Lloydspharmacy.com Health - Asthma and children

Reviewed by Dr Stuart Crisp, consultant paediatrician

What is an asthma attack?

The mucous membranes in the small branches of the airways (bronchi) swell and the circular muscles contract ('spasm' or bronchospasm).

More mucus is produced in the already restricted airways, which makes breathing a struggle. This usually produces a wheezing sound, when breathing out.

What symptoms in children can be due to asthma?

Small children (up to three years):

a wheezing sound, when breathing out
coughing, wheezing or breathlessness with exercise
feeling of a tight chest
prolonged coughing, not because of a cold, often worse at night
generally feeling unwell
recurrent colds from which it takes a long time to recover.

Children from 3 to 15 years:

a wheezing sound when breathing out
prolonged coughing, especially at night
waking up coughing during the night or in the morning
inactivity or lethargy – no longer wishing to play physical games or take other exercise when they have enjoyed this before.

How common is asthma in children?

Chronic asthma is the most frequent long-term children's disease.
About 1 to 2 per cent of all children get chronic asthma during their childhood.
Approximately 15 to 20 per cent of all children will have symptoms of wheeze, without having chronic asthma.

What causes asthma in children?

In young pre-school children, wheezing is usually brought on by a viral infection – causing a cold, ear or throat infection.

Some people call this 'viral-induced wheeze' or 'wheezy bronchitis', whilst others call it asthma.

Most children will grow out of it, as they get to school age.

In older children, viruses are still the commonest cause of wheezing. But other allergens may also cause an asthma attack like those listed below:

What makes a child's asthma worse?

Exposure to the things that they are allergic.
Cigarette or pipe smoke.
Colds.
Pollution and dust.
Exertion or exercise: however exercise should be encouraged, with asthma symptoms relieved by medication.

When should a parent visit the doctor?

If you suspect your child may have asthma.
When the asthma medication normally used doesn't work, or it's needed more than two or three times per week.

When is it necessary to call the doctor urgently?

If the child has trouble breathing.
If the skin changes colour to white or blue, particularly on the lips or around the mouth.
If the breathing difficulty deteriorates dramatically.
If the asthma attack is much worse than normal.
If you're using the ventolin puffer more than every 4 hours.

How does the doctor decide whether a child has asthma or not?

By listening to the symptoms described by parent and child.
By examining the child by listening to their chest using a stethoscope.
By measuring the capacity of your child's lungs with a peak flow monitor – a simple device that measures the maximum speed at which the child can blow out. The reading is reduced if the airways are tight. This can be done at home or in the doctor's surgery.
By checking whether the treatment recommended by the doctor works.

Why should a child take the medication?

It is often both necessary and helpful to give children medication because it can:

remove their symptoms allowing them to play and exercise again, like other children
subdue the allergic reaction of their body and reduce the inflammation in the airways
remove or lessen damaging effects on your child's lungs so they develop naturally.

Which medication should my child use?

Medicines for asthma are generally thought of in two main groups:

relievers (bronchodilators): these are quick-acting drugs that relax the muscles of the airways. They relieve the symptoms of wheeze, cough and breathlessness and are the first-line treatment of an acute asthmatic attack.
preventers (anti-inflammatories): these act over a longer time and work by reducing the inflammation within the airways.

Relievers

There are two groups of these.

The different types of reliever can be combined if necessary.

Beta 2 agonists

These drugs act on molecule-sized receptors on the muscle of the bronchioles. The drug fits the receptor like a key fits a lock and stimulates the muscle to relax. Examples of those that act for a short time (three or four hours following a single dose) are salbutamol (eg Ventolin) and terbutaline (eg Bricanyl).

These drugs (and the other inhaled drugs mentioned below) are inhaled from a variety of delivery devices, the most familiar being the pressurised metered-dose-inhaler (MDI). Special adaptors and types of inhaler are available to make it easier to administer inhaled medication to young children. A doctor or practice nurse can recommend which type will be the most suitable.

Longer-acting beta 2 agonists include salmeterol (eg Serevent). Their action lasts over 12 hours, making them suitable for twice daily dosage. These medications are particularly good for exercise-induced problems and night-time symptoms. They are not suitable for very young children.

Anticholinergics

One of the ways in which the size of the airways is naturally controlled is through nerves that connect to the muscles.

The nerve impulses cause the muscles to contract, thus narrowing the airway. Anticholinergic drugs block this effect, allowing the airway to open.

The size of this effect is fairly small, so it's most noticeable if the airways have already been narrowed by other conditions, such as chronic bronchitis.

These drugs are therefore not commonly used in children, but ipratropium (eg Atrovent) is available for use in children if required.

Preventers

There are four main groups of these.

Corticosteroids

Corticosteroids (or steroids), such as beclometasone (eg Becotide), budesonide (Pulmicort) and fluticasone (Flixotide), have made an enormous difference to the management of asthma.

They work to reduce the amount of inflammation within the airways, reducing their tendency to contract and have allowed many people with previously troublesome asthma to lead almost symptom-free lives.

They are usually given as inhaled treatment, although sometimes short courses of oral steroid tablets may be required for bad attacks.

Although steroids are powerful drugs, with many potential side-effects, their safety in asthma has been well established.

It's also important to balance the problems that arise from poorly treated asthma against the improvement in health that occurs when the condition is well treated.

Cromones

There are two drugs in this group: sodium cromoglicate (eg Intal) and nedocromil sodium (Tilade).

They also act to reduce airway inflammation. They tend to be best for mild asthma and are more effective in children than adults.

The drugs are given by inhalation and usually well tolerated. This is a good first-line preventative treatment in children, but they may take up to six weeks to have an effect.

Leukotriene receptor antagonists

Leukotrienes are compounds released by inflammatory cells, within the lung, and which have a powerful constricting effect upon the airways.

By blocking this effect with these antagonist drugs, the constriction is reversed.

One of these drugs, montelukast (Singulair paediatric), is presently licensed for children over two years old. Zafirlukast (Accolate) can be used in children over 12 years old.

Theophylline

Theophylline and aminophylline are given by mouth, and they are less commonly used in Britain because they're more likely to give side-effects than inhaled treatment.

They are still in wide use throughout the world.

What are the long-term prospects?

Most children outgrow the disease.
The milder it is, the greater the chance of outgrowing it.

Based on a text by Dr Carl J Brandt and Dr Finn Rasmussen

Last updated 20.04.2010