Dr Mark Rosenthal

MD MB ChB FRCP FRCPCH BSc

Consultant in Paediatric Respiratory Medicine

also specialist in Food Allergies & Disorders of Sleep

A | A | A

T: 0207 351 8832

E: s.harvey@rbht.nhs.uk

A:The Royal Brompton Hospital, London, SW3 6NP

Asthma Treatment For Children

asthma-attack-treatment-for-children

20% of all children have asthma at some point during their childhood up to 16 years of age and although the word asthma carries a lot of ‘baggage’ attached to it striking terror into the hearts of parents, in reality the huge majority of asthmatics are mild and easy to treat and personally if that was their only health issue in their lives I would say ‘great’ in comparison to other choices such as diabetes for example. It is very unusual to occur before the age of 3 years and typically occurs after age 4 years presenting with recurrent multi-trigger wheezing (a sighing or whistling breathing out sound) or coughing or a combination of the two. There are 4 main triggers: viral infections, exercise, emotion (crying, laughing etc) and specific responses most commonly to cats and cigarette smoke so asthmatics will have symptoms to more than one of these four triggers.


asthma-treatment-for-children

Risk Factors of Asthma in Children

There is an increased risk of asthma in children whose parents smoke especially the mother, in those with a close positive family history of asthma, where traffic pollution is severe although this effect is not great, and in those with severe atopic disease such as problematic eczema or multiple food allergies remembering that 50% of all infants have a diagnosis of eczema to some degree in their first year of life. Nevertheless most asthmatics do not have eczema or food allergies!

Asthma Diagnosis

There are no specific blood tests that diagnose asthma, it is diagnosed on careful history taking, examination and measuring lung function in those over 6 years of age with a spirometer. This is asking the child to blow for as hard and as long as they can into a machine to measure flow and volume. This is different from a peak flow meter found in many GP surgeries.

Asthma Treatment

Treatment is usually quite simple. Most children will be prescribed a steroid inhaler coloured brown, orange or red) to prevent symptoms and a salbutamol type bronchodilator (a blue inhaler) to relieve symptoms or to take before exercise. A red (Symbicort) inhaler can also be used to prevent and treat symptoms (the so-called SMART regime). The mere mention of the word ‘steroids’ often leads to a lot of parental anxiety about side effects. NO medicine is absolutely free of side effects but inhaled steroids have been used for about 50 years now and overall have an outstanding safety record; children do not grow two heads or become a body builder! Long term studies show that several years of treatment reduces adult height in boys by 6-7 millimetres and about 12-14 millimetres in girls.

Inhalers come in two types, a metered dose inhaler (often called a puffer) and a dry powder device for older children usually more than 6 years. Puffers must always be used with a spacer as without it the dose the child gets is almost zero and is mostly eaten rather than breathed in. Spacers with a mask are used for children up to about age 3 years only and after that, the spacer goes straight into the mouth without a mask.

Asthma Treatment Limitations

The biggest single problem in treating asthma is that the preventing steroid inhaler is not given regularly so it is no surprise the asthma is not being well controlled. It should be used twice a day but research shows that on average this inhaler is used only about half the times it is meant to be used. All children capable of taking the inhaler themselves (so aged more than 10-12 years) must still be watched taking it. Shouting into the bedroom ’Have you taken your puffer?’ and them replying ‘yeah’ is a complete waste of time! Other problems are parents continuing to smoke and deluding themselves that doing it near a window or at the back door is ok and the other issue is continuing to keep pets especially cats to which the child is manifestly allergic.

Many asthmatics especially boys improve during puberty although a proportion of them have returning symptoms as young adults. Whilst treatment is excellent, a cure continues to elude us.

FAQs

Yes to a degree - a child is more likely to have asthma during their childhood if one and especially both parents have asthma or had significant asthma as children. However that does not mean 100% of children will have asthma there are other factors, some known and some not.
First a correct diagnosis needs to be made by a suitable doctor with experience of childhood respiratory disease. Then the parents and the child need to be taught how and also when to use the treatment. Once this has occurred the parents MUST supervise the child, whatever their age, every time the preventative, usually steroid, inhaler is used, almost always twice a day. If all this is carried out well, then the need for acute reliever medication is greatly reduced but parents must not be at all hesitant in using the reliever, blue salbutamol medication if it is needed. Finally things that make asthma symptoms more likely to be worse such as smoking at home, lots of soft toys on the bed, old pillows and pet cats all need careful consideration. As always, if symptoms start to get worrying then you should always seek medical help.
Yes they need to know and the school needs the child’s blue salbutamol reliever medication with the child’s spacer device should symptom relief be required at school. The school needs to also know what circumstances are likely to lead to symptoms in their particular child and the advised dosage to use.
Tricky to advise as there are many NHS doctors who can look after asthma very well, so this is a parental choice but might be more likely if the advice given does not seem to be working or there is doubt about the diagnosis or the best way of treating the asthma.
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