Avoid common triggers to manage your child's asthma

Asthma is the most common chronic disease of childhood. An estimated six million children between ages 3 and 17 have the condition. While the number of asthma attacks in American children has been on the decline over the last 10 years, about half of children with asthma still have flare-ups every year. Here’s what parents need to know about childhood asthma, including how to avoid and manage potential triggers.

Asthma and its symptoms

Asthma is a persistent inflammatory condition in the tubes that carry air to the lungs. People with asthma have narrow, irritated, and inflamed airways, even when typical asthma symptoms aren’t present. Because of this, airways are oversensitive and can easily spasm or become blocked when triggered.

While asthma symptoms vary, they can include coughing (often during sleep), wheezing, difficulty breathing, and a cough that lingers for weeks following every viral cold.

Diagnosing childhood asthma

If your child is experiencing these symptoms, their provider can help determine if asthma is the cause. They may ask how often your child experiences illnesses, if their daily activity or sleeping is affected by symptoms, and if there is a family history of asthma or other respiratory conditions.

If your child is old enough (typically age 7 and older), they may also be tested using an in-office test called spirometry to assess their lung function. They will breathe into a device to see if there their airway is limited due to inflammation. If necessary, additional testing could include imaging and more complex lung function testing. Any child who has asthmatic symptoms more than twice a week should seek treatment to control airway inflammation.

Asthma attacks

An “asthma attack” refers to the sudden spasm and tightening of all of the airways due to the immune system’s over-activation to a trigger. This tightening makes it hard to get air into the lungs, and even harder to fully exhale the air. This causes children to feel their chest is “tight,” and the air that is moving whistles through the tiny swollen airways causing the characteristic wheezing sound. To compensate, a child might frequently cough short dry coughs or breathe faster and more shallowly than normal. When this happen, it's important to give their rescue medication and get medical attention right away.

Understanding common asthma triggers

To help avoid asthma flare-ups, it's helpful to understand what can trigger an attack.

• Viral infections: Viral respiratory illnesses like the cold, RSV, and influenza can cause symptoms that are harder to manage with your child’s typical asthma treatments. If they need their rescue inhaler more often than usual during a sickness, it’s important to contact their provider.
• Indoor allergens: Dust mites, cockroaches, mice, and pet dander can trigger an attack. To minimize that possibility, wash your child's bedding weekly with hot water, keep the environment dust-free, and use a dehumidifier when possible. If they have a specific pet allergy, avoid contact with that animal.
• Outdoor allergens: Pollen and mold are seasonal triggers, particularly in warmer months. If your child is exposed to a known outdoor trigger like pollen or grass, bathe them after being outside. Be mindful of air quality reports, and stay indoors if the quality is poor.
• Cold air: Sudden temperature changes (such as leaving a warm house and going outdoors) can trigger a spasm and potential asthma attack. Dry air, and even air conditioners, can also dry out and irritate the lungs. If your child is having more flare-ups due to changes in the weather, discuss potential medication adjustments with their provider.
• Exercise: Many kids with asthma develop wheezing and tightness in their chest during or after exercise, known as exercise-induced asthma. Their provider may recommend taking albuterol via an inhaler up to a half hour before exercise.
• Secondhand cigarette smoke: Children exposed to tobacco smoke have more severe asthma, worse wheezing, and longer-lasting symptoms. All children should not be exposed to secondhand tobacco smoke. If you smoke, consider taking steps to quit.
• Stress: If your child is highly affected by stress and anxiety, their asthma may be triggered. Their provider can offer guidance about mental and physical health.

Asthma treatment

There are two types of inhalers for asthma treatment, and since they act differently on the lung tissue, it’s critical to know which should be used daily and which is only for exacerbations (attacks).

Many children will need a daily inhaler containing a small dose of steroid. This keeps the immune system’s inflammatory status normal, rather than persistently over-reactive. By calming the hyperactive immune system, it’s much less likely an asthma attack will occur quickly, even when encountering a known trigger. This inhaler should be taken daily whether the child is well or sick.

Albuterol is a medication that causes the muscles around the main airway to relax quickly. An inhaler with albuterol is used in an acute asthma attack. Its effect lasts only about four hours.

Inhaler treatments get to the lungs most effectively by using a spacer. This plastic tube allows your child to inhale medication appropriately without having to time their inhale with the release of the inhaler.

Do children grow out of asthma?

Most children with asthma tend to have it for life; however, it often improves with age. The key to keeping symptoms in check is using control medicine as prescribed, always having medication available at home and with your child, and knowing which inhaler treats daily asthma vs. asthma attacks.

Remember always to follow your child's provider’s instructions. It’s estimated that about half of children prescribed asthma medication don’t use it as regularly as recommended. If you have questions about your child’s symptoms, triggers, or medication, schedule an evaluation with their provider or specialist.