asthma resources

• Allergy and Asthma Network – Mothers of Asthmatics provides useful information about asthma to families and support for parents of children with asthma.
• American Lung Association provides information about all lung diseases, including asthma.
• American Academy of Allergy, Asthma and Immunology provides information about the relationship of allergies and asthma.
• If you or someone you know is a smoker and is considering quitting, try visiting Colorado QuitLine for ideas or assistance. Download the ONE Step brochure (.pdf) today for tips on how to quit smoking. You can also download the ONE Step brochure (.pdf) in Spanish.