For Parents of Young Children with Asthma

Different types of asthma | Treatments | Is your child's asthma getting worse? | Coping with childcare| What to do in an asthma attack? |The Five Minute Rule | What to do when a child with asthma joins your class?

A definitive diagnosis of asthma can be difficult to obtain in young children.

At least one child in five will have 'wheezing' at some point during their early years. Many of these children will not go on to have asthma in later childhood, so your doctor may not want to use the term 'asthma' at this stage.
Asthma can be difficult to diagnose in children under 5 years of age because tests of lung function which are key to diagnosis in older children and adults are not reliable in this age group. A peak flow meter is used for older children, but is unsuitable for children under the age of six.

The pattern of symptoms that develops over time shows whether a child has asthma or not. Your doctor may ask you to keep a record of your child's symptoms and when they happen. This will help the doctor, and you, to make a diagnosis.

If your child is under the age of two, it is even more difficult to tell if they have asthma. There are a number of different wheezing illnesses, including acute bronchiolitis, 'wheezy bronchitis', as well as asthma, which can make your baby wheezy. Also, some children wheeze after a chest infection such as bronchiolitis. They may or may not require treatment. However, if they are quite well they are known as 'Happy Wheezers'!

The typical symptoms of asthma in young children are:

  • Coughing, particularly at night and after exercise.
  • Wheezing or a whistling noise in the chest.
  • Getting short of breath - perhaps your child is not running around as much as usual, or needs to be carried more.

Different types of asthma

Doctors often use the words 'mild', 'moderate' and 'severe' to describe asthma. Below are some guidelines explaining what they mean.

Mild: Coughs and wheezes but plays happily and feeds well

Moderate: Waking at night, can't run around or play without coughing and wheezing

Severe: Too restless to sleep, unwilling to play at all, too breathless to talk or feed, lips may turn blue.

It is important to get control of your child's asthma as soon as it is diagnosed. This will help prevent symptoms and will help your child lead a full and active life. The following treatments are the main forms of asthma management: A pressurised metered dose inhaler with a volumatic spacer (Plus a face mask) is the preferred delivery system.

In most cases regular asthma treatment is done in a step-like way. The first step in treatment will be to use a "reliever" medicine that is used whenever the child needs it. Depending on the severity of your child's asthma, how well they respond to reliever medicines and how often they need to use them, the next step of treatment is to begin regular "preventer" medicine.

 Treatments

Relievers (Bronchodilators)
Relievers are medicines that children can take immediately when asthma symptoms appear. They quickly relax the muscles surrounding the narrowed airways. Relievers are also called bronchodilators. This allows the airways to open wider making it easier to breathe again. However, relievers do not reduce the swelling in the airways.

  • Relievers are essential in treating asthma attacks.
  • If taken before exercise they can reduce the chances of your child getting wheezy.
  • Relievers usually come in blue inhalers.
  • Salbutamol and terbutaline are two examples of relievers. Ipratropium bromide is a different type of reliever medicine. It is most commonly used in children under one.

Not all relievers work well for all children under one year old. Your doctor will probably try different relievers to find one that works best for your child.
Relievers are an effective medicine and have few side effects if taken as prescribed. They can make your child excitable and may increase the heart rate, but this is usually when relievers are given in high doses or is your child shows a sensitivity to their particular inhaler. The side effects generally subside with time.

Preventers (Controllers)
Preventers are commonly referred to as the "brown inhaler". Preventers may be recommended if your child needs to use a reliever more than twice a week on a regular basis. Preventers help calm down the swelling in the airways and stop them from being so sensitive. This means the airways are less likely to react badly when they are exposed to an asthma trigger.
Preventers:

  • Reduce the risk of a severe asthma attack
  • Reduce asthma symptoms - improve quality of life.
  • The protective effect of a preventer builds up over a period of time so they need to be taken every day, usually morning and evening, even if your child is feeling well. When your child first starts using them it may take up to 14 days before you notice any improvement in asthma symptoms and several months before they reach their optimum effect.

The first choice of preventer is an inhaled steroid. There are several kinds of inhaled steroids but they all work in the same way; beclomethasone, budesonide and fluticasone are all examples.

Combination Inhalers

For some children a doctor may prescribe a combination inhaler that combines an inhaled steroid with a long-acting bronchodilator. These inhalers contain both an inhaled preventer (reduces inflammation) and a long acting reliever (keeps airways open) and are taken on a daily basis. Examples of combination inhalers are Seretide and Symbicort.

If an inhaled steroid alone does not control symptoms, an alternative preventer is a leukotriene modifier antagonist or 'LTRA', leukotriene receptor antagonist. An LTRA can be used as an alternative to inhaled steroids or when inhaled steroids cannot be used. LTRA medicines block the action of naturally occurring chemicals in the lungs called leukotrienes, which are known to cause narrowing of the airways and inflammation in the lungs which can lead to asthma symptoms. These medicines are available as tablets, chewable tablets (in some cases flavoured), and as granules which may be given with food for children as young as six months. This ensures that the child gets all of the medication in a way that is easy to take.

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Concerns about steroids
Some parents worry about giving their child steroids to treat their asthma. Here are some points to remember:

  • The steroids used to treat asthma are called corticosteroids.
  • Corticosteroids are similar to those produced naturally in our bodies.
  • They are completely different from the anabolic steroids used illegally by body builders and athletes.
  • Most children use inhaled steroids which go straight into the airways, so very little is absorbed into the rest of the body.
  • Your doctor will prescribe the lowest possible dose of inhaled steroids to get your child's asthma under control.
  • Low doses of inhaled steroids do not commonly cause serious side effects or affect growth.

When are steroid tablets used in asthma?
A short course of steroid tablets (usually 3-5 days) is sometimes needed to treat an acute severe asthma attack. They are very effective at bringing severe asthma symptoms under control quickly.

Steroid tablets can lower the body's resistance to chickenpox. If your child has had a course of steroid tablets in the last month and is in contact with chickenpox, go and see your doctor. Talk to your doctor or practice nurse about any concerns you have about the side effects of your asthma treatment.

Learn more about the triggers of asthma in children.

Is your childs asthma getting worse?
The following signs could mean your child's asthma is getting worse.

  • Wheezing and coughing first thing in the morning.
  • Increased wheezing and coughing after exercise, or doing less exercise.
  • Waking at night with a cough or wheeze.
  • Needing more and more reliever medicine with less and less effect.

Your doctor or practice nurse can draw up an asthma management plan for you. It will explain when to use the preventer and reliever and what to do if your child's symptoms get worse.

Coping with childcare

Finding the right childcare can be difficult, especially for parents of children with asthma. Whatever sort of childcare you arrange for your child, it is important to make sure the child care worker understands about your child's asthma.
Think about the following:

  • Will anyone be smoking around your child?
  • Are there any pets around?
  • Will your child's carers give your child medication if necessary? If so, will they understand when and how to use it?
  • Does your child's carer know how to recognise and deal with an emergency?
  • Can they contact you quickly at all times?

Make sure you leave clear written instructions for carers. You can give them a copy of your child's asthma management plan available from the Asthma Society of Ireland. This will show them which medicines your child needs to take, when to give them and what to do in an emergency.

What to do in an asthma attack?

Occasionally an asthma attack may occur no matter how careful you are about taking your asthma treatment and avoiding triggers. An asthma attack normally doesn't occur suddenly; most people find that asthma attacks are the result of a gradual worsening of symptoms over a few days. If your symptoms are getting worse, do not ignore them. Quite often using your reliever may be all that is needed to get your asthma under control again. At other times symptoms are more severe and more urgent action is required.

The Five Minute Rule

The Five Minute Rule contains the recommended steps to follow in an asthma attack

  1. Ensure the reliever inhaler is taken immediately. This is usually blue and opens up narrowed air passages.
  2. Sit down and loosen tight clothing.
  3. Stay calm. Attacks may be frightening and it is important to stay calm.
  4. If there is no immediate improvement continue to take the reliever inhaler every minute for five minutes or until symptoms improve: two puffs if MDI/evohaler or one puff if turbohaler.
  5. If symptoms do not improve in five minutes, or if you are in doubt, call 999 or a doctor urgently. Continue to give reliever inhaler until help arrives or symptoms improve.

Do not be afraid of causing a fuss, even at night.

If you are admitted to hospital or an accident and emergency department because of your asthma, take details of your treatment with you. Bring your asthma management plan if you have one to the hospital. You should also make an appointment with your doctor or nurse after you are discharged from hospital, so that you can review your asthma treatment to avoid the situation rising again.

What to do when a child with asthma joins your class?

If your school has an asthma guideline, ensure you are familiar with it, otherwise take the following steps:

  • Enquire from parents about their child's asthma control and current treatment. This information can be recorded on a school asthma record sheet.
  • Allow the child free access to their reliever medication: older children should be allowed to carry their relievers in their pocket and in the case of younger children the reliever should be kept in the classroom in an easily accessible location. Relievers should never be locked away.
  • Before exercise, remind the child to carry his/her medication. They may be shy about this, encourage positive attitudes towards pupils with medical conditions.
  • On school trips encourage the child to carry his/her medication at all times. Include this information on school circulars to parents.
  • Inform the child's parents if the child has an asthma exacerbation or uses their reliever medication.
  • If concerned about a child with "severe symptoms" e.g. missing school or tired in class secondary to disturbed sleep from coughing, speak with parents. Some children with severe asthma may require extra support due to days lost.

How to develop good school asthma management guidelines

Asthma in PE and school sports

How to cope at exam time

Back to School Advice for Students with Asthma

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Information provided by the Asthma Society of Ireland