Asthma is the most common serious chronic disease of childhood, affecting
nearly five million children in the United States. Asthma in children is the
cause of almost three million physician visits and 200,000 hospitalizations
Children with asthma cough, wheeze, experience chest tightness and
shortness of breath. Many parents do not realize that a chronic cough may be
the only symptom of asthma and that a child does not have to wheeze to have
asthma! Children with reactive airway disease, recurrent bronchitis or
wheezy bronchitis probably have asthma.
Up to 80% of children with asthma develop symptoms before age five. The
child's physician must rely heavily on parents' observations to make a
To make a diagnosis of asthma your child's physician will want to know
about the following:
- Does your child cough, wheeze (a whistling sound when breathing), have
chest tightness or shortness of breath?
- Do colds go right to your child's chest and last much longer than
- Does your child cough or wheeze with exercise, play and laughter or
during temper tantrums?
- Is there a family history of asthma or allergies?
- What triggers your child's symptoms - colds, allergens (like the
family pet) or exercise?
- How often are the symptoms and how bad?
- Is your child missing school?
- Is coughing or wheezing keeping you and your child up at night?
If your child is old enough (usually older than 5-6), he or she may do a
Pulmonary Function Test. The results will tell the physician about how the
child's lungs actually work. This test helps not only in the diagnosis but
will help the doctor follow the response to medication.
For children, asthma symptoms can interfere with many school and
extracurricular activities. Parents may notice their child has less stamina
during play than his or her peers, or they may notice the child trying to
limit or avoid physical activities to prevent coughing or wheezing. More
subtle signs of asthma, such as chest tightness, are often not identified as
such by children. Sometimes they will complain that their "chest hurts" or
that they cannot "catch their breath." Often, recurrent or constant coughing
spells may be the only observable symptom.
The two most common triggers of asthma in children are colds and
allergens (substances that trigger allergies). In fact, most kids with
asthma are allergic and should have an allergy evaluation as part of their
care. Common allergens include dust mite, animal dander, cockroach, pollen
and molds. We cannot do a lot about viral illnesses but there are ways to
limit allergen exposure in the home environment if you know what you need to
The goals for managing childhood asthma are simple. Children with asthma
should be able to:
SLEEP, LEARN and PLAY
If asthma is waking the family at night: if the child cannot play soccer
or dance ballet; if he or she is chronically missing school (and parents
missing work) then the asthma is not controlled!
Every child with asthma should have a written asthma management plan.
This tells the child and parents what medications to take when well; how to
go up on medication when the child has increasing symptoms and when to call
the physician. This plan gives control to the patient and their parents and
allows for early treatment of symptoms, before the asthma flare gets out of
As part of an effective asthma management plan, the child's physician may
prescribe specific medications and devices. These can include a peak flow
meter to measure ease of breathing, metered dose inhalers, spacers that
attach to inhalers, nebulizer that deliver medication in a mist, dry powder
inhalers, or oral (tablet) medications. The physician should not only
prescribe these medications and devices, but should teach children and
parents how to use them correctly.
Asthma medications include rescue medication or quick relievers to treat
symptoms (ie albuterol) and long-term controller medicines to control the
inflammation that causes asthma. If a child has symptoms more than twice a
week or wakes more than twice a month at night, they should be on long-term
controller therapy. For more information on asthma medications, please see
the Tip brochure in this series.
Answers to commonly asked questions
Will my child outgrow his/her asthma?
The challenge to the physician who cares for children and the parent is to
identify the child who wheezes early in life and will outgrow their asthma,
vs. the child who will continue to have persistent wheezing. Some babies who
wheeze with viral respiratory illnesses will stop wheezing as they grow and
their airways get bigger. If a child has atopic dermatitis(eczema), there is
smoking in the home or if the mom has asthma, there is a greater chance that
the child will have persistent wheezing. Some children have asthma symptoms
that improve during adolescence, while others worsen. Often, symptoms in
young children seem to resolve, but their asthma may flare up later in life.
Can asthma be cured?
Currently there is no cure for asthma. However, for most children, asthma
can be controlled with appropriate management and treatment. While asthma is
a chronic illness, it should not be a progressively debilitating disease - a
child with asthma can have normal or near-normal lung function with
appropriate management and medications.
Should my child exercise?
Parents may have the urge to restrict their asthmatic child's physical
activity to prevent wheezing. But once a child is taking proper medications,
aerobic exercise needs to become part of his or her daily activities,
because it improves airway function. Children must be encouraged to
participate in normal activities as much as possible. It is also very
possible for a child with asthma to excel in athletics - several Olympic
athletes have asthma.
Asthma at school
The child, family, physician and school personnel must work together to
prevent and/or control asthma symptoms at school. Many children with asthma
are embarrassed about their need for medication. In some cases, children may
have difficulty because they are required to go to another part of the
school building, such as a nurse's office, to take their medication. School
officials and parents must create a supportive environment. With the
approval of physicians and parents, school-age children with asthma should
be allowed to carry metered dose inhalers with them at all times and use
them as appropriate. Many states have now passed laws to allow responsible
children to keep their inhaler in their book bag.
To ensure optimal care at school, parents can also take the following
- Meet with teachers, the school nurse, coach and perhaps the principal
at the beginning of the school year.
- Have your child's doctor provide a written asthma plan for school such
as the Asthma School Action Plan. You can find this on the Patients &
Consumers resources page of the AAAAI Web site, www.aaaai.org.
- Encourage local educational programs to improve education for schools
For children with asthma to function normally, school personnel, families
and health care providers must effectively communicate and work together to
encourage them to fully participate in activities with their peers. This
team effort will help create a positive, healthy and safe environment for
the child - both in and out of school - and ensure the best asthma care
Your allergist/immunologist can provide you with more information on
Tips to Remember are created by the Public Education Committee
of the American Academy of Allergy, Asthma and Immunology. This brochure was
updated in 2003.
The content of this brochure is for informational purposes only. It is
not intended to replace evaluation by a physician. If you have questions or
medical concerns, please contact your allergist/immunologist.
American Academy of Allergy,
Asthma and Immunology
555 East Wells Street
Milwaukee, WI 53202-3823
AAAAI Physician Referral and
AAAAI Web site