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Asthma is a disease of the respiratory tract that sometimes makes it difficult to breathe. Prolonged coughing is also common. Asthma is treated with various kinds of medicines that the child can breathe. With proper treatment, children with asthma can live an active life without being hindered by asthma.

This text is mainly about asthma in children younger than 12 years. If the child is older than twelve years, you can also read the text Asthma.

Children can have respiratory problems for many reasons, often with a cold. Here you can read more about other types of breathing difficulties in children.

Different types of asthma

There are several different types of asthma in children.

Common asthma or real asthma

One type of asthma is because the child has inflammation in the trachea. It is called ordinary asthma or real asthma.

Children with this type of asthma are usually allergic. They may have asthma problems if they are exposed to something they cannot tolerate, but it is also common for them to suffer from colds and when they exert themselves.

Cold Asthma

Another type of asthma causes problems only in colds and respiratory infections. That form is called cold asthma or infective asthma.

The problems are usually felt during the child’s first year of life, but the problems have almost always disappeared before the child is 6–7 years.

Symptoms of asthma in children

Asthma makes the air difficult to pass to and from the lungs. Then it becomes harder to breathe. In case of an asthma attack, the child quickly becomes much more difficult to breathe. Then it’s kind of like holding your nose and breathing through a straw.

These are common symptoms if the child has asthma due to inflammation:

  • The child breathes heavily or becomes very tired as they strain.
  • The child coughs as they strain.
  • The child has a long-term cough when cold.
  • The child has a prolonged cough without any other explanation. The cough comes, especially at night. 
  • It beeps and hisses as the child breathes.
  • The child has bouts of shortness of breath, that is, they do not get air.

The symptoms of asthma usually come in periods. The trouble can be few if the child has mild asthma. Then they can come, for example, in the case of a cold or when the child is trying hard physically. Even in children with more severe asthma, the problems usually vary. Some children only suffer from occasional complaints, while others may have problems despite treatment.

Cold Asthma

In the case of cold asthma, the child only has trouble with colds and infections of the airways, never otherwise. Breathing becomes heavy, often wheezing, and the child becomes difficult to breathe.

When and where should I seek care?

If any of the following is true, contact a health care center or pediatric clinic:

  • You think your child has asthma.
  • Your child has asthma and the problems start to come more often or are more difficult to stop.

If it’s in a hurry

If the child has difficulty breathing, contact a health center or on-call reception immediately. It also applies if they have used bronchodilator drugs, without getting better. If closed, seek care at an emergency room.

  • The child is very difficult to breathe.
  • The baby’s skin is pale or bluish.
  • The baby has strained to breathe and the skin is pulled in between the ribs and in the neck pit as the baby breathes.

Investigations

In order for the doctor to be able to diagnose, the child needs to undergo an examination.

At the doctor’s get the child and you tell about the problems. The doctor does a body examination and examines, among other things, how the child breathes. It does this by listening with a stethoscope to the baby’s chest and back. The doctor also looks at how the chest moves as the baby breathes.

Sometimes it can be difficult to detect asthma in children. This is because the child can be without trouble just when the examinations are done. Then the doctor makes the diagnosis based on what you tell. The child also usually gets to try drugs for a while to see if it helps. This also applies if the child is too young to measure how the lungs work.

An allergy investigation is always included

An allergy study is included in an asthma study. The investigation shows whether the child has an allergy, which is common in children who have asthma.

You as an adult, together with the child, can tell you something that the child does not seem to tolerate. Often it is about allergies to birch or grass or to fur animals. The child may also be allergic to some food, ie something they eat or drink.

Sometimes an allergy prick test is done and sometimes the child may have a blood test.

A so-called food provocation is often needed if the doctor suspects that the child has an allergy to any food. Then the child may eat or drink a small amount of the food or drink that the doctor thinks the child is allergic to. Then the amount of food is increased to see if it causes any problems.

Test of lung function

The child also usually gets a test of how the lungs work, if they are old enough. It is called a lung function test and can usually be done from the age of 5 to 6 years. Then the child can usually understand how to do it during the test.

Spirometry is the most common method

Spirometry is the most common method of testing how the lungs work. The child is then allowed to blow everything they can into a tube connected to a meter, to investigate how much air they can blow out in a second. The amount of air the child exits measures how narrow the airways are.

After the first blowout, the baby is allowed to inhale drugs that widen the trachea. After 15 minutes, the child is allowed to blow again. This study is called the reversibility test. If the lung function is clearly improved by the bronchodilator drugs, it indicates that the child has asthma.

PEF measurement is often done at home

The lung function can also be tested with a PEF meter. The child then blows everything they can into a small tube. The PEF meter measures how fast the child can blow out the air, ie how fast the air flows.

Sometimes the child brings home a PEF meter. The child is allowed to blow morning and evening for one to two weeks, to see how much the airflow varies from one day to another. If the baby clears better on certain days, and worse on other days, it indicates that the child has asthma.

Many have their own PEF meter for measuring at home. It can be printed as an aid. Sometimes you can borrow a meter at the reception.

Other tests and examinations

Sometimes more examinations are needed, for example, if the doctor is uncertain about the diagnosis.

NO measurement

Sometimes the amount of nitric oxide in the air is measured as the baby exhales. NO is an abbreviation for nitric oxide. There is more nitric oxide in the exhaled air in case of allergic inflammation in the trachea, such as in asthma.

The child blows for a few seconds in a tube, which is connected to a meter. This measurement is a complement to other studies.

Exercise and provocation tests

It can sometimes be difficult for the doctor to determine if the child has asthma. The child’s problems, for example, may be unclear to interpret, or may only arise in special situations. Then so-called provocation tests and exertion tests are sometimes used. They mean that the child is allowed to do things that can temporarily impair lung function. The lung function is measured several times during the test to compare.

The tests can be done in several ways. For example, the child may run on a treadmill, breathe dry air for a few minutes, or inhale increasing doses of various substances that may affect the function of the lungs.

The child must usually be at least 6–7 years of age to pass the tests.

Radiographic examination

The youngest infants often need to be examined for pulmonary x-rays, as congenital damage to the lungs and airways can cause symptoms similar to asthma. Sometimes X-rays are also used for older children when the diagnosis is unclear or the treatment is not working.

What can trigger asthma problems and asthma attacks?

There are some things that can cause asthma or make it worse. They are often called trigger factors. Different children are different sensitive, but here are the most common factors that usually make asthma worse:

  • It is mainly colds that cause more severe asthma problems and attacks, regardless of the type of asthma the child has. All types of respiratory tract infections can cause problems.
  • Physical exertion is another common cause of the aggravation of ordinary asthma. However, if the asthma is treated properly, children with asthma should be able to play and exercise largely as a child without asthma.
  • Many children with normal asthma suffer from more trouble from cold air, smoke and dust.
  • Allergic children with asthma can have asthma problems or asthma attacks if they come into contact with what they are allergic to. For example, playing or playing football on a lawn can cause more asthma problems in children who are allergic to grass.
  • Some who have common asthma are sensitive to strong scents and smells, such as perfume.

What can I do to make the child feel better?

It is important that the child uses his or her medicines, and that they are used properly.

In addition to this, there are several things you can think of to avoid the worsening of asthma.

Learn more about asthma

You as a parent and the child need to have a good knowledge of the disease and how it is treated.

All health centers and pediatric clinics that treat children with asthma should offer some form of asthma education. It can be individual or held in groups. Ask which courses are available at the reception you are in contact with. 

Avoid what the child is allergic to

Children who have allergies should not be unnecessarily exposed to what they are allergic to. For example, avoid having a dog if your child is allergic to dogs. However, you should not avoid things that the child is not allergic to. It does not protect against asthma or allergies.

Do not smoke and have a good indoor environment

Avoid all kinds of tobacco smoke near the child. The smoke irritates the respiratory tract and makes the drugs work worse. Smoke also does more harm to those who have asthma than others. Some children also experience increased asthma problems from the smell of smoke. It is important that people with asthma do not start smoking. There is a lot of help to get if you or someone in your area wants to quit smoking.

Correct moisture damage and poor ventilation in the home, if any.

Physical movement is good

It is good if the child is exercising and moving. There is research showing that children who have asthma suffer less from asthma if they move. However, the child needs to prepare before with warming and sometimes a few extra doses of bronchodilator medication. 

Visits to the health care

Go on regular visits to see that the treatment works and that the disease is under control.

Some drugs may need to be avoided

Some people with asthma may have severe asthma problems with some medicines for pain. This applies to medicines containing acetylsalicylic acid and anti-inflammatory drugs. Especially adults with asthma can react, but also some children with asthma.

In the case of pain and fever, people with asthma are usually recommended medicines containing paracetamol, such as Clevedon or Panadol.

Contact your child’s doctor if you are wondering which pain medication your child can use, especially if the child, due to other illnesses, needs special pain medication.

Treatment for asthma in children

With the right treatment, children with asthma should be able to play, sport and live an active and good life without any real obstacles due to the disease.

Different kinds of drugs

A large part of the treatment for asthma is treated with drugs. This applies no matter what kind of asthma the child has.

There are many different kinds of drugs used in asthma. Here is a brief summary of the different drug groups:

  • Respiratory widening drugs are used in all types of asthma. They widen and open the trachea quickly. In the case of mild and very temporary problems, it may be sufficient medication. The most common bronchodilator drugs are beta 2 stimulants. They are used both for asthma attacks and when needed to prevent or treat temporary asthma problems. 
  • Anti-inflammatory drugs are used if the symptoms of asthma are more frequent. They dampen inflammation of the airways, which makes the airways less sensitive. The drugs are used preventively for a long time. Common anti-inflammatory drugs are cortisone and antileukotrienes.
  • In severe asthma or when the child cannot tolerate the usual drugs, the child may need other medicines. It may be other types of anti-inflammatory drugs, and also long-lasting bronchodilator drugs.

Most often, the child is allowed to inhale the drugs

The drugs are available in different forms. They can be taken by inhalation or as tablets, powders or in liquid form.

Usually, different types of drugs are used that the child should inhale. It’s called inhaling. The medicines are taken with a spray or with powder in an inhaler.

Younger children need the help of an adult to take the drugs. They also need special aids to inhale. Most often, a respirator with a respirator is used. It is also called a spacer.

In order to get the drug in, it is important that the inhaler is used properly. Both children and adults should train together with the nurse at the reception.

Treatment for common asthma

In asthma due to inflammation, both anti-inflammatory and bronchodilator drugs are used.

Most children with regular asthma use anti-inflammatory drugs every day to prevent symptoms. They also take bronchodilator drugs with rapid effect, when needed and before exercise. It is important that the child always has his or her breathing tube medicine.

Objectives of the treatment

These are the goals of treatment for common asthma:

  • The child can handle normal physical activities, including play and sports.
  • The child needs a bronchodilator medication at most twice a week unless the drug is taken for preventative purposes before tough physical exercise sessions.
  • The child has no cough or asthma problems at night.
  • The child does not have severe asthma attacks.
  • The baby’s lungs are functioning properly.
  • The child has no troublesome side effects of the drugs.

Discuss with a doctor what you can do if the child has problems despite their treatment.   

Treatment of cold asthma

Children who have cold asthma only have trouble with colds. Most often, the child is given bronchodilator medication when the cold is in progress. The child may also need anti-inflammatory drugs when the cold is on, if the problems become severe.

If it does not help, the child will usually try preventative medication in the same way as in normal asthma. Preventive treatment may also be needed if the symptoms of asthma are frequent. This is because it is not always possible to determine if it is cold asthma that the child has, or whether it is ordinary asthma that mainly causes colds.

Allergy treatments

There are two additional treatments if the symptoms of asthma are due to allergy. One is allergy vaccination, also known as allergen immunotherapy. Then the child receives syringes for several years to reduce allergy sensitivity.

This treatment is most common in children who suffer from pollen or cat asthma. The vaccination causes less allergy to the substances against which the child has been vaccinated, which makes asthma easier to treat.

The second treatment method is used only in very severe allergic asthma when other drugs do not produce sufficient effect. The treatment means that the child receives a syringe with a so-called biological drug every two to four weeks. This means that the child does not react allergically. Then asthma becomes much easier to treat.

Good with a treatment plan

With a treatment plan, parents and older children can change the medication themselves if needed. The best thing is to work with the doctor to make a treatment plan for how the medication should be adjusted.

For example, the plan may include what to do if the child suddenly becomes much worse, in airway infections, in impaired PEF values, during pollen season, before exercise and during periods when the child has no symptoms.

Return visits and asthma checks

Children who have asthma go on regular visits at least once a year. How often this happens depends on the child’s age and the severity of the child’s asthma. Virtually all pediatric clinics and health centers have special teams for patients with asthma.

You can answer questions

During the visits, the child is examined whether the child is feeling well and whether the medication is working. The child can tell himself how he feels, with the support of his parents or guardians. Older children and teenagers may talk to the doctor or nurse alone, as they are given more responsibility for the treatment.

Most receptions also usually use a questionnaire that measures how well the child is feeling and how the treatment works. From the age of four, the child, together with parents, answers the questions, from the age of twelve answers themselves.

The doctor does a body examination and listens to the child’s lungs and heart, among other things. If the child is 5 to 6 years or older, how the child’s lungs work, at least once a year, is examined.

The child is allowed to measure and weigh. Cortisone can affect how the child grows and if the child regularly uses inhalation cortisone, the length of the child is measured one to two times a year.

A nurse usually checks if the child can take his or her medication properly. Every now and then, the nurse usually goes through how to inhale. It is especially important when the child is given a new drug to inhale.

Increased responsibility the older the child becomes

As the child grows older, they need to take on more responsibility for their treatment. A treatment plan usually helps. The older the child is, the more important it is that the child himself participates in discussions and decisions about the treatment. It becomes especially important during adolescence.

The child gradually needs to be prepared for his or her own responsibility when it comes to discussions and decisions about his or her situation. This may include, for example, the medications the child should have and how they should be taken, about other treatments, occupational choices and other possible consequences of asthma.

Living with asthma

For some, asthma is a disease that has a shorter duration, for others, asthma becomes a part of everyday life for many years. Here are some examples of things that can be good to think about in childhood asthma.

It’s good with exercise and sports

Treatment and medication mean that children with asthma can live just as actively as children without asthma. Exercise and sports are therefore usually not a problem. It is good for children to exercise and sports. It is good to know that many top-level elite athletes have asthma.

However, the careful warm-up is important, as it reduces the risk of having asthma problems due to the exertion. Children also usually need to take bronchodilator medication before exercise, to prevent the trouble.

Allergies may require special consideration

Although today’s asthma treatment is very effective, an allergy can involve limitations in daily life. If the child has fur allergy, for example, they should not have their own animals or ride and care for horses. Some children with asthma also have severe allergies to birch and grass pollen which makes spring and summer difficult. If the child has an allergy to any food, it can cause concern for both children and parents.

In many cases, however, it is good to have temporary contact with animals and to cope with spring and summer with the help of medicines for allergies. For many children with severe allergic asthma, the new so-called biological drugs have made asthma much better.

Young people need to discuss and problematize

In adolescence, it may feel extra important not to be different when it comes to health. Many teens question their illness and can sometimes stop taking their medication, perhaps without telling their parents or doctors.

Teens need to have their own and open dialogue with doctors and nurses and to discuss and ask questions about the diagnosis and treatment themselves. Sometimes it happens that the teenager absolutely wants to stop taking drugs, to test. In such cases, it should be done in agreement with the doctor. Then more visits need to be scheduled in order for the doctor to be able to detect if asthma is getting worse.

What is asthma and what is it due to?

Asthma is a disease of the trachea, which makes it more difficult to breathe. What causes the different types of asthma differs.

Common asthma is due to inflammation of the mucous membranes

Common asthma is due to inflammation of the mucous membranes. The trachea swells and it becomes difficult for the air to get to and from the lungs. The mucous membranes of the trachea become extra sensitive by the inflammation and react more easily to certain substances such as pollen and fur animals.

In the case of an asthma attack, several things happen simultaneously in the trachea. The mucous membrane of the trachea swells and the muscles around the trachea contract. Tough mucus is formed which can clog the small airways that lead into the lungs. It makes it difficult to breathe and it can beep or hiss when the baby is breathing.

In well-treated asthma, the inflammation is under control and the respiratory tract is no longer swollen. Then they can be exposed to, for example, exertion and cold air.

Most people who get asthma get it as a child. But you can get the disease at any time of life. As with many other diseases, both heredity and the environment are important. Children may inherit an increased risk of having asthma or allergies, but this need not be the case.

Normal asthma can be alleviated or disappear during childhood.

Children with asthma are often allergic

Common asthma can be divided into allergic asthma and non-allergic asthma. Allergic asthma is meant that the child has an allergy to something. In non-allergic asthma, the child has no allergies. Inflammation of the airways is, however, usually of the same type. This means that almost all the medicines used for allergic asthma can be used for non-allergic asthma.

Almost all school-aged children who have asthma also have an allergy. This means that the child may have asthma problems from what they are allergic to, for example, pollen, fur animals or mites. The child may also have trouble if they eat or drink something they cannot tolerate. Children who have allergic asthma often also have eczema.

There is both a rapid allergic reaction that comes within an hour and a slower one that comes only after a few hours. Therefore, the trouble can come several hours after the child has been in contact with something that they are allergic to. However, in severe allergic reactions to something the child has eaten or drank, the complaints usually come quickly.

Cold asthma disappears as the child gets older

It is not really clear what cold asthma is due to. But research indicates that the trachea is too narrow and soft because the lungs have not yet grown clear. This causes the child to have trouble when there is an infection of the respiratory tract, especially in the case of colds. The child cannot keep the trachea open as long as the infection is ongoing. Once the infection has passed, the child can breathe again as usual. This type of asthma is also called infectious asthma.

The problems usually start early, usually during the child’s first year of life. As the child grows, the airways become more stable, which causes the problems to disappear within a few years. They usually disappear before the child is 6–7 years.

The first two times a child without allergies or eczema gets asthma-like problems, the diagnosis of obstructive bronchitis is used. From the third time, the diagnosis of cold asthma or infective asthma is used. In many countries, infectious asthma is not considered asthma.

Affect and participate in care

You can seek care at any healthcare center or open specialist clinic you want throughout the country. Sometimes a referral to the open specialized care is required.

Children should be involved

There is no age limit when a child is allowed to participate in a care situation. The child’s right to decide for himself is related to the child’s maturity. The older the child, the more important it is for them to be involved in their care. In order to be active in health care and to make decisions, it is important that you understand the information you receive from health care personnel.

You have the opportunity to get help from an interpreter. You also have the opportunity to get help from an interpreter if any of you have a hearing loss.

You should get information about different treatments

The healthcare staff should tell you what treatment options are available. They should make sure you understand what the various alternatives mean, what side effects are available and where the child can be treated. This way you can help decide which treatment is right.

Muhammad Nadeem

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