Ask Dr. Bell: Breathing Easier with Asthma

Louis Bell, MD, chief of the Division of General Pediatrics at CHOP, shares the latest in medical thinking on an important topic: asthma.

Published on in Children's View

Ask Dr. BellAlong with changing leaves and a new school year, for some families fall coincides with more trips to the hospital. Chilly weather and bouts of the common cold can make it harder for kids with asthma to breathe. How can you tell if your child has asthma? What can you do to keep him or her out of the emergency room?

Tyra Bryant-Stephens, MD, founder and director of the Community Asthma Prevention Program at CHOP, offers some general guidelines for preventing and treating asthma. Asthma is complex and individual to each child, and it is the most common chronic childhood disease — affecting about 7 million kids in the U.S. — and one of the most common reasons for emergency room visits and hospitalization.

Asthma typically is diagnosed with classic wheezing episodes and/or coughing episodes. Infants and children younger than 3 years old may experience four or more wheezing episodes during a cold or respiratory infection, and children between the ages of 3 and 6 may complain of nighttime coughing — perhaps your first clue that your child has asthma. Children older than 6 can be diagnosed with a breathing test.

Finding the asthma 'trigger'

The next step is to determine what might be the cause of the episodes, what’s known as the trigger, which can be anything from environmental factors in the home such as dust mites and cigarette smoke to allergies and respiratory tract infections.

If your child’s colds seem to last much longer than seven to 10 days with a lot of coughing, which is worse at night, he or she may have asthma.

An asthma trigger causes inflammation and swelling of the airways, narrowing them and resulting in wheezing and coughing. One important way to manage asthma is to remove triggers; something as simple as cleaning and using pillow and mattress covers can minimize your child’s exposure to indoor triggers, particularly dust or cockroaches — a major allergen in cities.

Children sensitive to cigarette smoke still can be affected if an adult smokes in another room with the window open.

Preventative medication

In addition to avoiding triggers, if a child wheezes more than once or twice a year, he or she may also need daily preventive medication. The most effective are inhaled corticosteroids from a handheld inhaler — commonly called a puffer — attached to a small plastic tube called a spacer that delivers the medicine deeper into the lungs.

Many parents worry about their child taking steroids for asthma, but the medication is different from the steroids that athletes take to build muscle, with no significant side effects or risk of addiction.

Because asthma is always present, even when there are no visible symptoms, it’s vital to take the controller medicine once or twice a day. Forgetting could lead to breathing trouble, requiring a dose of quick-relief “rescue” medicine and potentially a visit to the emergency room.

Parents should learn to notice the signs of labored breathing to determine if their child’s asthma can be managed at home or requires a doctor. Parents should also continue monitoring their children even when they’re older, as teenagers are notorious for skipping their medication.

Leading an active life with asthma

Though parents may be concerned about their child being “sick” for the rest of his or her life, if a child’s asthma is managed, he or she can lead an active, healthy life; in fact, there are a number of Olympic athletes who have asthma or had it during childhood. The goal is not to have children do less, but to have better control so that they can do everything they want to.