Controlling Asthma in Children - A Guide For Families

Asthma is a chronic inflammatory disease of the airways that affects millions of children nationwide. Yet with proper management and avoidance of the triggers that cause flare-ups, it doesn't have to rule your child's life.


How Asthma Impacts the Lives of Kids and Their Families

Child 1: I was 8 years old when I noticed I couldn't jump rope, run, like my friends.

Child 2: I've been coughing, been wheezy. I sneeze a lot.

Mom 1: She had this continuous hacking cough. It was scary. She couldn't catch her breath.

Mom 2: He got so sick at one point he ended up being brought to Children's Hospital by ambulance.

Mom 1: So I put her in the car to take her to the hospital, and she kept saying, "Mom, we're not going to make it."

Dad: The way he was I was saying, "Man, he's not going to be able to have a, you know, just go to school.

Mom 2: Because after I had Avery, my intent was to go back to work, and I never went back to work. I had to end up staying home because he was sick so often.

Mom 1: And they diagnosed her with asthma.

Dad: We just wanted him to be a normal kid.

Narrator: Asthma--it's a common problem, one that affects millions of children nationwide and causes many emergency visits and hospital admissions every year. But asthma doesn't have to rule your child's life. By consistently following some simple steps, you can do a great deal to reduce daily symptoms and help your child control their asthma. In the next few minutes, you will hear from physicians who work with families every day helping them learn to best ways to control their children's asthma. You'll also hear from parents and children who will describe how they have successfully brought asthma under control. We'll cover the answers to common questions that many families have including, "What is asthma?" "How can asthma be controlled?" "What are the benefits of asthma control?"

What is Asthma and How Is It Treated in Children?

Tyra Bryant-Stephens, MD: Asthma is a chronic disease of the lungs, and it can occur as early as six months. It can occur later in life as well.

Julian Allen, MD: Normally, the way your lung functions is that you have airways that go from your mouth into your lungs, and they end up in little air sacs. In the normal lung those tubes are wide open. It makes it very easy for air to flow in and out. In somebody with asthma those tubes, or airways, are narrow because the wall of the tube is inflamed, so that makes it more difficult to breathe in someone with asthma. It's like breathing through a straw.

Narrator: Children with asthma can have different signs, also known as symptoms, that show their asthma is not well controlled. Common symptoms of asthma are wheeze, a whistling noise in the chest, cough, especially late at night, shortness of breath, and chest tightness.

Tyra Bryant-Stephens, MD: Asthma can look many different ways. Some children may cough with their asthma. Some children wheeze. Some children work really hard to breathe using their chest muscles and their stomach muscles.

Julian Allen, MD: They may cough when they exercise. They may cough when they go out in the cold air.

Dad: He'd step outside. He'd run across the yard one time. He's coughing. We got to pick him up and bring him in the house.

Julian Allen, MD: When they get a cold, the cold may just not seem to go away.

Nicholas Pawlowski, MD: Coughing or awaking after midnight in the middle of the night, that's the most severe symptom.

Tyra Bryant-Stephens, MD: When you have a child who is waking up at night with a cough, then they're experiencing the beginning of a flare.

Julian Allen, MD: Most people associate asthma with asthma attacks.

Nicholas Pawlowski, MD: During an asthma attack the inflammation process kicks in in the lungs. The muscles tighten around the airways. Extra mucus is produced, and there's swelling in the airways. The patient can feel pain or shortness of breath.

Child 2: When I have an attack, it's not a good thing. My chest hurts. I cough a lot.

Child 1: Like every time I breathe, it just didn't feel right. It hurted.

Mom 1: Me and her father had to rush her to the hospital.

Narrator: Asthma flares, also known as "attacks", occur when swelling in the airways worsens. This can happen due to a cold virus or a trigger in the child's environment. If a child's asthma is not well controlled before the flare, symptoms can be more severe. Symptoms of asthma, such as wheeze, cough, or shortness of breath, are early warning signs that a flare may be beginning. The key to preventing asthma flares is to control daily symptoms of asthma and recognize early warning signs when symptoms are worsening.

Tyra Bryant-Stephens, MD: Many children think that early warning signs are a normal part of life because they are used to those symptoms, and they're not used to their asthma being in control. So it's very important for parents to understand and to stay clued in as to what their early warning signs are and, in fact, inform any of the children's caretakers about the early warning signs.

Mom 3: He's silent. He just sits there and daze off. And then I just start looking at him, and then I see him breathing, like trying to get some air, going like this. And then I look at his throat, and I see that this part right here starts sucking in. Then I know he's in distress.

How Can Asthma in Children Be Controlled?

Julian Allen, MD: The good news is that asthma is easy to control and you have the ability to take charge, take control of asthma, and by doing so, your child will be able to do everything that a normal child can do.

Tyra Bryant-Stephens, MD: There are two ways to control asthma. One is to control the environment, that is, the asthma triggers for the child with asthma. And the other is to stay on a daily medicine regiment. Asthma triggers are things that make asthma flares occur.

Nicholas Pawlowski, MD: The three basic groups of asthma triggers include cold viruses, allergy triggers that can be inside or outside the house, and irritants like cigarette smoke.

Tyra Bryant-Stephens, MD: So, if a child has dust as one of the things that triggers their asthma or tobacco smoke, the way we control it is keeping them from that environment.

Nicholas Pawlowski, MD: With their asthma doctor or clinician, they should identify the things that create inflammation in the patient's environment and home.

Mom 2: We took up the carpets in his bedroom. We got rid of all the fuzzy things around his room, and we usually clean his room with white vinegar and water.

Tyra Bryant-Stephens, MD: If the child's symptoms continue after avoiding all the known asthma triggers, it's important to see your doctor about a daily medication. This daily medication is called "controller medicine."

Narrator: There are two types of asthma medicines-- quick-relief and controller medicines. Quick-relief medicines, such as Albuterol, relax tightened muscles in the airways during a flare. Quick-relief medicines should be taken only as needed for asthma symptoms. If a child needs to take quick-relief medicines regularly, it is a sign that the asthma is not under good control. Controller medicines, such as inhaled steroids, help reduce swelling, also known as inflammation, in the lung. Controller medicine should be taken every day to reduce symptoms and prevent flares.

Dad: You can't take your medication when you're just having symptoms, you know. I think you waited too late then.

Tyra Bryant-Stephens, MD: It's very important that you take the medicines every day whether the child has symptoms or not.

Child 2: When I don't take my medications every morning and every night, I can't really do my gymnastics as good. I get tired.

Nicholas Pawlowski, MD: Patients should incorporate their daily steroid or controller medicines into their daily lives just as they brush their teeth or change their clothes every day. That's the key to success in using these medicines.

Tyra Bryant-Stephens, MD: The controller medicines are steroids. When parents hear that their children will be on steroids every day, they're concerned about several things.

Mom 2: Steroids--at first they did concern me. Because, I guess, as a natural reaction you hear steroids and it definitely -- it alarms you.

Julian Allen, MD: The steroids that we use are natural products of your adrenal glands. They're a normal part of the chemicals that your body produces.

Nicholas Pawlowski, MD: The most important concerns seem to be about growth.

Julian Allen, MD: However, there's a number of studies now that show that children with asthma who use inhaled steroids for many, many years develop and achieve the full growth potential that they would have achieved had they not gotten inhaled steroids.

Nicholas Pawlowski, MD: Many people are concerned that taking medicines for their asthma will make them dependent on those medicines or that, if they use them regularly or every day, that they may not work as well.

Julian Allen, MD: But this really isn't the case. There are a number of studies that show that asthma medicines work better if you take them every day, and they don't lose their effectiveness over time.

Mom 2: I've seen my child very, very sick, and I realize that he needs these medications. And it's just like any other type of illness. If you have medication that can help your child, you have to give the medication.

Narrator: Families need to know the facts about controller medicines. These medicines are safe and work through natural ways that the body heals swelling and inflammation. They use low doses delivered directly to the airways where asthma occurs. Controller medicines have been shown to prevent flares and emergency visits and reduce symptoms for children with asthma. In order to work best, controller medicines must be taken every day. Children receiving controller medicines do need to see a doctor regularly to make sure the dose and type of controller medicine are right for the child.

Mom 2: Well, if you ever end up in the Emergency Department, it's very important that after that experience you make an appointment with your family doctor, go to the doctor, and get some kind of course of action, some type of plan in place.

Tyra Bryant-Stephens, MD: The asthma management plan is a written way for you to know when to use your child's asthma medications.

Julian Allen, MD: If your child has not had an asthma management plan until now, it's time to make one with your doctor.

Mom 2: No one wants to keep going back and forth to the Emergency Room. That's no way to treat asthma. The best way though treat asthma is to take more of a proactive approach instead of a reactive approach. If you wait for the symptoms to occur, a lot of times you end up with your child being sick unnecessarily.

Dad: You don't want to go through that. You want to catch it soon.

Mom 1: The key is consistency-- medication and consistency.

Narrator: Remember, there are several steps to controlling asthma. Since each child is different, it is important to make regular office visits to access what the triggers of asthma are and how to avoid them. Many children with asthma need to have take daily controller medicines, which are safe and effective when taken correctly. Every child with asthma should also have a written care plan that guides the family on what to do to treat asthma every day. You and your doctor should discuss the right way to control asthma for your child.

Topics Covered: Asthma in children

Related Centers and Programs: Asthma Program