Asthma in children

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.


image of narrowed airways due to asthma

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:

  • has severe difficulty breathing
  • is too breathless to talk
  • is floppy and very tired
  • is becoming less responsive
  • has blue lips and tongue
  • has periods of stopping breathing.

While waiting for an ambulance follow your asthma action plan and use your child's short-acting reliever.

Allergy symptoms

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.

Read more about asthma action plans

How is asthma treated?

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.
    • Common relievers include salbutamol and terbutaline.
  • Asthma preventers 
    • These reduce the inflammation inside the airways and reduce the risk of further asthma attacks.
    • Preventer inhalers are taken every day to prevent symptoms from developing. They do not provide quick relief of asthma symptoms.
    • The two main types of preventers commonly used are:
  • Corticosteroids 
    • Examples include prednisone (tablets) or prednisolone (liquid).
    • These are usually taken for very severe episodes of asthma and works more intensely to reverse the swelling of the airways. 

Read more about asthma medications 

Asthma inhalers & spacers

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. 

Read more about inhaler devices and spacers

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Learn more

Learn about lungs Asthma & Respiratory Foundation, NZ
Asthma
Kids Health NZ
Asthma in children NHS Choices

Credits: Health Navigator team. Image from 123rf.com.