Childhood Asthma

Asthma is the most common chronic condition in children. Childhood asthma is a type of asthma where symptoms start during childhood. Allergies, viral infections, or other exposures can trigger symptoms.¹

Children with asthma face unique challenges. For example, asthma may interrupt school and other activities. Symptoms often continue into adulthood. But treatments can control symptoms and prevent complications. Talk to your doctor if you notice any symptoms of asthma in your child.

What are symptoms of pediatric/childhood asthma?

Most children with asthma show symptoms before 5 years old. Common symptoms include:²

• Coughing that worsens during infections, sleep, exercise, or cold air
• Wheezing
• Shortness of breath
• Chest congestion or tightness

Your child may have 1 symptom or several. You may notice they have difficulty sleeping because of symptoms. This can lead to fatigue during the day and interfere with school and activities.^2,3

Symptoms are similar to other breathing conditions. Recurring symptoms may distinguish asthma from these conditions. Take your child to a doctor if you notice recurring asthma symptoms. Early diagnosis and treatment can help prevent complications, including:²

• Asthma attacks that require emergency treatment
• Permanent decline in lung function
• Worse academic performance
• Interference with sports and other activities

What causes childhood asthma?

We do not know exactly what causes certain children to have asthma. Some possible risk factors include:²

• Other allergic conditions
• Other conditions, such as obesity and gastroesophageal reflux disease (GERD)
• Family history of asthma
• Viral infections during infancy
• Exposure to environmental factors, such as cigarette smoke and air pollution

Asthma symptoms happen when an immune reaction causes the airways to narrow. Certain environmental exposures can trigger this immune reaction, such as:²

• Viral infections, such as a common cold
• Air pollution
• Allergens, such as dust mites, pet dander, pollen, insects, rodents, and mold
• Physical activity
• Weather changes

It can be hard to identify what triggers your child’s asthma symptoms. Symptoms may also happen without any obvious triggers.

How is childhood asthma diagnosed?

Symptoms

Your doctor will first ask about breathing symptoms. The pattern of symptoms helps distinguish asthma from other conditions. So your doctor may ask how symptoms vary over time or after certain exposures.⁴

Family history and physical exam

If your child’s symptoms are typical of asthma, your doctor will ask about risk factors. Children with other allergic conditions (eczema, hay fever/allergic rhinitis, or food allergies) are more likely to have asthma. Family of history of allergic disease also increases the risk of asthma.⁴

Your doctor may also perform a physical exam. They will listen to your child’s lungs, examine their skin, and look into their nose.⁴

Lung function tests

If risk factors and physical exams support an asthma diagnosis, your doctor will perform lung function tests. However, these tests are not accurate for children under 5 years old because they are usually unable to perform them. Lung function tests include:^2,4

• Spirometry to see how much air your child can exhale over a few seconds
• Spirometry after taking a bronchodilator (an inhaled drug that widens the airways) to see if lung function improves
• Spirometry after certain inhalation challenges, such as exercise or methacholine (an inhaled drug that narrows the airways)
• Exhaled nitric oxide testing

Other tests

Doctors may diagnose young children only from symptoms and risk factors. Sometimes, they cannot confirm a diagnosis until months or years of observing symptoms. Other tests may help diagnose asthma in children under 5 years old, such as:^4,5

• Trying an asthma medicine for 2 to 3 months to see if symptoms improve
• Testing for allergies
• Chest X-rays

How is childhood asthma treated?

The goals of childhood asthma treatment are to:^2,4

• Control symptoms
• Maintain normal activity levels
• Reduce the risk of long-term complications
• Reduce side effects from asthma drugs

Avoiding asthma triggers is an important way to achieve these goals. This can prevent asthma attacks and reduce the need for asthma drugs. Maintaining a healthy weight and controlling other conditions can help.²

Asthma drug types

Long-term asthma control drugs work in different ways to manage symptoms. These drugs are usually taken daily. The right medicine for your child depends on age, symptoms, and other personal factors. Some types include:^2,4

• Inhaled corticosteroids
• Leukotriene modifiers
• Combination of inhaled steroids and long-acting beta agonists (LABAs)
• Theophylline

Quick-relief drugs provide short-term relief during an asthma attack. These drugs include short-acting beta agonists (SABAs).^2,4

Severe asthma flares may be treated with oral or intravenous (IV) steroids. They work to reduce inflammation. Since these drugs can have severe side effects, they are often reserved for significant symptoms that may worsen.^2,4

Stepwise approach

Your doctor will follow a stepwise approach to treating asthma. Your child may start by taking only quick-relief medicines as needed. If they use them too often or have symptoms despite treatment, they may then be prescribed daily inhaled steroids. If symptoms continue, your doctor may increase the dose or add a second medicine.⁴

If symptoms are well-controlled, your doctor may reduce medicines. This can help lower the risk of side effects. Long-term inhaled steroids may slightly slow growth in children. The benefits of controlling asthma outweigh these risks. However, finding the lowest dose can help minimize the risk.^4,5