THE BASICS: “What is it?”

Childhood asthma is the same disease as adult asthma—chronic (long-term) airway inflammation with periodic symptom flare-ups that cause breathing problems. In children, these symptoms may include:

  • Wheezing (a whistling sound when exhaling), considered a classic symptom of asthma

o   However, some children with asthma do not wheeze.

  • Shortness of breath
  • Frequent bouts of coughing, often at night (disturbing sleep—this is sometimes the only asthma symptom) or in the early morning
  • Longer-than-usual time recovering from a cold or the flu
  • Chest tightness and/or pain
  • Dark under-eye “bags”
  • Fatigue
  • Irritability

About 7 million American children under age 18 have asthma, one of the most common chronic childhood disorders. Childhood asthma is the top cause of:

  • Missed school days
  • Children’s emergency room visits for chronic illness flare-ups

The way asthma affects children can range from mild to severe:

  • Some may have only mild symptoms that occur from time to time or only after physical activity (this is called exercise-induced asthma, or EIA).

o   They may be able to breathe normally for weeks or months between flare-ups. However:

o   Even simple coughing may progress to more severe breathing problems.

  • Others may have asthma so severe that, unless properly treated, it can be incapacitating and even life-threatening.

Symptoms of an asthma attack may include:

  • Severe wheezing or coughing
  • Struggling for breath so hard that inhaling “sucks” your child’s abdomen down and under the ribs

o   Note: Shortness of breath with reduced wheezing—indicating less air is getting into and out of your child’s lungs—is especially alarming.

  • Visibly using abdominal muscles to “force” breathing
  • Widened nostrils when inhaling
  • Having to stop to catch his or her breath when talking
  • Being short of breath even though not particularly active
  • Rapid pulse
  • Sweating
  • Blue lips, face, and/or fingernails
  • Difficulty walking and/or talking
  • Severe confusion or drowsiness
  • No improvement after using rescue (quick-relief) asthma medication—a condition known as status asthmaticus

If your child has any symptoms (particularly wheezing) that may mean he or she has asthma, contact your pediatrician or family doctor as soon as possible.

Worsening asthma can cause serious complications, including:

  • Severe asthma attacks requiring emergency care or hospitalization
  • Permanent airway narrowing
  • Missed school days or getting behind in schoolwork
  • Fatigue and disturbed sleep
  • Symptoms that interfere with activities such as playing or sports

What happens in asthma is the same for children and adults: Inflamed airways narrow, preventing free movement of air in and out of the lungs.

  • This narrowing results from:

o   Swelling of the lining of the airways

o   Tightening of the muscle around the airways

o   Secretion of too much mucus in the airways

There’s no cure for asthma, although some children eventually outgrow it.

Allergic asthma

What makes children develop asthma?

Although genetic (inherited) traits and other risk factors may be involved—such as heartburn (gastroesophageal reflux disease, or GERD) and exposure over time to cigarette smoke and other lung irritants—the biggest cause of childhood asthma, by far, is development of an overly reactive immune system leading to allergic asthma.

  • About 90 percent of childhood asthma is allergic asthma.

In children as in adults, an allergy starts when the body’s immune system mistakenly “flags” a normally harmless substance, such as pollen, as an “invader.”

  • This can happen at any time, even if your child has often inhaled the substance before.

Trying to protect the body from the invader, your child’s immune system prepares for the next “invasion” by developing special protective cells, called antibodies, that will “fight” that invader if your child is exposed to it again.

  • Your child’s body is now “sensitized” to the invader, which has become an allergen (trigger).

Next time your child is exposed to that trigger, the antibodies recognize it and activate mast cells (the cells that cause an allergic response) throughout his or her body.

  • The mast cells burst open and release chemicals, such as histamine, that cause allergy symptoms, such as swelling in your child’s airways and nose.

o   This reaction may be delayed in some children, causing difficulty in identifying the trigger involved.

The most common asthma triggers include:

  • Pollens from grasses, trees, and flowers
  • Air pollution—for example, from street traffic or nearby factories
  • Tobacco smoke and smoke from burning wood or other plants
  • Mold spores
  • Dust mites (invisibly tiny bugs that live all around and on us and are easily breathed into the lungs)
  • Cockroaches and their droppings
  • Furry pets and pet dander (tiny flakes, similar to dandruff in humans, shed from an animal’s skin)

Less common triggers include:

  • Physical exercise
  • Some medications, both over-the-counter (OTC) and prescription
  • Upper respiratory infections such as colds and the flu
  • Acid reflux (stomach acids rising up into the esophagus, or food tube, causing heartburn and indigestion)
  • Weather extremes such as thunderstorms or high humidity
  • Breathing cold, dry air
  • Some foods, food additives, and fragrances

One or more of your child’s asthma triggers may not be listed here. Tell your doctor about everything that seems to trigger his or her asthma symptoms.

If appropriate for your child, allergy testing can help identify his or her personal allergic asthma triggers.

You’ve increased your knowledge of what childhood asthma is and what you can do to help protect your child’s health. Next step:

  • Getting to know the health professionals who will provide the care your child needs
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