Pediatric Asthma

Pediatric asthma is a chronic inflammatory condition of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It is one of the most common chronic diseases in childhood, affecting approximately 6 million children in the United States alone. In children with asthma, the airways are hyperresponsive and become inflamed and narrow when triggered by certain stimuli such as allergens, respiratory infections, exercise, or cold air. This narrowing reduces airflow to the lungs, causing the characteristic symptoms. While some children may outgrow asthma as they get older, many will continue to have the condition into adulthood. With proper management including medication, trigger avoidance, and education, most children with asthma can lead normal, active lives with minimal symptoms and few limitations.

Causes

Genetic predisposition - Family history of asthma or allergies increases risk
Allergies - Children with allergies to airborne substances like pollen, dust mites, pet dander, or mold have higher asthma risk
Respiratory infections - Viral infections like respiratory syncytial virus (RSV) in early childhood may increase asthma risk
Environmental factors - Exposure to air pollution, tobacco smoke, or other irritants can trigger asthma development
Early life factors - Premature birth, low birth weight, or exposure to certain medications during pregnancy
Obesity - Overweight children have higher asthma rates, though the relationship is complex
Gender - Before puberty, asthma is more common in boys; after puberty, it becomes more common in girls
Hygiene hypothesis - Limited exposure to infections in early childhood may affect immune system development
Gut microbiome - Alterations in intestinal bacteria may influence asthma development
Stress - Chronic stress and psychological factors may contribute to asthma susceptibility and symptom severity

Signs and Symptoms

Wheezing - A whistling sound when breathing, especially when exhaling
Coughing - Often worse at night, early morning, or during/after physical activity
Shortness of breath - Difficulty breathing that may worsen with activity
Chest tightness or pain - Feeling like something is squeezing or sitting on the chest
Rapid breathing - Breathing at a faster rate than normal
Trouble sleeping due to coughing or breathing difficulties
Fatigue - Tiredness that may result from disrupted sleep or increased breathing effort
Exercise intolerance - Difficulty keeping up with peers during physical activity
Recurrent respiratory infections - More frequent or severe colds that often go to the chest
Symptoms that vary in frequency and intensity - May be mild, moderate, or severe
Symptoms that worsen at night or early morning - A characteristic pattern of asthma
Symptoms triggered by specific exposures - Such as allergens, cold air, exercise, or infections
In young children, irritability, difficulty feeding, or slower weight gain may be signs

Diagnosis

Medical History and Physical Examination

The diagnostic process begins with a detailed history of symptoms, their pattern, triggers, and family history of asthma or allergies. Physical examination focuses on the respiratory system but also looks for signs of allergic conditions like eczema or allergic rhinitis, which often coexist with asthma. The doctor listens to the child's breathing with a stethoscope to detect wheezing, reduced air entry, or other abnormal sounds.

Lung Function Tests

For children typically age 5 and older who can follow instructions, spirometry measures how much air the child can breathe in and out and how quickly. This test may be performed before and after administering a bronchodilator medication to see if lung function improves, which supports an asthma diagnosis. Peak flow monitoring uses a simple handheld device to measure how fast a child can blow air out, which can help assess airway obstruction and track asthma control over time.

Allergy Testing

Since allergies often trigger asthma symptoms, skin prick tests or blood tests may be performed to identify specific allergens the child reacts to. Skin tests involve placing a small amount of allergen on the skin and observing for a reaction. Blood tests measure levels of specific IgE antibodies to allergens. Results help guide environmental control measures and may indicate whether allergen immunotherapy (allergy shots) might be beneficial.

Trial of Asthma Medications

A positive response to asthma medications can support the diagnosis. The doctor may prescribe a short course of a bronchodilator, inhaled corticosteroid, or other asthma medication and assess whether the child's symptoms improve. This approach is particularly useful for younger children who cannot perform lung function tests.

Chest X-ray

While not needed for most cases of childhood asthma, a chest X-ray may be ordered to rule out other conditions that can cause similar symptoms, such as pneumonia, foreign body aspiration, or structural abnormalities of the airways. It may also be performed during severe asthma exacerbations to check for complications like pneumonia or pneumothorax (collapsed lung).

Additional Tests for Complicated Cases

For difficult-to-diagnose cases, additional tests may be considered. Exhaled nitric oxide measurement detects airway inflammation. Bronchoprovocation testing deliberately exposes the child to triggers under controlled conditions to see if airways narrow. Chest CT scan provides detailed images of the lungs and airways. These advanced tests are typically performed by pediatric pulmonology specialists.

Treatment Options

Medication Management

Medications are the cornerstone of asthma treatment. Quick-relief medications (bronchodilators) like albuterol relax airway muscles to provide immediate relief during symptoms or attacks. Long-term control medications, taken daily, reduce inflammation and prevent symptoms. These include inhaled corticosteroids (the most effective controller medications), leukotriene modifiers, long-acting bronchodilators (for older children, always combined with corticosteroids), and biologic therapies for severe asthma. Medication plans are individualized based on the child's age, asthma severity, and response to treatment, with the goal of using the lowest effective doses.

Asthma Action Plan

Every child with asthma should have a written asthma action plan developed with their healthcare provider. This personalized document outlines daily management, how to recognize and handle worsening symptoms, and when to seek emergency care. It typically uses a color-coded system (green, yellow, red) corresponding to different levels of symptom control. The plan includes which medications to take, when to take them, and how to adjust treatment during illnesses or symptom flares. Copies should be provided to schools, daycare providers, and other caregivers.

Trigger Identification and Avoidance

Identifying and minimizing exposure to asthma triggers is crucial for management. Environmental modifications may include using allergen-proof bedding covers, regular vacuuming with HEPA filters, removing carpeting, controlling humidity to prevent mold, eliminating exposure to tobacco smoke, and using air purifiers. For children with exercise-induced symptoms, pre-treatment with medication before physical activity may be recommended. For those with allergic asthma, allergen immunotherapy (allergy shots) may be considered to reduce sensitivity to specific allergens.

Education and Skills Training

Comprehensive education for both children (age-appropriate) and caregivers is essential for successful asthma management. This includes understanding the nature of asthma as a chronic condition, proper use of inhalers and spacers, recognition of early warning signs of exacerbations, and the importance of adherence to treatment plans even when symptoms are absent. Demonstrations and return demonstrations of inhaler technique should be performed at regular intervals, as technique often deteriorates over time.

Regular Monitoring and Follow-up

Ongoing assessment of asthma control is necessary to adjust treatment as needed. This includes regular follow-up visits with healthcare providers, typically every 3-6 months when stable and more frequently when initiating treatment or during periods of poor control. During these visits, symptoms, medication use, emergency visits, school absences, activity limitations, and if possible, lung function are evaluated. Home monitoring with peak flow meters may be recommended for some children to detect early changes in lung function before symptoms appear.

Management of Comorbid Conditions

Conditions that commonly occur alongside asthma and can worsen its control should be identified and treated. These include allergic rhinitis (hay fever), sinusitis, gastroesophageal reflux disease (GERD), obesity, and obstructive sleep apnea. For example, treating allergic rhinitis with nasal corticosteroids and antihistamines can improve asthma symptoms, while weight management programs may benefit children whose asthma is complicated by obesity.

Home Remedies

Creating an Asthma-Friendly Home Environment

Reduce indoor allergens by using allergen-proof covers on mattresses and pillows, washing bedding weekly in hot water, removing or regularly cleaning stuffed toys, minimizing carpeting and upholstered furniture, and controlling humidity levels between 30-50%. Keep windows closed during high pollen seasons and run air conditioning with clean filters. Ban smoking inside the home and car, and avoid wood-burning fireplaces or stoves. Clean regularly using damp cloths and mops to reduce dust, and consider HEPA air purifiers for the child's bedroom.

Developing Good Inhaler Technique

Proper inhaler technique is crucial for medication effectiveness. Always use a spacer device with metered-dose inhalers for children of all ages. Practice the correct sequence: shake inhaler, attach to spacer, exhale completely, place mouthpiece in mouth with tight seal (or mask for younger children), press inhaler once, take slow deep breath and hold for 10 seconds if possible, then wait 30-60 seconds before repeating if additional puffs are needed. Clean spacers weekly according to manufacturer instructions. Regularly review technique with healthcare providers.

Maintaining Physical Activity

Regular physical activity strengthens respiratory muscles and improves overall health. Work with your child's doctor to develop a pre-exercise medication routine if needed, typically using a quick-relief inhaler 15-20 minutes before activity. Warm up gradually before vigorous exercise. Choose activities the child enjoys and can succeed at to build confidence. Swimming is often well-tolerated as the warm, humid air can be less triggering. Be aware of weather conditions that might exacerbate symptoms, such as cold, dry air or high pollution days.

Supporting Emotional Well-being

Help your child develop a positive attitude toward asthma management rather than feeling limited by the condition. Encourage age-appropriate understanding and gradual responsibility for self-management. Consider connecting with other families through asthma support groups or camps for children with asthma. Watch for signs of anxiety or depression, which can both trigger and result from asthma symptoms. Teach simple relaxation techniques like deep breathing or progressive muscle relaxation, which can help during episodes of breathlessness and reduce anxiety.

Preventing and Managing Respiratory Infections

Since respiratory infections are common asthma triggers in children, emphasize good hand hygiene and teach proper handwashing technique. Ensure your child receives recommended vaccinations, including annual influenza vaccine. Avoid close contact with people who have colds or other infections when possible. Develop a clear plan with your doctor for adjusting asthma medications during illnesses. Start interventions at the first sign of a cold rather than waiting for asthma symptoms to worsen. Maintain adequate hydration during illnesses to help thin mucus secretions.

Preventive Care

Adhere to prescribed controller medications even when the child feels well, as these prevent inflammation and reduce the risk of exacerbations
Keep rescue medication (e.g., albuterol) available at all times, including at school, during travel, and for extracurricular activities
Ensure annual influenza vaccination and stay current with all recommended immunizations to prevent respiratory infections
Schedule regular follow-up appointments with healthcare providers to monitor asthma control and adjust treatment as needed
Maintain an updated written asthma action plan and review it regularly with all caregivers, teachers, and school nurses
Consider allergen immunotherapy (allergy shots) for children with significant allergic triggers that cannot be adequately avoided
Monitor and record symptoms, medication use, and peak flow measurements (if appropriate) to identify patterns and early warning signs
Avoid exposure to tobacco smoke and other indoor air pollutants; encourage family members who smoke to quit or smoke only outdoors
Teach children age-appropriate self-management skills, gradually increasing responsibility as they mature
Ensure proper nutrition, adequate sleep, and regular physical activity to support overall health and immune function
Be prepared for seasonal changes in asthma triggers and adjust environmental controls and medications proactively
Work with school personnel to ensure appropriate asthma management during school hours, including medication access and activity modifications if needed

Surgical Options

Bronchial Thermoplasty

This minimally invasive procedure is rarely used in children and is reserved for older adolescents (typically 18 years and older) with severe, persistent asthma that remains poorly controlled despite maximal medical therapy. It involves delivering controlled thermal energy to the airways during bronchoscopy, which reduces the amount of smooth muscle in the airway walls. This decreases the ability of the airways to constrict during an asthma attack. The procedure is performed in three separate sessions, each treating different sections of the lungs. While not a cure, it may reduce severe exacerbations and emergency visits in carefully selected patients with severe refractory asthma.

Learn More About This Procedure

Note on Surgical Options for Pediatric Asthma

Unlike some other medical conditions, asthma is primarily managed with medications, environmental control measures, and education rather than surgical interventions. True surgical options specifically for asthma treatment are extremely limited, with bronchial thermoplasty being the only procedure directly targeting asthma pathophysiology, and even this is rarely used in pediatric populations. However, surgery may sometimes be indicated for conditions that can worsen asthma control.

Learn More About This Procedure

Adenotonsillectomy

While not a direct treatment for asthma itself, removal of enlarged adenoids and tonsils may be beneficial for some children who have both asthma and obstructive sleep apnea or recurrent upper airway infections that trigger asthma exacerbations. By improving upper airway patency and reducing infections, this procedure may indirectly improve asthma control in selected cases. The decision involves weighing potential benefits against surgical risks, and is made in consultation with otolaryngology specialists.

Learn More About This Procedure

Endoscopic Sinus Surgery

For children with severe chronic sinusitis that triggers or exacerbates asthma and has not responded to medical management, endoscopic sinus surgery may be considered. This procedure improves drainage from the sinuses and can reduce the frequency of sinus infections. Since upper and lower airways are closely linked (the "unified airway" concept), better control of chronic sinusitis may lead to improved asthma outcomes in some patients. This approach is typically considered only after extended trials of medical therapy.

Learn More About This Procedure

Anti-reflux Procedures

In rare cases where severe gastroesophageal reflux disease (GERD) contributes significantly to poorly controlled asthma despite maximal medical therapy, anti-reflux surgery such as Nissen fundoplication might be considered. However, evidence for improvement in asthma outcomes following such procedures is limited, and they are generally reserved for children with severe reflux symptoms or complications beyond asthma exacerbations. Careful evaluation by a multidisciplinary team is essential before pursuing this approach.

Learn More About This Procedure

Schedule a Consultation

If you're experiencing symptoms of pediatric asthma, our expert team is here to help you find the right treatment approach for your specific needs.

Book Appointment Call (040) 4402 0000