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, a tight feeling in your chest 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 can lead to wheezing, coughing, breathlessness and a tight feeling in your chest.
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, emotions such as anxiety and excitement, 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 may be 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 squeaky noise in your chest)
difficulty breathing, feeling out of breath and as though you can’t get enough air out of your lungs
a tight feeling across your chest.
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 seek 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
reliever medication isn’t working.
While waiting for an ambulance follow your asthma action plan and use your child's short-acting reliever. Sit your child down and try to stay calm, give 6 puffs of reliever through a spacer, taking 6 breaths for each puff. Repeat this every 6 minutes until your child improves or until help arrives.
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.
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.
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 their age, as it needs needs maturity, cooperation and understanding 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 as healthy as possible
stop asthma from interfering with school
help your child 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 relievers, preventers and corticosteroids (for severe asthma attacks).
Type of asthma medication
Description
Relievers
Relievers are used for quick relief when your child has 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.
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 and to ensure that more medicine gets into their lungs, children should always 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.
Teresa Demetriou is the head of education and research at the Asthma and Respiratory Foundation NZ and co-author of the Child and Adolescent Asthma Guidelines. As a registered nurse with a wide range of experience in primary health, respiratory healthcare and education, she is responsible for ensuring that evidence-based best practice is implemented into all of the Foundation’s training, guidelines and resources.
Credits: Health Navigator Editorial Team. Reviewed By: Teresa Demetriou, head of education and research, Asthma and Respiratory Foundation NZ
Helping your child live well with asthma
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
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 preventer 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 medications. 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. The main types are:
asthma preventers - taken every day to prevent symptoms from developing
prednisone - tablets or liquid, used for a short time when asthma symptoms are severe.
Asthma medicines are generally available in two main types of inhaler devices – metered dose inhalers (MDI) or puffers and dry powder inhalers such as Turbuhalers, and Accuhalers. Metered dose inhalers (puffers) can be used with a spacer. Read more about inhalers and spacers.
What do relievers do? Relievers are used for quick relief when your child has 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 2 times per week, tell your doctor – you will need your child's asthma medication to be reviewed.
Preventers
Preventers are used long term to prevent asthma symptoms from coming on.
Preventers must be taken every day, even when you are not having symptoms.
Preventers take days or weeks to work. They do NOT provide quick relief of asthma symptoms.
The main types of preventers commonly used are: ◦steroid preventers ◦long-acting bronchodilator preventers.
They work by reducing swelling of your airway and preventing mucus build up, which narrows the airways.
Your child's asthma can get worse if they skip a few doses because they feel better. It's important not to skip doses. Rather, talk to your doctor about the possibility of reducing your child's dose.
Side effects:
Research has found steroid preventers to be safe when used for long periods.
There are some side effects that can be reduced by using a spacer and rinsing your child's mouth after using their preventer.
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.
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, it's likely their asthma is not well controlled, then you need to review their asthma plan with their doctor.
In younger children who cannot swallow tablets, a liquid form is available calledprednisolone(Redipred®).
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 inhaler devices are:
metered dose inhalers (MDIs)
dry powder inhalers such as Turbuhalers and Accuhalers.
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 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 for 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:
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 letter allowing access to 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.
Teachers' 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 that some of these resources are from overseas and the support and services information will be different to those used in New Zealand.
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.
Medicated asthma prevalence showed no significant change during the study period in adults or children. The hospitalisation rate for asthma peaked in 2009 at 218 per 100,000 people, and overall declined slightly over the study period. Asthma mortality rates, however, which appeared to be declining in the previous report, have returned to previous higher levels, peaking at 2.0 deaths per 100,000 in 2014.
Risks for asthma were similar across measures. Prevalence, hospitalisation and mortality were all significantly higher for both Māori and Pacific peoples, and in more socioeconomically deprived neighbourhoods. In children, all asthma measures were higher for boys, whereas for adults, asthma measured higher for women.
Socio-economic differences in asthma hospitalisation saw rates 2.7 times higher in the most deprived NZDep2013 quintile 9-10, and 1.9 times higher in NZDep2013 quintile 7-8, compared to the wealthiest NZDep2013 quintile. These differences were similar to mortality differences. Asthma prevalence showed a deprivation gradient for female children, but not for female adults, and not for males.
2017 asthma hospitalisation rates were lower than the national average in all South Island DHBs except West Coast, and higher than the national average in all North Island DHBs except Auckland, Waitematā, MidCentral and Capital and Coast; 2015 mortality rates were highest in the Tairawhiti and Lakes DHBs.
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 
