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This topic provides information about asthma in children. If you are looking for information about asthma in teens and adults, see the topic Asthma in Teens and Adults.
Asthma makes it hard for your child to breathe. It causes swelling and inflammation in the airways that lead to the lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for your child to breathe. These flare-ups are also called asthma attacks or exacerbations.
Asthma affects children in different ways. Some children only have asthma attacks during allergy season, when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.
Even if your child has few asthma attacks, you still need to treat the asthma. If the swelling and irritation in your child's airways isn't controlled, asthma could lower your child's quality of life, prevent your child from exercising, and increase your child's risk of going to the hospital.
Even though asthma is a lifelong disease, treatment can control it and keep your child healthy. Many children with asthma play sports and live healthy, active lives.
Experts do not know exactly what causes asthma. But there are some things we do know:
Symptoms of asthma can be mild or severe. When your child has asthma, he or she may:
Many children with asthma have symptoms that are worse at night.
Along with doing a physical exam and asking about your child's symptoms, your doctor may order tests such as:
Your child needs routine checkups so your doctor can keep track of the asthma and decide on treatment.
There are two parts to treating asthma, and they are outlined in the asthma action plan. The goals are to:
If your child needs to use quick-relief medicine on more than 2 days a week, talk to your doctor. This is a sign that your child's asthma is not controlled and can cause problems.
Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your child's asthma action plan.
You can prevent some asthma attacks by helping your child avoid those things that cause them. These are called triggers. A trigger can be:
It can be scary when your child has an asthma attack. You may feel helpless, but having an asthma action plan will help you know what to do during an attack. An asthma attack may be bad enough to need urgent medical care. But in most cases you can take care of symptoms at home if you have a good asthma action plan.
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Learning about asthma:
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The cause of asthma is unknown. Health experts believe that inherited, environmental, and immune system factors combine to cause inflammation of the bronchial tubes, which carry air to the lungs. This can lead to asthma symptoms and asthma attacks.
Symptoms of asthma can be mild or severe. Your child may have no symptoms; severe, daily symptoms; or something in between. How often your child has symptoms can also change.
Symptoms of asthma may include:
If your child has only one or two of these symptoms, it does not necessarily mean he or she has asthma. The more of these symptoms your child has, the more likely it is that he or she has asthma.
Many children have symptoms that become worse at night (nocturnal asthma). In all people, lung function changes throughout the day and night. In children with asthma, this often is very noticeable, especially at night. Nighttime cough and shortness of breath occur frequently. In general, waking at night because of shortness of breath or cough indicates poorly controlled asthma.
It can be hard to know how severe your child's asthma attack is. Knowing this is important, because severe attacks may require emergency treatment. But in most cases you can take care of your child's symptoms at home with an asthma action plan, which is a written plan that tells you which medicine your child needs to use and when you should call a doctor or seek emergency treatment.
Asthma often begins during childhood or the teen years and may last throughout your child's life.
Asthma is classified as intermittent, mild persistent, moderate persistent, and severe persistent.
An asthma attack occurs when your child's symptoms suddenly increase. While some asthma attacks occur very suddenly, many get worse over a period of several days.
Things that can lead to an asthma attack or make one worse include:
Most asthma attacks result from a failure to control asthma with medicines. When your child strictly follows his or her asthma action plan and takes all medicines correctly, it is possible to prevent attacks.
At times, the inflammation of the airways in asthma causes your child's airways to narrow and produce mucus, resulting in asthma symptoms such as shortness of breath.
Loss of lung function in asthma appears to start early in childhood. Asthma also may increase the risk of a partial collapse of lung tissue (atelectasis) or a collapsed lung (pneumothorax).
Sometimes asthma does not respond to treatment because children are not taking their medicines or are not taking them correctly, are not avoiding triggers, and are otherwise not following their asthma action plan. It is very important that you and other caregivers make sure your child is following his or her action plan to keep asthma from getting worse and to reduce the risk of death from asthma.
By following asthma plans, most children who have asthma can live a healthy, full life.
Many things can increase a child's risk for asthma. Some of these are not within your control; others you can control.
Experts are also not sure about the effect that pets in the home have on getting asthma. An analysis of several studies found that having a pet cat appeared to protect against asthma. Having a pet dog slightly increased the risk for asthma. The effect of other furry pets on the risk of asthma was not clear.footnote 7
If your child already has asthma and allergies to pets, having a pet in the home may make his or her asthma worse.
Your child may be at increased risk for severe asthma attacks if he or she:
Triggers also may make asthma worse and may lead to asthma attacks.
Call 911 or other emergency services immediately if:
Call your doctor now or seek immediate medical care if:
Call your doctor if:
If your child has not been diagnosed with asthma but has asthma symptoms, call your doctor and make an appointment for an evaluation.
Watchful waiting is a period of time during which you and your doctor observe your child's symptoms or condition without using medical treatment.
If you think your child has asthma, watchful waiting is not appropriate. See your doctor.
If your child has been getting treatment for 1 to 3 months and is not improving, ask your doctor whether the child needs to see a specialist (allergist or pulmonologist).
Watchful waiting may be appropriate if your child follows his or her asthma action plan and stays within the green zone. Monitor your child's symptoms, and continue to avoid asthma triggers.
Health professionals who can diagnose and treat asthma include:
Your child may need to see a specialist (an allergist or pulmonologist) if he or she:
Diagnosis of asthma is based on medical history, a physical exam, and simple lung function tests such as spirometry.
Diagnosing asthma in babies and toddlers is often very difficult. Symptoms may be the same as those of other diseases, such as infection with respiratory syncytial virus (RSV) or inflammation of the lungs (pneumonia), sinuses (sinusitis), and small airways (bronchiolitis). If you have a very young child, spirometry is not practical. So the diagnosis is made based on your report of symptoms.
In an older child, lung function tests can diagnose asthma, determine its severity, and check for complications.
A newer test to monitor asthma is the NIOX nitric oxide test system. This test measures nitric oxide in exhaled air. A decrease in nitric oxide suggests that treatment may be reducing inflammation caused by asthma. But some experts believe that this test is not useful for monitoring asthma.footnote 8
Asthma sometimes is hard to diagnose because symptoms vary widely from child to child and within each child over time. Symptoms may be the same as those of other conditions, such as influenza or other viral respiratory infections. Tests that may be done to determine whether diseases other than asthma are causing your child's symptoms include:
Other tests may be done to see whether your child has health problems such as sinusitis, nasal polyps, or gastroesophageal reflux disease.
You need to monitor your child's condition and have regular checkups to keep asthma under control and to review and possibly update your child's asthma action plan. A checkup is recommended every 1 to 12 months depending on how well your child's symptoms are controlled.
During checkups, your doctor will ask you and your child whether symptoms or peak expiratory flow or both have held steady, improved, or become worse. He or she will also ask about asthma attacks during exercise, at night, or after laughing or crying hard. You and your child track this information in an asthma diary.
If your child has persistent asthma and takes medicine every day, your doctor may ask about his or her exposure to substances (allergens) that cause an allergic reaction. For more information about tests for allergies, see the topic Allergic Rhinitis.
Although your child's asthma cannot be cured, you can manage the symptoms with medicines and other measures.
It's very important to treat your child's asthma. Although he or she may feel good most of the time, even mild asthma may cause changes to the airways that speed up and make worse the natural decrease in lung function that occurs as we age.
Your child can expect to live a normal life by following his or her asthma action plan. Asthma symptoms that are not controlled can limit your child's activities and lower his or her quality of life.
By following your child's treatment plan, you can help your child meet these goals:
Babies and small children need early treatment for asthma symptoms to prevent severe breathing problems. They may have more serious problems than adults because their bronchial tubes are smaller.
An asthma action plan tells you which medicines your child takes every day and how to treat asthma attacks. It may include an asthma diary where your child records peak expiratory flow (PEF) or symptoms or both. You also can list the cause of the symptoms and the quick-relief medicine used for asthma symptoms. This helps you to identify triggers that can be changed or avoided and to be aware of your child's symptoms. A plan also helps you make quick decisions about medicine and treatment.
See an example of an asthma action plan(What is a PDF document?).
Your child will take several types of medicines to control his or her asthma and to prevent attacks. These include:
You and your child will learn how to use a metered-dose inhaler (MDI) or dry powder inhaler (DPI). An MDI delivers inhaled medicines directly to the lungs. Most doctors recommend using a spacer with an MDI. For more information, see Medications.
Your child needs to monitor his or her asthma and have regular checkups to keep asthma under control and to ensure the right treatment. The frequency of checkups depends on how well your child's asthma is controlled.
Being around triggers increases symptoms. Try to avoid situations that expose your child to irritants (such as smoke or air pollution) or substances (such as animal dander) to which he or she may be allergic. Using an air filter machine in your house reduces smoke and other particles in the air, which can help prevent asthma symptoms in children.footnote 9
You can monitor your child's symptoms by checking peak flow or by watching for changes in how much your child is coughing, wheezing, or short of breath.
It is easy to underestimate the severity of your child's symptoms. You may not notice them until his or her lungs are functioning at 50% of the personal best peak expiratory flow (PEF).
Measuring PEF is a way to keep track of asthma symptoms at home. It can help you and your child know when lung function is becoming worse before it drops to a dangerously low level. This is done with a peak flow meter.
Special things to think about in treating asthma include:
If your child's asthma is not improving, talk with your doctor and:
If your child's medicine is not working to control airway inflammation, your doctor will first check to see whether your child is using the inhaler correctly. If your child is using it correctly, your doctor may increase the dosage, switch to another medicine, or add a medicine to the existing treatment.
If your child's asthma does not improve with treatment, he or she may require more treatment, including larger doses of medicines. An asthma specialist typically prescribes these medicines.
If your child has a severe asthma attack (the red zone of the asthma action plan), give him or her medicine based on the action plan. Talk with a doctor right away about what to do next. Your child may have to go to the emergency room for treatment.
At the hospital, your child will probably receive inhaled beta2-agonists and steroid medicines. He or she may be given oxygen therapy. Doctors will assess your child's lung function and condition. Depending on the response, further treatment in the emergency room or a stay in the hospital may be needed.
While there is no certain way to prevent asthma, experts continue to look at things that may reduce a child's chance of getting asthma.
Common irritants in the air, such as tobacco smoke and air pollution, can cause asthma symptoms in some children.
Controlling tobacco smoke is important because it is a major cause of asthma symptoms in children and adults. If your child has asthma, try to avoid being around others who are smoking. And ask people not to smoke in your house.
Consider keeping your child inside when air pollution levels are high. Other irritants in the air (such as fumes from gas, oil, or kerosene, or wood-burning stoves) can sometimes irritate the bronchial tubes. Avoiding these may reduce asthma symptoms.
You may also want to use an air filter machine in your house to reduce the amount of dust and other pollutants.
You can limit the impact asthma has on your child's life by learning about asthma and learning how you can help your child follow his or her treatment plan.
A trigger is anything that can lead to an asthma attack. If your child can avoid triggers, he or she may reduce the chance of having an asthma attack.
It is easy to underestimate the severity of asthma. Measuring peak expiratory flow (PEF) is a way to keep track of asthma symptoms at home and to know when your child's lung function is getting worse before it drops to a dangerously low level.
Your child may be allergic to certain substances (allergens). You may reduce your child's asthma symptoms by limiting exposure to those substances. In some cases, your child's doctor may recommend immunotherapy, such as allergy shots.
It also may be necessary to avoid exposure to other types of triggers that cause asthma symptoms.
Coughing and wheezing can wake your child. Special problems that might cause night symptoms include:
Treating a sinus infection, cold, or allergies can keep your child's symptoms from occurring at night.
Upper respiratory infections, including the common cold, cause 85 out of 100 asthma attacks in young children.footnote 10 Basic preventive measures include the following:
Taking medicines is an important part of asthma treatment. But it can be hard to remember to take them. To help you and your child remember, understand the reasons people don't take their asthma medicines. And then find ways to overcome those obstacles, such as taping notes on the bathroom mirror.
Most medicines for asthma are inhaled. With inhaled medicines, a specific dose of the medicine can be given directly to the bronchial tubes, avoiding or reducing the effects of the medicine on the rest of the body. Delivery systems for inhaled medicines include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler (MDI) is usually used by older children, and nebulizers are used most often with infants. For more information, see Medications.
To manage your child's asthma:
It is important to treat your child's asthma attacks quickly. If your child does not improve soon after treating an attack, talk with a doctor.
Medicine does not cure asthma. But it is an important part of managing the condition. Medicines for asthma treatment are used to:
Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks. Most children with persistent asthma need to use long-term medicines daily. Quick-relief medicines are used as needed and provide rapid relief of symptoms during asthma attacks.
Most medicines for asthma are inhaled, because a specific dose of the medicine can be given directly to the bronchial tubes. Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.
Most doctors recommend that every child who uses a metered-dose inhaler (MDI) also use a spacer, which is attached to the MDI. A spacer may deliver the medicine to your child's lungs better than an inhaler alone. And for many people a spacer is easier to use than an MDI alone. Using a spacer with inhaled steroid (corticosteroid) medicines can help reduce their side effects and the need for the oral (pill) kind.
The most important asthma medicines are:
Long-term medicines sometimes used alone or with other medicines for daily treatment include:
Other medicines may be given in some cases.
Medicine treatment for asthma depends on your child's age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.
Your child's doctor will work with you and your child to help find the number and dose of medicines that work best.
Some parents worry that children who use inhaled steroid (corticosteroid) medicines may not grow as tall as other children. A very small difference in height and growth was found in children using inhaled steroid medicines compared to children not using them.footnote 11 And one study showed a very small difference in height [about 0.5 in. (1 cm)] in adults who used inhaled steroid medicines as children compared to adults who did not use these medicines.footnote 12 But the use of inhaled steroid medicine has important health benefits for children who have asthma. If you are worried about the effects of asthma medicines on your child, talk with your doctor.
If your child has asthma symptoms that are triggered by allergens, your child's doctor may recommend immunotherapy. For this treatment, your child get shots or uses pills that have a small amount of certain allergens in them. Your child's body "gets used to" the allergen, so your child reacts less to it over time. This kind of treatment may help prevent or reduce some allergy symptoms.
Allergy shots have been shown to reduce asthma symptoms and the need for medicines in some people.footnote 15 But allergy shots are not equally effective for all allergens. Allergy shots should not be given when asthma is poorly controlled.
Research has shown that (in addition to taking medicine) family therapy, such as counseling, may be helpful to children who have asthma.footnote 16 In one small study, peak expiratory flow and daytime wheezing improved in children who had therapy compared with those who didn't. Another small study found that children showed overall improvement from therapy.
Complementary medicine is a term used for a wide variety of health care practices that may be used along with standard medical treatment.
While most mind and body practices such as acupuncture, breathing exercises, and yoga seem to be safe when used in the right way, be sure to check with your child's doctor first. Talk about any complementary health practice that you would like your child to try or that your child is already using. Your doctor can help you manage your child's health better if he or she has the whole picture about your child's health.
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Eichenfield LF, et al. (2003). Atopic dermatitis and asthma: Parallels in the evolution of treatment. Pediatrics, 111(3): 608-616.
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Szefler SJ, et al. (2008). Management of asthma based on exhaled nitric acid in addition to guideline-based treatment for inner-city adolescents and young adults: A randomised controlled trial. Lancet, 372(9643): 1065-1072.
Butz AM, et al. (2011). A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure. Archives of Pediatrics and Adolescent Medicine, 165(8): 741-748.
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Guilbert TW, et al. (2006). Long-term inhaled corticosteroids in preschool children at high risk for asthma. New England Journal of Medicine, 354(19): 1985-1997.
Kelly HW, et al. (2012). Effect of inhaled glucocorticoids in childhood on adult height. New England Journal of Medicine, 367(10): 904-912.
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Other Works Consulted
Bisgaard H, et al. (2006). Intermittent inhaled corticosteroids in infants with episodic wheezing. New England Journal of Medicine, 354(19): 1998-2005.
Global Initiative for Asthma (GINA) (2014). Global Strategy for Asthma Management and Prevention. http://www.ginasthma.org/documents/4. Accessed May 21, 2014.
Gold DR, Fuhlbrigge AL (2006). Inhaled corticosteroids for young children with wheezing. Editorial. New England Journal of Medicine, 354(19): 2058-2060.
Gotzsche PC, Johansen HK (2008). House dust mite control measures for asthma. Cochrane Database of Systematic Reviews (2).
Joint Task Force on Practice Parameters (2005). Attaining optimal asthma control: A practice parameter. Journal of Allergy and Clinical Immunology, 116(5): S3-S11. Available online: http://www.allergyparameters.org/file_depot/0-10000000/30000-40000/30326/folder/73825/2005+Asthma+Control.pdf.
Malveaux FJ, et al., eds. (2009). State of childhood asthma and future directions: Strategies for implementing best practices. Pediatrics, 123(Suppl 3).
Pollart S (2015). Asthma in children. In ET Bope et al., eds., Conn's Current Therapy 2015, pp. 1087-1094. Philadelphia: Saunders.
ByHealthwise StaffPrimary Medical ReviewerJohn Pope, MD - PediatricsE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerLora J. Stewart, MD - Allergy and Immunology
Current as ofJanuary 29, 2018
Current as of:
January 29, 2018
John Pope, MD - Pediatrics & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Lora J. Stewart, MD - Allergy and Immunology
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