Dr. Christopher Webber Answers the Top Ten Questions About Asthma in Children

1. What is asthma in children?

Asthma is treatable and a largely reversible inflammation in the lungs that causes increase in mucous and thickened airways (reducing oxygen supply). It also causes airway muscle instability (causing the muscles to "pinch" off the airways, which leads to wheezing, shortness of breath, and breathing problems).

2. What can I do to help my child with his asthma?

If you think your child has asthma, the best first step would be to talk to their pediatrician or an allergist.

3. How are children treated for asthma?

A recommended treatment plan includes:

-  Improving asthma control. This is often accomplished with a daily or twice a day inhaler of either inhaled steroids or combination "controller" inhalers.  

-  Purchasing a "rescue" inhaler in case of emergencies.

-  Taking a detailed history of triggers. This often involves allergy testing (either blood testing from the primary care provider or skin testing from an allergist). The key is to identify, then reduce exposure to as many triggers as possible.

-  After the lungs are stable and the triggers are identified and treated, reduce medication to the lowest dose needed to keep the airways stable. As a general rule, asthma medications should be lowered every 3-6 months if symptoms are controlled. 

4. What are the early warning signs of an asthma attack in children?

Every child's presentation is a little different for an asthma attack. Some of the key symptoms would be shortness of breath, difficulty breathing, chest tightness or chest pain, wheezing or "incomplete breaths" that don't feel normal. Any of these COULD indicate an asthma attack, and it is best to go see a doctor for these signs sooner rather than later.

Usually, these symptoms are the same ones that people use their rescue inhaler to treat. However, if your child needs a rescue inhaler multiple times a day, or if the rescue inhaler seems to be helping less than before, it would be best to go see your doctor.

5. What happens to my child's lungs during an asthma attack?

During an asthma attack, two things happen.  First, the inflammation starts to worsen and becomes uncontrolled.  This can lead to decreased oxygen use, increase in mucous and, most importantly, can lead to the muscles around the airway to tighten and "pinch off" the airways.  Once the muscles tighten then we see worsening shortness of breath, wheezing, and the worsening of all the usual asthma symptoms.  Often times when we think of an asthma attack, it is the symptoms that happen when the muscles tighten but the asthma attack may have started before that.  The key is if you suspect an asthma attack, see your primary care or allergist SOONER RATHER THAN LATER.  It is often easier to treat mild exacerbations with fewer medications and faster results than if you wait until the symptoms become severe.

6. What are the health risks of not treating my child’s asthma?

Asthma is a problem with your child's airways. One of the risks of not treating is the same as having any problems breathing: increased fatigue and exercise problems, decreased oxygen to the muscles and brain, decreased concentration and mental abilities. A lesser known risk is that not treating asthma can lead to a permanent loss of height as well (and a larger risk of height problems than any medication)!  In addition to this, uncontrolled asthma may lead to an increased risk of lung infections (bronchitis or pneumonias).

Asthma is a lung problem that is reversible with proper treatment. It is possible that if you don't treat asthma that some or all of the problems will become permanent (this is called COPD). So not treating asthma could lead to a permanent lung problem.

7. Can children outgrow asthma &/or allergies?

Children are very unlikely to outgrow seasonal allergies. As a whole, seasonal allergies tend to start during our childhood, peak in our 20-40s, then can improve with each decade after that. Many people will "outgrow" their allergies, but it's in their later decades of life (60s-80s).  

"Outgrowing asthma" is a tricky answer. Many young children are diagnosed as having asthma after severe infections (particularly RSV), which can appear as asthma for many years, but then "outgrow" the diagnosis and never have a problem again. Current literature suggests that about 1 in 5 children (20%) with a full asthma diagnosis will "outgrow" their symptoms.  However, of that group, about 1 in 3 (33%) will have symptoms that return later in life.

8. How can asthma affect a child's performance in school?

This is a great question that is difficult to answer. There are many factors you have to include such as, is the school in the inner city or is it rural, types of activities at school, other medical problems etc. However, a synopsis of several studies suggests:

- Kids with poorly controlled asthma show lower quality schoolwork and overall lower academic performance. 

- Kids with asthma were about 1 1/2 times more likely to have academic problems than kids without asthma.

- Kids with asthma were also about 1 1/2 times more likely to have behavior problems in school.

- Asthma causes more missed school days compared to children without asthma. 

- Kids with poorly controlled asthma often have more sleep disturbances and sleepless nights, which can also cause school and behavior problems.

9. How does sleep deprivation affect a child with asthma?

Uncontrolled asthma often causes sleep problems or non-restful sleep. This can cause problems in school, such as a negative affect on academic performance or behavioral issues.

10. How can a kid with asthma safely ride horseback at summer camp?

For many children, asthma is worsened by both allergy and irritant exposures. Horses are a major trigger of allergies (so is being outside during horseback riding weather), and we know that if allergies worsen, asthma can worsen. Horses also kick up a lot of dust and debris, which can cause a non-allergic/irritant trigger of asthma. The best way to safely ride horses is to PREVENT these triggers. I recommend these four steps:

 - Ensure your asthma is well controlled before horseback riding.

-  Consider pretreating 5-7 days before horseback riding with your antihistamine medications.

-  If you have more constant allergies, consider increasing your allergy control with nasal steroids or other nasal sprays.

-  After a day of horseback riding, make sure to shower so that you're not continuing to irritate your lungs.