Asthma is a condition that leads to narrowing of the airways of the lungs.
Symptoms include wheeze, cough and difficulty breathing.
Common asthma triggers are colds (viruses), exercise, dust, pollens and cigarette smoke.
What is asthma?
Asthma is a common breathing condition. It affects the small and medium-sized airways (bronchi) in the lungs.
In asthma, your child's airways are inflamed and there is:
swelling of the airway wall
an increase in mucus or phlegm
tightening of the muscle in the airway wall (see the image below).
These changes cause narrowing of your child's airways. This leads to wheezing, cough and difficulty with breathing.
Wheezing is a musical, whistling sound that children make, usually when breathing out. It can also happen when they breathe in. The sound comes from the chest, not from the nose or throat.
Image credit: Wikimedia
Why do some children have asthma?
One in 4 tamariki in New Zealand will have asthma at some time during childhood. It is not clear why some children have asthma when others do not.
Asthma in children is more likely if:
the mother smoked during pregnancy
they have eczema, hay fever or allergies
there is asthma in the family – parent, brother or sister
one or both parents have an allergic condition such as asthma, hay fever or eczema.
Modern Western lifestyle may play a part in the rise in asthma that has happened over the last few decades. Changes in housing, diet and a more hygienic environment may contribute. Outdoor environmental pollution may make asthma symptoms worse but it does not actually cause asthma. Experts continue to study the reasons for the increase in asthma.
What causes an asthma attack?
Children with asthma have airways that are sensitive and react to certain triggers. Some children have asthma all year round. Others may only have it in certain seasons or situations.
Triggers that cause an asthma attack include:
viruses – eg, a cold with a runny nose
things you are allergic to such as pollens, moulds, pet hair and dust-mites
cold or humid weather, or a change in the weather
exercise
emotions such as anxiety and excitement
air pollutants, such as cigarette smoke.
Keep a symptom diary and a record of possible triggers
Asthma symptoms and triggers may differ from child to child and from time to time. It is useful to know your child's triggers. Keep a symptom diary and keep a record of possible triggers.
Make sure your child's environment is smoke-free
Ensure your child's environment is smoke-free, wherever they happen to be. Asthma increases in children whose parents smoke. Tobacco smoke also triggers asthma attacks and makes a child's asthma more severe than it would otherwise be. Many environmental factors contribute to asthma; cigarette smoke is one that you can avoid.
If you want to give up smoking:
call the free Quitline on 0800 778 778 or text 4006
You should see your doctor and ask about asthma if your child:
wheezes and coughs with a cold (virus)
wheezes and coughs after exercise
wheezes and coughs during the night
cannot keep up when they are running around with children of the same age
says they are out of breath or breathless
complains they feel tired or asks you to carry them (depending on their age) when you go for a walk
does not run around as much as other children of the same age.
These are some of the symptoms of asthma in children, but they may also be due to other less common conditions. Talk to your doctor about them.
If my child has asthma
Every child with asthma needs an action plan. If your child has asthma, ask your healthcare provider for an asthma action plan. The plan will tell you how to prevent asthma attacks and how to manage them when they happen. Read more about asthma action plans.
(Asthma UK, 2018)
How do I prevent my child from having asthma attacks?
Preventers help prevent asthma.
Not all children need preventer medicine. If your child is getting wheezy more than once a week, your family doctor may suggest a preventer medicine. Your child needs to take their asthma preventer every day, sometimes twice a day, even when they are well. Most asthma preventers are inhalers that you need to use a spacer with. Sometimes, your doctor may give you a preventer that is a tablet.
How do I treat my child's asthma attack with prescribed medications?
If you have had asthma medicine prescribed, you will need to use the blue inhaler (salbutamol) with a plastic tube called a spacer.
give 2 puffs of the blue inhaler, one puff at a time, using the spacer, every 4 hours
for each puff of the blue inhaler, your child will need to take 6 breaths through the spacer.
If your child is still not improving:
you can give up to 6 puffs of the blue inhaler every 4 hours
You need to take your child to your family doctor, or an after-hours clinic, or the hospital:
if you need to give the blue inhaler more often than every 2 hours
if there is no improvement 30 minutes after giving 6 puffs of the blue inhaler
How do I treat my child's asthma attack if I don't have asthma medications?
If your child is showing symptoms of an asthma attack and you don't have a blue inhaler, call 111 for emergency help. While you are waiting for help there are things you can do to help your child breathe better.
Sit them upright. Don't lie them down.
Focus on breathing. Get them to take slow and steady breaths.
Remain calm, as panicking will make things worse.
When should I seek urgent help for my child's asthma attack?
Many children have only mild asthma. But be careful - it's possible for any child with asthma to have a severe, life-threatening attack.
When to see a doctor urgently
Keep your child sitting up and give them 6 puffs of the blue inhaler through the spacer and see a doctor urgently if your child has any of the following symptoms:
Is breathing fast, wheezing and having to use extra effort to breathe.
Is breathless at rest.
Looks unwell.
Looks pale and is beginning to get tired.
Gets worse after beginning to get better.
Has trouble completing a sentence because of difficulty breathing.
With severe asthma it is usually better to dial 111 rather than drive your child in your own car to the hospital.
Keep your child sitting up and give them 6 puffs of the blue inhaler through the spacer. Immediately dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for emergency medical help 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.
With severe asthma, it is usually better to dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for emergency medical help, rather than drive your child in your own car to the hospital.
While you are waiting for the ambulance, keep giving your child 6 puffs of the blue inhaler through the spacer every 5 minutes.
Will my child grow out of asthma?
Asthma is a long-term condition. The majority of children with asthma have less troublesome asthma as teenagers. Symptoms can appear again in adulthood. If your child has severe asthma, it is more likely to continue or return in later life.
Your child should learn about asthma and gradually take over responsibility for its management, as they become a teenager, with support from you.
Credits: KidsHealth NZ & Health Navigator Editorial Team.
Last reviewed: 02 May 2022
Asthma medications
There are many different types of asthma medications. The choice of medication will depend on how bad your child's asthma symptoms are and how often they experience them. Sometimes more than one medicine is needed to control symptoms. A spacer with or without a mask can help deliver doses of medicines from inhalers.
Most asthma medication is available as 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 inhaled medicines are relievers and preventers.
The inhaled medicines can be delivered by different types of inhaler devices. The different types of inhaler devices are:
metered dose inhalers (MDIs) such as Respigen
dry powder inhalers such as Turbohalers and Accuhalers.
The type of inhaler should be chosen to 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.
Relievers are used for quick relief when your child has difficulty breathing. They are fast-acting and improve breathing immediately.
Relievers should only be when needed. Using them too often means that your child's asthma is not well controlled.
Relievers don’t have a lasting effect like preventers – their effect wears off in a few hours and they don’t change the swelling in the breathing tube.
Preventers
Preventers are used long term to prevent asthma symptoms from coming on.
Preventers must be taken every day, even when your child is not having symptoms.
Preventers take days or weeks to work. They do NOT provide quick relief of asthma symptoms.
What do combination steroid + long-acting bronchodilator preventers do?
If your child's asthma symptoms are not fully controlled with the steroid preventer alone, your doctor may add a long-acting bronchodilator preventer in a combination inhaler.
The long-acting bronchodilator widens (dilates) the airways (bronchi) by relaxing the muscle that surrounds the airways for a longer period of time.
The long-acting reliever is combined with the steroid inhaler to help prevent and control symptoms.
Prednisone (liquid or tablets)
Prednisone is a steroid medicine that works quickly to reduce inflammation in the airways.
Prednisone is used if your child's asthma symptoms become severe or they have an asthma attack
It works slowly over several hours to reverse the swelling of the airways.
Montelukast is a type of anti-inflammatory medicine that comes in tablet form. Montelukast is NOT used to treat an acute attack of asthma. Read more about montelukast.
Spacers
A spacer is a long plastic tube that the inhaler fits onto. It makes it much easier to use an MDI and delivers more medicine to the lungs. In younger children, the spacer is attached to a mask that holds the spacer in place over the nose and 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. Read more about Spacers.
TIP: You can get a spacer free from your doctor or nurse – just ask them for one.
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:
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:
Many of the resources below are translated into multiple languages. Please note that some of these resources are from overseas and the support and services information will be different to those used in New Zealand.
Note: This resource is from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.
Note: This resource is from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.
Note: These resources are from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.
Malachi's story – asthma plan reaps positive results
Malachi Douds Nanapoy is a six-year-old from New Plymouth who has asthma. Malachi was born 31 weeks gestation (average is 40 weeks) and lives with respiratory conditions that impact on his health and his learning.
Malachi now has an asthma plan which he and his family follow. Through the guidance of their asthma nurse Sharani at Taranaki Hospital, they have become educated in managing Malachi’s asthma much more effectively. He only had one hospital visit in 2015, which is a big improvement from recent years.
Malachi's grandmother Vicki says, "as a family we are becoming more educated and able to manage without escalating crisis. Bouts of breathlessness and coughing are recognised earlier and the plan is actioned".
Malachi can now understand some of the triggers and helps his family to recognise the signs that he is not coping effectively. He understands that the cold wind affects his breathing and will come inside. Malachi also takes his inhalers, counts his puffs and lets his family know if it has not been done properly.
The improvement in Malachi's health has allowed him to attend school more frequently, and the teachers have started to see progress in his learning.
Malachi doesn't let his condition hold him back, and lives a very active life. He enjoys swimming lessons, is a great cricket player, and has done very well in cross country. Malachi came second in his first school cross country, when he only had to stop to get his breath once.
Swimming is important to Malachi and unfortunately it was an activity he could not participate in often as he had no breath. He is now becoming a confident regular swimmer at a private swimming school where the water is warmer and he can enjoy being part of a class and shooting off in the water.
Malachi also enjoys mega bounce and is quite skilled at riding his bike, remembering to come inside when it is windy.
“Malachi’s extremely confident in sports, and the joy it brings to him when he has completed a game of cricket is just awesome. We are all looking to enjoy more involvement in the community rather then being extremely ill and missing out on being an active 6 year old child," says Vicki.
Tomairangi's story – 89 hospital admissions yet still smiling
Tomairangi's severe brittle asthma has sent her to hospital 89 times. Here, her mum Sharon talks about her daughter's resilience and the effect her condition has had on the whole family, both good and bad.
"Our daughter Tomairangi is 12 years old. She's been in hospital 89 times – that's 272 days of her life. That makes you question things, like the amount of school she’s missed out on. Not just from an academic perspective, but everything else that she misses out on. She has friends, but these are friends for school. She never has enough time to develop her friendships. Never had a best friend. Doesn’t get invited to parties or birthdays. Never gets a visit from any of her friends while she’s in hospital. Friendships need time to grow, to nurture and deepen. You can’t really do that when you’re in hospital. Her best friends are probably the nurses and the play therapist.
My daughter’s asthma is classed as severe brittle. It’s unpredictable. It’s stubborn. It takes on a life of its own. It keeps trying to kill her, again and again. It nearly succeeded last year, but our daughter is strong, so resilient. When you have two respiratory arrests, and lose a cardiac output twice and need CPR for a total of 11 minutes and it still can’t take you, you’re superhuman. That day was the worst. I play it over and over in my head at times.
The fear is always there. Stuff like that plays with your head and makes things so much harder to cope with. The post-traumatic stress is in all of us. Me, Tomairangi, my husband and our other children. Every time Tomairangi has a bad asthma attack, every time she looks at me with sheer panic in her eyes that she can’t breathe. Every time the phone rings and the caller ID says it’s either school or the hospital, my heart skips a beat, my stomach drops and I lose my breath.
We sleep in power nap mode with one ear always open. Every cough, every cry, every wheeze, I hear them all. We probably get two to three hours of uninterrupted sleep every night, from 1 to 3 am. In between those times it’s puffers, and drinks of water, breathing exercises and coughing up phlegm. It’s tears, and fears of not being able to breathe. It’s relentless.
Our other children manifest their fear in different ways. One misbehaves at school, starts fights, gets frustrated and angry and tearful. The other goes quiet. Doesn’t get in the way, doesn’t bother anyone, retreats back into herself. They’ve seen a lot over their few short years. Spent far too much time in hospitals. Their relationship with their sister is difficult. Like friendships, it’s hard to maintain a healthy relationship when one half is never there. So when they do end up all together, it’s chaotic. Laughs, fights, tears all in the space of a few minutes. It’s an extreme roller coaster of emotions and these kids don’t know whether to laugh and enjoy it or cry and get off the damn thing.
Work is very understanding. Allowing me the time I need to look after our daughter. My husband’s work not so. It’s the same with every manager he’s ever had. Sure they’re understanding and sympathetic to start with, really feel sorry for our situation. But then one absence turns into another and another and another, and then the questioning starts.
It’s not like this for every child with asthma, but it is like this for us. It’s a hard road to travel. But you know what? Through all of this our little family is so strong. We know what’s important and what isn’t. Determined to do what we can to give our daughter the life she deserves.
We’re excited by the prospect that a cure for asthma may be found in her lifetime. We hold onto that hope. So that she can be her own person and not someone defined by her medical condition."
To help manage you or a family members' asthma, it's important to have an asthma plan in place. See your doctor and ask for an asthma plan.
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."
(Goodfellow Unit, NZ, 2017)
Asthma and COPD Fundamentals
Asthma and COPD Fundamentals Course Asthma & Respiratory Foundation NZ This course aligns the latest research with specific information for the New Zealand context, such as recently funded medications, treating Māori and Pasifika peoples, and best practice health literacy.
The course aligns with the latest New Zealand asthma guidelines. It includes two half day workshops covering the key aspects of COPD and asthma pathophysiology, management and practice.
