Childhood Asthma – Diagnosis and Treatment

Diagnosis

Asthma can be difficult to identify, especially in younger children. Doctors use a mix of medical history, symptoms, and special tests to diagnose asthma. They consider several factors because other conditions can cause similar breathing problems.

Doctors look for common symptoms such as:

• Wheezing
• Coughing, especially at night
• Shortness of breath
• Chest tightness

Doctors ask how often these symptoms occur and if certain triggers, such as mold, dust, or exercise, make them worse. They also check if close family members have asthma or allergies.

Other conditions that may cause similar symptoms include:

Condition	Description
Rhinitis	Swelling of the nose lining due to allergies or viruses
Sinusitis	Swelling of the sinuses
Acid reflux (GERD)	Stomach acid coming up into the esophagus
Dysfunctional breathing	Breathing patterns that are not normal
Respiratory tract infections	Infections like bronchiolitis or RSV

Checking Lung Health in Children

Doctors use lung function tests, called spirometry, to check how well the lungs work. Spirometry measures how much air a child can breathe in and out, and how fast.

Sometimes doctors perform these tests after the child exercises or after using an asthma medicine to see how much things change.

Doctors may also use the exhaled nitric oxide test to check for nitric oxide in the breath, which can indicate lung inflammation. High levels might mean the child’s asthma would respond to steroid medicines.

Spirometry often works best in children over age five. For younger children, doctors rely more on findings from regular checkups and parent reports about symptoms. Sometimes, doctors need many visits over several months or years to make a clear diagnosis.

Tests to Find Allergy Triggers Linked to Asthma

When doctors suspect allergies worsen asthma, they may suggest skin testing. In this test, a doctor places a small amount of common allergens, such as animal dander, mold, or dust mites, on the skin using a tiny prick.

If the skin becomes red or raised, the doctor can identify the child’s allergies. This information helps decide what to avoid and how best to manage the child’s asthma.

Common allergens that may trigger asthma symptoms:

• Animal dander
• Mold
• Dust mites
• Pollen

Identifying asthma triggers helps guide treatment, making it easier for children to breathe and stay healthy.

Treatment

Ongoing Daily Medicines for Asthma

Asthma management often involves daily medicines to reduce airway swelling and prevent symptoms. These are called long-term control drugs. Children with asthma commonly use these medicines to avoid flare-ups and stay active.

Types of ongoing medicines:

• Inhaled Corticosteroids: These medications help reduce airway inflammation and are typically the first-line treatment for ongoing asthma control. They may take a few days or weeks to reach full effect. Providers monitor for possible side effects, such as slowed growth, though the benefits usually outweigh the risks.

• Leukotriene Receptor Antagonists: These oral medications reduce inflammation and help with asthma symptoms for up to 24 hours. They are often used in children who do not respond well to inhaled corticosteroids.

• Combination Inhalers: These inhalers include both an inhaled corticosteroid and a long-acting beta agonist (LABA). They offer improved symptom control when single therapies are not enough.

• Methylxanthines: This class of daily oral medication helps relax airway muscles to improve breathing. Children taking these medicines often need routine blood tests to monitor drug levels.

• Biologic Therapies: For children aged 6 and older with severe asthma, biologic treatments target specific immune pathways involved in inflammation. These are typically given as injections and are used when other treatments are not effective.

Fast-Acting Medicines for Immediate Relief

Doctors prescribe quick-relief medicines, sometimes called “rescue medicines,” when asthma symptoms occur. These medicines relax muscles in the airways, providing fast results during an asthma attack or before exercise if recommended.

Types of fast-acting medicines:

• Short-Acting Bronchodilators: These medications quickly open the airways within minutes and provide relief that lasts a few hours. They are commonly used as rescue inhalers during asthma flare-ups.
• Systemic Corticosteroids (Oral or IV): These may be prescribed for severe symptoms to reduce inflammation throughout the body. They are typically used for short periods due to the risk of side effects when taken too often.

Approaches for Asthma Triggered by Allergies

For some children, allergies make asthma worse. Treating the allergic triggers can lead to better overall control.

Options for managing allergy-related asthma:

• Anti-IgE Therapy: This type of injectable treatment helps reduce allergic responses and is typically given every two to four weeks for individuals with both allergies and severe asthma.
• Antihistamines and Nasal Sprays: These help relieve allergy symptoms, which can also reduce asthma flare-ups.
• Immunotherapy (Allergy Shots): Doctors deliver these weekly at first, then monthly for several years, to help the body become less reactive to specific allergens over time.

Why Fast-Acting Medicines Alone Are Not Enough

Relying only on short-acting bronchodilators is not safe for long-term asthma management. While these inhalers provide quick relief and help with immediate breathing, they do not prevent future flare-ups or control underlying inflammation.

Core facts:

• Quick-relief medicines only fix the symptoms for a few hours.
• Children who need a rescue inhaler often may have poorly controlled asthma.
• Increasing use of quick-relief medicines is a warning sign; doctors may need to change long-term control treatment.

Tip: Parents should keep a record of how many times a week quick-relief inhalers are used. If the number is high, schedule a visit with the healthcare provider to review asthma control.

Tools and Devices for Inhaled Medicines

Inhaled medicines play a key role in asthma treatment. Different devices help children get the right amount of medicine.

Types of Devices:

Device Type	Best For	Description
Metered Dose Inhaler	Children and teens	Handheld, delivers measured dose
Spacer or mask	Young children	Used with inhaler to improve delivery
Dry Powder Inhaler	Older children, teens	Delivers powder, needs deep breath
Nebulizer	Babies, toddlers	Turns medicine to mist, baby wears mask

• Metered Dose Inhaler (MDI): A small device with a pre-measured puff of medicine. Most children use this type.
• Inhaler with Spacer: A tube attached to the inhaler that makes it easier to inhale the medicine, especially for younger kids.
• Dry Powder Inhaler: Releases medicine as a fine powder, used by older children.
• Nebulizer: Changes liquid medicine into mist. Babies and very young children use a mask to breathe in the medicine easily.

Creating and Following an Asthma Management Plan

A written asthma action plan helps keep symptoms under control and provides steps to follow during an asthma flare-up or attack. Families and healthcare providers work together to create this plan.

What an asthma plan should include:

• Steps for adjusting medicine as needed.
• How to monitor symptoms and record asthma control.
• Ways to identify worsening symptoms or asthma attacks.
• Clear directions for when to get emergency help.

Plans often group symptoms and breathing test results into color-coded zones:

Zone	Description	What to Do
Green Zone	Well-controlled symptoms	Keep current medicines
Yellow Zone	Warning signs, mild symptoms	Adjust medicine, monitor closely
Red Zone	Severe symptoms, emergency	Seek urgent help, follow emergency steps

Families may use a peak flow meter, a hand-held device, to check how well the lungs are working and know when to adjust treatment.

Children’s needs change as they grow, so triggers, symptoms, and medicine doses often need updating. Doctors call this “step-up” or “step-down” treatment.

Self-Care

Proper self-care helps children with asthma avoid triggers and breathe easier. Parents and caregivers can take several steps to make the home safer and healthier.

Keeping humidity low in the house is important, especially in damp regions. Using a dehumidifier may help control moisture and reduce mold growth. Clean indoor air also reduces asthma risk.

Change air filters regularly and have a professional check heating and cooling systems yearly. Installing filters designed for small particles may also help.

Limit exposure to indoor allergens in several ways. Children who are sensitive to animal dander should avoid pets with fur or feathers. If keeping pets is necessary, keep them out of children’s bedrooms and bathe or groom them often.

Wash bedding and use dustproof covers on mattresses and pillows to reduce dust mites, which are common asthma triggers. Hard flooring is easier to clean than carpets, and washable curtains or blinds may also help control dust levels.

Using air conditioning can make a big difference, especially during pollen season. It keeps windows closed so less pollen enters the house. Air conditioners also help control both pollen and dust mites by lowering humidity.

Follow a weekly cleaning routine to keep dust, pet hair, and other allergens under control. Sweep, vacuum with a HEPA filter, and wipe surfaces to reduce potential asthma triggers. Pay extra attention to bedrooms, where children spend much of their time.

Some children have asthma symptoms triggered by cold air. Wearing a face mask outdoors in cold weather can help warm the air they breathe in.

Parents should also remember possible triggers like tobacco smoke, strong smells such as perfume, and environmental conditions like viral infections and pollution.

Limiting a child’s exposure to these factors, along with focusing on healthy weight and regular exercise, can help manage asthma more effectively.

Asthma Trigger	How to Avoid/Control
Dust mites	Use dustproof covers, wash bedding, avoid carpets
Pets	Keep out of bedrooms, regular grooming, avoid if allergic
Pollen	Use air conditioning, close windows during high pollen times
Tobacco smoke	Keep environment smoke-free
Cold air	Wear a face mask outdoors
Strong smells	Avoid perfumes, scented cleaning products
Humidity	Use a dehumidifier, keep air dry
Viral Infections	Maintain good hygiene, prevent spread of illness

Alternative Ways to Manage Asthma

Some people use alternative methods alongside regular asthma treatments. Common options include different breathing and relaxation exercises, as well as certain supplements.

Breathing exercises such as the Buteyko method, Papworth method, and pranayama (yoga breathing) can help people control their breathing patterns. Many try these techniques to ease symptoms or support their overall health.

People also use relaxation methods like meditation, biofeedback, hypnosis, and progressive muscle relaxation. These methods may lower stress, which can trigger asthma attacks in some people.

Some people take herbal remedies and dietary supplements like black seed, fish oil, and magnesium. However, researchers have not found solid proof for their benefits, and these products can cause side effects or interact with other medicines.

Note: Always consult a healthcare professional before starting any new herbal or supplement-based approach.

Coping and Support

Staying organized helps when supporting a child with asthma. Making treatment part of the daily schedule can reduce stress. Caregivers can treat medicine routines as another activity, like brushing teeth or having breakfast.

Caregivers can create and share a clear action plan with everyone involved. Below is a simple table showing who should have a copy of the plan:

Who Should Have the Plan?
Parents
Teachers
School Nurse
Childcare Providers
Coaches
Friends’ Parents

The plan should outline how to spot early signs of asthma, provide guidance on daily care, and list actions to take during flare-ups. When everyone uses the same information, care becomes smoother and more predictable.

Children benefit from a positive environment. Caregivers should highlight what the child can do and encourage normal play and activity. Encouraging participation in sports and regular exercise is safe as long as asthma is well-managed.

If symptoms appear with activity, caregivers can adjust the care plan with a provider.

Staying calm during difficult moments helps. If symptoms worsen, caregivers should follow the action plan carefully. Involving the child in these steps builds understanding and confidence.

Connecting with others can also make a difference. Parents may find it helpful to talk to others in similar situations through online forums or local groups.

Children can also benefit by meeting peers with asthma, either at special camps or organized group activities. These experiences help them feel less alone and more confident in handling their condition.

Getting Ready for Your Visit

Steps You Can Take Beforehand

To make the most of the appointment, prepare a list that includes:

• Symptoms: Write down the signs your child experiences, how strong they are, and when they usually occur. Note if symptoms get worse in the morning, at night, during cold weather, when exposed to pollen, or with physical activity.
• Important Life Details: List any major changes or stresses your child has gone through recently that could affect their health.
• Medications and Supplements: Record all medicines, vitamins, and other supplements your child uses, along with the dosages.
• Questions to Ask: Consider bringing written questions to the appointment. Examples could include:
  • What is causing my child’s symptoms?
  • Are tests needed to find out more?
  • Is this condition long-term or short-term?
  • What treatments are recommended?
  • Are there any activities or foods they should avoid?
  • Should a specialist be involved?

Tip: Bring your child’s regular medicine bottles and a symptom diary to help the doctor understand the situation better.

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What the Health Provider Might Ask or Do

The provider will want to gather details to help diagnose and treat your child. Expect some of these questions:

• When did the symptoms first start and how often do they occur?
• Do your child’s breathing issues happen all the time or just in certain situations?
• Does your child have allergies, like hay fever?
• Do any triggers make the symptoms worse, such as exercise, cold, or certain environments?
• What actions or medicines relieve the symptoms?
• Does anyone in the family have allergies or asthma?

The doctor may also ask about daily routines and recent life changes. Provide honest and detailed answers to help the provider care for your child.

The provider may perform some simple tests during the visit or refer your child to a lung or allergy specialist.