Managing childhood asthma

Managing childhood asthma

Childhood asthma is often quoted as the number one reason for children missing school and being hospitalised. However, new medications and treatment strategies have changed this bleak outlook. Today, asthma flare-ups/attacks can be avoided, controlled and managed successfully. Here’s how…

Asthma basics

Knowledge is power and knowing the basics of this condition is a prerequisite to managing it successfully.

Asthma is a chronic, inflammatory lung condition that causes the airways to narrow and tighten to such a degree that breathing becomes difficult.

Asthma flare-ups or attacks are usually caused by changes in the airways such as:

    • Inflammation of the airways
    • Excessive mucus production that may act as “plugs” in the narrowed airways
    • Bronchoconstriction when the muscles lining the airways tighten up and further narrow the airways.

During a flare-up/attack the child may experience the following:

    • Insistent coughing, especially at night
    • Wheezing (a whistling sound) when breathing
    • Tightness in the chest (like an elephant standing on your chest)
    • Breathlessness (shortness of breath that makes speaking difficult)
    • Increased heart rate
    • Perspiration due to the effort to breathe and fatigue.

The things that trigger asthma flare-ups/attacks differ from child to child.

The following are some of the more common triggers:

    • Exercise
    • Allergies
    • Viral infections such as colds and the flu
    • Environmental triggers such as air pollution, smoke, chemical odours, pollen, dust, grasses, etc.
    • Indoor allergens such as cigarette smoke, mould, dust mites, animal dander, cockroaches, air fresheners, aerosols, hair spray, perfume, food dyes, etc.
    • Weather changes especially when breathing in cold air.

There are four main categories of children’s asthma:

Mild intermittent, when the typical symptoms of asthma (coughing, wheezing and shortness of breath) occur briefly, no more than twice a week and maybe twice a month at night.

Mild persistent, when typical symptoms occur more than twice a week but less than once a day. Night time awakenings (due to coughing, wheezing and shortness of breath) may occur at least twice a month. Normal physical activity may/may not be affected.

Moderate persistent, when typical symptoms occur daily and flare-ups occur more than twice a week, sometimes lasting days. Night time awakenings may also occur more than once a week and normal physical activity will most probably be affected.

Severe persistent, when symptoms and flare-ups/attacks occur frequently and continuously and also at night. This is a severe, difficult form of asthma that may require emergency treatment and sometimes hospitalisation. Normal physical activity may be severely affected.

Asthma management plan

Asthma flare-ups or attacks often seem to happen unexpectedly, one minute the child is fine and breathing normally and the next an attack starts. Although it seems unexpected, these attacks actually develop over time and can be anticipated, avoided where possible and effectively treated with fast-acting medications and a long-term asthma management plan.

Managing your child’s asthma begins with the proper diagnosis by a doctor or asthma specialist and may also involve the help of an allergy specialist. With their help a personalised asthma management plan for your child can be set up.
An asthma management plan may include the following steps:

Avoiding and controlling the triggers
It may take time to figure out what triggers your child’s asthma, apart from the most common causes. As soon as you know you can start taking the necessary steps to minimise and avoid your child’s exposure to these triggers. Start by banning smoking in your home and thoroughly cleaning your home and the child’s living space of all known allergens/triggers.

Anticipating and preventing flare-ups
Learn to monitor your child’s breathing and lung health daily with the use of a peak flow meter. It is a simple tool that will give advance warning that a flare-up/attack may be brewing. Make this a no-fuss, daily activity for smaller children, the same as brushing teeth. Older children and teenagers will quickly master its use and can keep their own asthma diary and even learn how to prevent flair-ups/attacks when peak flow measurements reach a certain level. Some action plans include nifty peak flow measurement and symptom zone charts characterised by the colours green, yellow and red to show whether the child’s asthma is under control, somewhat controlled or poorly controlled. It is of the utmost importance to monitor these zones because it may entail adjusting (lowering or stepping up) treatment and medication.

Treating symptoms promptly and effectively
Use the right medicine as prescribed by your doctor. Asthma medication usually includes both short-term, quick-working rescue type medication to open up swollen airways during an attack, as well as long-term medication taken daily to reduce inflammation in the lungs and prevent the build-up of such an attack. Both are necessary to help manage your child’s asthma. Babies, infants and toddlers may need a face mask attached to a metered dose inhaler or nebuliser to get the correct dose of medicine. Older children and teens may be able to self-administer these medicines as they usually come in the form of inhalers. It is, however, very important to teach them how to use the inhaler properly. Other medications may have to be taken orally. Allergy shots and other forms of allergy therapy may also be necessary.

Childhood asthma can be controlled

The well-documented good news is that most childhood asthma cases can be successfully controlled when monitored carefully, assessed frequently and by using a self-management asthma action plan drawn up by the child’s doctor or specialist.

Although children with asthma sometimes feel depressed, left out and different because flare-ups/attacks keep them out of school or limit participation in some forms of physical activity, parents and caregivers should encourage them not to give up. Well-controlled asthma should not prevent a child from having fun, living a full life and taking part in sport and other physical activities. Asthma control may take some time to master but it is definitely worth the effort!

In fact, many Olympic athletes such as Bill Koch, American medallist in Nordic and cross country skiing (not usually recommended for asthmatics); Ann van Dyke, swimming champ with four gold medals (definitely recommended); and Paula Radcliff, winner of seven marathons (not recommended at all) were diagnosed with asthma as children, learned to control their asthma and achieved acclaim anyway!

Childhood asthma. Retrieved from:
Managing asthma. Retrieved from:
Tips for managing asthma. Retrieved from:
Roth, E. 2012. Childhood asthma. Retrieved from: