Asthma—chronic inflammation of the airways that causes trouble breathing—can be a scary and life-threatening disease for children, but it can also be very well controlled with proper medication. It's a common condition, affecting an estimated 8.4% of children in the United States.
At Yale Medicine, the goal for all pediatric asthma patients is to find a treatment plan that prevents symptoms (asthma attacks) and allows them to lead normal, active lives. Our Asthma Program brings all aspects of a child’s care team under one umbrella. Not only do our patients see highly trained specialists, they meet with registered nurses who are certified asthma educators.
What are the most common types of pediatric asthma?
Many children have what is called allergic asthma, meaning that it’s set off by exposure to an allergen. These children are often hypersensitive to common allergens such as dust mites, mold, pets or pollen.
Children can also have virus-induced asthma, which means that they only have coughing or trouble breathing when they have a cold.
Likewise, children with exercise-induced asthma have symptoms during or after physical activity or active play.
Finally, in some children, asthma symptoms can be caused by multiple triggers, including viruses, allergies, exercise and weather change.
What are the symptoms of pediatric asthma?
In children, asthma symptoms can include coughing, wheezing, chest tightness and shortness of breath. “Often, kids can’t describe themselves what they’re feeling, but they may say they feel pain in their chest when they run, for example,” says Alia Bazzy-Asaad, MD, director of the Asthma Program at Yale Medicine.
Some children with asthma have a chronic cough that doesn’t go away. This is known as cough variant asthma. In young children, breathing louder or faster than normal may also be a sign of asthma.
What are the risk factors for pediatric asthma?
Medical research shows that asthma seems to be caused by a combination of genetics and environmental factors.
For example, children who have symptoms such as coughing and shortness of breath, and who also have a family history of asthma, are more likely to have asthma. Asthma is also closely related to allergies, so children who have other allergy-related conditions such as eczema, hay fever or food allergies or who have a family history of them are also at increased risk.
The environment is another important factor. Exposure to air pollution and cigarette smoke has also been shown to raise children’s risk of developing asthma symptoms. Children who live in urban areas have higher rates of asthma than those who don’t.
Obesity has also been linked to asthma. Children who are obese are more likely to have the condition diagnosed, and their cases are likely to be more severe, with more frequent symptoms.
Most children who develop asthma start to have symptoms by 5 years old, and for reasons that are unclear, boys are more likely to have asthma than girls.
There are many reasons children could have trouble breathing, especially when they have colds or congestion. There are other conditions that cause coughing and/or wheezing, so it is important to have your child evaluated.
How is pediatric asthma diagnosed?
Pediatric asthma is usually diagnosed by a pediatrician or primary care doctor. To make a diagnosis, the doctor performs a physical exam and takes a detailed medical history, asking questions about the child’s symptoms—including what triggers them and what makes them better or worse—and any family history of asthma or allergies.
Chest X-rays or other imaging tests may be performed, so that doctors can get a closer look at a child’s lungs and make sure that there is no other condition that may be causing the symptoms.
Children 5 and older are also given a lung function test, known as spirometry. This test involves blowing forcefully into a tubelike instrument, or spirometer, to measure the volume and the speed of air flowing through it. Because asthma causes the airways to be inflamed, they may be narrow, making it harder to blow out air fast—like blowing through a straw.
Once asthma has been diagnosed, doctors may also test to see whether the child has other conditions—such as allergies or gastroesophageal reflux disease (GERD)—that may be setting off or exacerbating his or her asthma.
If a child’s asthma doesn’t get better with treatment, he or she may need to see a specialist. At Yale Medicine, children with uncontrolled or worsening asthma control are seen by the Pediatric Asthma Care Team (PACT), which includes pulmonologists (doctors who treat lung disorders), allergy doctors, respiratory therapists and nurses who are asthma educators.
“Our job is not just to diagnose a child’s asthma, but also to figure out why their medicines aren’t working,” Dr. Bazzy-Asaad explains. “We want to know what else is going on that could be exacerbating it, whether it’s a stuffy nose, acid reflux, another chronic problem or triggers in the environment, such as cigarette smoke or pet dander, among others.”
Diagnosing asthma in children younger than 2 can be controversial, Dr. Bazzy-Asaad says, because it is difficult to tell what’s really causing their coughing or wheezing. “But usually, if children have symptoms consistent with asthma, they will be treated as having asthma and monitored as they get older,” she says. “Sometimes they get better and may no longer need medication.”
What are the treatment options for pediatric asthma?
For most children with asthma, inflammation in the lungs can be managed with drugs called asthma controllers. The most common asthma controllers are inhaled corticosteroids. Most children who have asthma need to take those medicines, via an inhaler (or a pill, in the case of one non-steroid medication), every day for long-term relief.
Doctors generally prescribe one type of inhaled corticosteroid and see whether the patient improves in four to six weeks; if not, they may try others. “They’re all slightly different, like comparing a Granny Smith to a Red Delicious apple,” says Dr. Bazzy-Asaad. “We try to choose the one we feel will be appropriate for the specific child.”
Children with asthma (or their parents) also need to carry emergency “rescue” inhalers in case they suddenly have trouble breathing. These types of inhalers contain drugs known as bronchodilators. They don’t reduce inflammation long term the way asthma controllers do, but they do work within 10 minutes to temporarily open up airways and help users breathe more easily.
Both types of medicines are very important for anyone with asthma. “This diagnosis can be overwhelming to both parents and children,” Dr. Bazzy-Asaad says. “So we make sure to review with them how to use their inhalers correctly and why it’s so critical to follow their treatment plan.”
Children with severe asthma may need additional medicines to prevent attacks. “There are several different classes of drugs,” Dr. Bazzy-Asaad says. “And we have the ability to go from simpler, lower doses to higher doses and combinations of medicines that have been studied and shown to work. I tell every parent that we will continue working with them and do whatever we can to get their child well.”
Children do sometimes outgrow their asthma, but they should never stop treatment without discussing it with their doctor. “Just because they feel fine doesn’t mean their asthma is under control,” says Dr. Bazzy-Asaad.
What makes Yale Medicine’s approach to pediatric asthma unique?
The Pediatric Asthma Program at Yale Medicine brings all aspects of a child’s care team together, ensuring that each patient receives individualized attention and the best possible treatment. Patients are seen by specialists with extensive experience in asthma and related conditions, and also meet with registered nurses who are certified asthma educators. All details of the visit are communicated back to the child’s primary care provider.
“The nurse educators spend time with each family at the end of their visit and go through proper use of medications, show them how to use their inhalers, and give them advice on controlling environmental factors,” Dr. Bazzy-Asaad says. “If a child has certain allergies, for example, they’ll talk about how to avoid those triggers.”
Pediatricians working with the Asthma Program regularly collaborate with experts in other departments, too. “If there’s a situation that doesn’t seem like straightforward asthma, it’s very easy for us to work with other specialists to get to the bottom of the problem more quickly,” Dr. Bazzy-Asaad says.