Asthma is a condition that causes cough, wheeze and shortness of breath. It is common, affecting 1 in 4 children in New Zealand. 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.
In asthma, the small and medium-sized airways, also called breathing tubes or bronchi, in the lungs become inflamed and there is:
swelling of the airways
tightening of the airway walls
an increase in mucus (phlegm).
These changes cause narrowing of the airways. This leads to wheezing, cough and difficulty with breathing.
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 hayfever, so if you have these in your family your child is more likely to develop asthma.
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 high emotion
chemicals that irritate the airways such as sprays, perfumes, cleaning fluids
some medications.
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 the chest)
difficulty breathing, feeling out of breath, can’t get enough air out of the 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.
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 all children, depending on the age of the child as it needs much 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 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.
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.
Credits: Health Navigator team. Image from 123rf.com.
Helping your child live well with asthma
There are many things you can do to improve how well your child's asthma is controlled. By working with your doctor or nurse to create an asthma action plan, you can reduce the severity of your child's asthma symptoms and how often they occur.
Tips for caregivers:
Complete an asthma action plan for your child, to help you remember what to do when your child has asthma.
Remember 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 this themselves, you will have to remember to do this for them.
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 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, for maximum benefit.
See an allergy specialist about managing your child's allergies if these are a known trigger.
Ask questions – make sure you understand how your child should take their medications and what triggers your child should avoid.
Check your child's spacer and inhalers – these need cleaning once a week and replacing once a year.
Don't smoke around your children.
Ask for an asthma action plan
Ask your doctor or nurse for an asthma action plan (see the side bar). You can take this home to help you remember what to do when your child is unwell with asthma.
Green zone – when well, take your preventer inhaler one or two times a day as directed by your doctor
Yellow Zone – if you develop a cold (runny nose, cough or sore throat) your doctor may suggest you take your reliever inhaler 2 to 4 times per day.
Orange Zone – if you are getting wheezy, coughing or your peak flow is dropping, follow the instructions about what to do.
Red Zone – this tells you what to do if your symptoms are getting worse or if anyone has trouble talking, or is very short of breath. In NZ, ring 111 for emergency help.
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's wise to discuss your child's asthma with the teacher and school health representative. Explain how they can prevent or recognise symptoms and provide them with a copy of your child's asthma plan to follow in an asthma attack. The school itself can also help by becoming an Asthma Friendly School and having an asthma policy in place.
Permission & contact details
Ensure the school has your written permission to give reliever medicine in an emergency and that your contact phone numbers are kept up to date in school records. Check to see if your child's school has an asthma policy.
Plan for trips & special activities
Parents and schools should have a plan for school trips, camps, sports clubs and all activities where children with asthma are participating.
What is an Asthma Friendly School?
An Asthma Friendly School (AFS) is one that:
identifies children with asthma when they enrol at the school
has staff educated in asthma safety
has an asthma policy
maintains a smokefree environment 24 hours a day, 7 days a week.
Benefits of Asthma Friendly Schools
Advantages of AFS schools include:
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. AFS schools will have fewer absences to cope with and more children will be 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.
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.
The Asthma Foundation can supply schools with a suggested asthma policy as part of its AFS programme. Schools that meet criteria receive an Asthma Emergency Kit including a reliever inhaler and a certificate stating they are an Asthma Friendly School.
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. On this page:
"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."
Ask your doctor or nurse for an asthma action plan (see the side bar). You can take this home to help you remember what to do when your child is unwell with asthma.
