Asthma is a condition that causes cough, wheeze and shortness of breath. It is common, with 1 in 7 children in New Zealand taking medication for asthma. With treatment, asthma can be well managed and children can run and play as normal. Many also grow out of it as they get older.
This page focuses on asthma in children. See also asthma in adults for more information.
Key points
Asthma is an inflammation of your airways. This leads to them becoming narrower, which makes it harder to breathe.
Key symptoms of asthma are coughing, wheezing and finding it hard to breathe.
Asthma is very common in children, but many grow out of it as they get older.
Asthma can be well managed through medication and managing triggers.
If your child has severe asthma, follow the steps below and seek urgent medical help.
What is asthma?
In asthma, the small and medium-sized airways in the lungs, called breathing tubes or bronchi, become inflamed. This causes:
swelling of your airways
tightening of your airway walls
an increase in mucus (phlegm).
These changes cause narrowing of your airways. This leads to wheezing, cough and difficulty with breathing.
Source: 123rf.com
What causes asthma?
Children with asthma have sensitive airways that react to certain triggers, such as allergens (substances that cause an allergic reaction), viruses, cold or humid weather, exercise and air pollutants, such as cigarette smoke.
It is not clear why some children get asthma and others don’t. Asthma is more common in people who have eczema or allergies such as hay fever, so if you have these in your family your child is more likely to develop asthma.
What are the symptoms of asthma?
Common symptoms of asthma include:
cough, which can be worse at night or in the morning, or with exercise
wheezing (a whistling, musical or squeeky noise in your chest)
difficulty breathing, feeling out of breath and as though you can’t get enough air out of your lungs.
Some children have symptoms more often and need to be managed with preventative medication, while other children only have symptoms when they have a cold, are exercising or are exposed to some other trigger.
If your child has mild asthma symptoms, follow their asthma action plan and use their short-acting reliever. If symptoms don't settle you should see a doctor straight away.
Keep an eye on your child's symptoms. If your child is getting wheezy more than 2 times a week, it may mean your child's asthma is not well controlled. See your doctor for a check up.
Severe asthma symptoms
Sometimes some children experience severe asthma symptoms. You should follow your child's asthma action plan and give them their reliever inhaler if they have the following symptoms:
breathing fast, wheezing and having to use extra effort to breathe
breathless at rest
look pale and unwell, and is beginning to get tired
have trouble completing a sentence because of difficulty breathing.
See your doctor straight away if symptoms have not improved within a few minutes of using their reliever inhaler or if you are worried.
When to see urgent medical help
Dial 111 within New Zealand and ask for an ambulance if your child:
If your child has symptoms of hay fever (also known as allergic rhinitis), such as a blocked or runny nose, talk to your doctor. They may recommend medication to treat these symptoms, such as antihistamines or steroid nasal sprays. Treating hay fever can improve asthma symptoms.
What are the common asthma triggers?
Learning what triggers your child’s asthma and finding ways to avoid or reduce the impact of these is an important part of managing your child’s asthma. The following are examples of common asthma triggers:
house dust mite
infections of the airways, such as colds and flu
pollen or mould
pets
cigarette smoke
weather, such as a change in temperature, cold weather or humid weather
exercise
stress and strong feelings
chemicals that irritate your airways, such as sprays, perfumes, cleaning fluids
some medications.
How do I know my child has asthma?
If you are concerned your child may have asthma take them to see their doctor, who will:
ask about your child’s asthma symptoms at present and in the past
ask whether your child or any close family relatives have any allergies such as eczema or hay fever
listen to your child’s breathing with a stethoscope
check how your child’s lungs are working with a device called a peak flow meter. This can be difficult to perform in children, depending on the age of the child, as it needs cooperation from the child.
Asthma action plans
If your child is diagnosed with asthma, your doctor will help set up an asthma action plan for your child. This plan will be tailored to suit your child’s condition. It will provide advice on how to manage your child’s asthma on a daily basis and how to recognise and handle worsening symptoms.
While asthma cannot be cured, the correct use of medication combined with other self-care measures means that symptoms can be well controlled in most children. Once a diagnosis of asthma is made, your doctor will assess which medication is right for your child.
The main aims of asthma treatment are to:
keep symptoms under control
prevent asthma attacks or exacerbations (sudden worsening of symptoms)
keep lungs healthy as possible
stop asthma from interfering with school or work
help you enjoy a full and active life.
Asthma medications
There are many different types of asthma medicines. The choice of medication will depend on how severe and frequent your child's asthma symptoms are. Sometimes your child will have to take more than one.
Asthma medications fall into the main categories of:
Symptom relievers
These provide short-term relief by relaxing the muscles around your airways.
This helps open up your airways, making it easier to breathe.
Asthma medication usually comes in an inhaler (puffer). An inhaler is a device used to get medicine into your lungs and airways. By getting medicine directly to your lungs, a smaller dose of medicine is needed, and it can start working more quickly. The main types of inhaler devices are:
metered dose inhalers (MDIs)
dry powder inhalers such as Turbuhalers, Accuhalers, and Handihalers.
To make using an MDI easier, children usually use it with a spacer – a clear plastic tube with a mouthpiece or mask on one end and a hole for their inhaler at the other.
Asthma is a common New Zealand illness, but it’s scary when it affects the child you care for. The good news is that it can be well managed and your child can be fit, healthy and happy.
The Asthma & Respiratory Foundation NZ has developed a guide for the parents, whānau and other caregivers of children with asthma. It teaches you how to help prevent an asthma attack and what to do if one does happen.
There are many things you can do to improve how well your child's asthma is controlled.
Get an asthma action plan
Ask your doctor or nurse for an asthma action plan for your child. You can take this home to help you remember what to do when your child has asthma.
Help them to use inhalers
Find ways to help your child remember to use their inhalers when they are supposed to. If your child is too young to do this themselves, you will have to remember to do it for them.
Help them to stay active
Encourage your child to keep active. Physical activity improves how well their lungs work, and children who are fit usually find they have less asthma and cope better when they do have it.
Visit your team
Visit your asthma team (your GP, your practice nurse and your pharmacist) regularly. They will review your child's medications and teach them how to use their inhaler properly so they get the most benefit from it.
See a specialist
See an allergy specialist about managing your child's allergies, if these are known to trigger their asthma.
Ask questions
Ask questions. Make sure you understand how your child should take their medications and what triggers your child should avoid.
Check their spacer and inhalers
Check your child's spacer and inhalers regularly. These need cleaning once a week and replacing once a year.
Quit smoking
It's important to not smoke around your children, so if you smoke, think about quitting.
Green zone – when well, make sure they take their preventor inhaler one or two times a day as directed by your doctor.
Yellow Zone – if they develop a cold (runny nose, cough or sore throat), your doctor may suggest they take their reliever inhaler 2 to 4 times per day.
Orange Zone – if they are getting wheezy, coughing or their peak flow is dropping, follow the instructions about what to do.
Red Zone – if their symptoms are getting worse, they are having trouble talking or are very short of breath, phone 111 for emergency help.
Asthma medications
There are many different types of asthma medicines. The choice of medication will depend on how severe and frequent your child's asthma symptoms are. Sometimes your child will have to take more than one. They fall into the main categories of:
asthma preventers (taken every day to prevent symptoms from developing)
prednisone (steroid tablets or liquid, taken when asthma symptoms are severe)
Most asthma medication is available as an inhaler ('puffer') which is commonly used with a spacer.
Relievers
What they do
Examples
Relievers are used for quick relief when your child is experiencing difficulty breathing. They are fast-acting and improve breathing immediately.
Relievers should only be used now and again. Using them too often means that your child's asthma is not well controlled.
Tip: If you find your child is using their reliever more than 3 times per week, tell your doctor – you will need your child's asthma medication to be reviewed.
These are available as puffers or inhalers such as:
If your child's asthma symptoms are not fully controlled by the steroid preventer alone your doctor may add a long-acting bronchodilator preventer.
A bronchodilator preventer widens (dilates) the airways (bronchi) by relaxing the muscle that surrounds the airways.
Bronchodilators are used in addition to your steroid inhaler.
The medicines in these inhalers work in a similar way to ‘relievers’, but work for up to 12 hours.
Types:
these are available as long-acting bronchodilators on their own, or
for convenience, some brands contain a steroid plus a long-acting bronchodilator in a single inhaler. You may hear these described as ‘combination’ inhalers
Prednisone is a steroid medicine that works very well to reduce inflammation in the airways.
If your child's asthma symptoms become severe or they have an asthma attack, your GP or asthma nurse may give them a short course of steroids for 3 to 6 days to help their asthma settle.
Short courses of prednisone are safe and have no lasting side effects.
If your child needs prednisone more than 2 times a year then their asthma is not well controlled and you need to review their asthma plan with your doctor.
In younger children who cannot swallow tablets, a liquid form is available called prednisolone (Redipred®).
Inhalers
Most asthma medication is available as a puffer (pump) or inhaler. An inhaler is a device used to deliver medicine to the lungs and airways. By getting medicine directly to the lungs, smaller doses of medicine are needed and it can start working more quickly. The main types of inhaler devices are:
metered dose inhalers (MDIs)
dry powder inhalers such as Turbuhalers, Accuhalers, and Handihalers.
The type of inhaler should suit your child's age and ability to use them properly. You should discuss the best choice for your child with your healthcare provider. Younger children can use MDIs with a mask attached to a spacer. As children get older, they can use their MDIs with a spacer (without a mask) or a dry powder inhaler.
A spacer is a long plastic tube into which the inhaler fits. It makes it much easier to use an MDI. In younger children, the spacer is attached to a mask that holds the spacer in place over the mouth. As your child gets older, they can use a spacer without a mask. Your doctor or nurse can show you how to use a spacer properly.
TIP: You can often get a spacer for free from your doctor – just ask them for one.
How to use a spacer and a mask for giving asthma medicines
Please note, the following video was developed following Australian guidelines. In New Zealand, the recommended ratio is 1 puff to every 5 breaths.
It can be hard to remember directions or instructions from your healthcare provider. That's why you also need an asthma action plan for your child. This is a written document to help you remember what you need to do to help them manage their asthma well.
It includes information on how to:
manage their asthma daily, including making sure they take their medications correctly
identify and avoid allergens and irritants that can bring about asthma symptoms
know what worsening asthma symptoms are and what to do when your child has them
know when, how and who to contact in an emergency.
You can develop your child's asthma action plan with your healthcare provider. It will be based on how severe their asthma is and your preferences. At each visit with your healthcare provider, you can review their plan and make changes as needed.
What are the benefits of an asthma action plan?
Using an asthma action plan that meets your child's needs has been found to:
reduce absences from school
reduce hospital admissions
reduce emergency visits to your general practice
reduce reliever medication use
improve lung function.
Sample asthma action plans
Note:Some of these resources are from other countries, so make sure you know the emergency numbers for New Zealand. In an emergency, phone 111 and if you want advice at other times, phone Healthline on 0800 611 116.
This website is for health professionals to create a PAMP (pictorial asthma medication plan) for children and their families to remind them to use their regular inhalers for asthma. Fill in plan online to create a pictorial resource of an asthma medication plan.
Start here by entering patient and medication details.
See an example of the completed plan in the following languages:
This page has information for parents and for teachers and other staff to help manage asthma in children.
Managing asthma at school – for parents
There are things you can do to help your child and the school staff to manage your child's asthma while they are at school.
Talk to the staff
Discuss your child's asthma with their teacher and school nurse or health representative.
Explain how they can prevent or recognise symptoms of asthma.
Give them a copy of your child's asthma action planto follow if they have an asthma attack.
Ask the school to become an asthma friendly school and put an asthma policy in place.
Provide your permission and contact details
Give the school your written permission for them to give reliever medicine to your child in an emergency.
Make sure your contact phone numbers are kept up to date in school records.
Plan for trips and special activities
Check to see if the school has an asthma policy.
Make sure there is a plan for school trips, camps, sports clubs and all activities your child is taking part in.
Managing asthma at school – for teachers and other staff
The Asthma & Respiratory Foundation NZ recommend that every school has a School Asthma Policy to maintain the wellbeing and safety of all students with asthma, both at school and during extra-curricular activities.
You can take steps to make sure your school is an asthma friendly school.
An asthma friendly school:
identifies children with asthma when they enrol at the school
maintains a smokefree environment 24 hours a day, 7 days a week.
Advantages of asthma friendly schools include the following:
Children with asthma are supported, learn more in the classroom and get more out of their school life.
Some 550,000 school days are lost to asthma each year in New Zealand. Asthma friendly schools have fewer absences to cope with and more children are at school learning, rather than unwell at home.
The risks of an asthma attack (or at least an attack nobody at the school can deal with) are reduced.
It means there is fuller student participation in physical activities. Children with asthma are often kept on the sidelines because their asthma is not managed. If everyone is more informed, it is much more likely that children with asthma will be able to take part in physical activities.
Schools that meet the criteria for an asthma friendly school receive an Asthma Emergency Kit, including a reliever inhaler and a certificate stating they are an asthma friendly school from the Asthma & Respiratory Foundation NZ . For more information on asthma friendly schools contact Asthma & Respiratory Foundation NZ.
Teacher's Asthma Toolkit
The information in this toolkit will help you and your learning community understand more about asthma and how you can support people with asthma to manage their condition.
Throughout this toolkit, you will find suggestions for using some of the materials in staff meetings. There are also links to resources and lesson plans you can use in your classroom, particularly in the context of Strands A and D of the Health and Physical Education learning area.
Many of the resources below are translated into multiple languages. Please note, some of these resources are from overseas and the support and services information will be different to those used in New Zealand.
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
"Dr Diana North, (Goodfellow Unit GP Advisor) talks with Dr David McNamara, (Paediatric Respiratory and Sleep Medicine Specialist employed at Auckland's Starship Children's Hospital) about what is new in the diagnosis and management of asthma in children up to 16 years of age."
Follow your child's 
