Asthma

About Asthma

Asthma is a common lung condition in kids and teens. It causes breathing problems, with symptoms like coughing, wheezing, and shortness of breath. Anyone can have asthma, even babies, and the tendency to develop it often runs in families.

Asthma affects the bronchial tubes, or airways. When someone breathes normally, air goes in through the nose or mouth and then into the trachea (windpipe), through the bronchial tubes, into the lungs, and finally back out again.

But people with asthma have inflamed airways that produce lots of thick mucus. The airways also are overly sensitive (or hyperreactive) to certain things, like exercise, dust, or cigarette smoke. This hyperreactivity makes the smooth muscle that surrounds the airways tighten up. The combination of airway inflammation and muscle tightening narrows the airways and makes it hard for air to move through.

More than 25 million people have asthma in the United States. In fact, it’s the No. 1 reason kids chronically miss school. And flare-ups are the most common cause of pediatric emergency room visits due to a chronic illness.

Some kids have only mild, occasional symptoms or only show symptoms after exercising. Others have severe asthma that, if not treated, can greatly limit how active they are and cause changes in lung function.

But thanks to new medicines and treatment strategies, kids with asthma don’t need to sit on the sidelines and their parents don’t need to worry constantly. With knowledge and the right asthma management plan, families can learn to better control symptoms and asthma flare-ups, letting kids do just about anything they want.

About Asthma Flare-Ups

Many kids with asthma can breathe normally for weeks or months between asthma flare-ups (also called asthma attacks, flares, episodes, or exacerbations) that cause the airways to narrow and become blocked, making it hard for air to move through them.

Flare-ups often seem to happen without warning, but they usually develop over time during a complicated process of increasing airway blockage.

All children with asthma have airways that are inflamed, which means that they swell and produce lots of thick mucus. And their airways are overly sensitive, or hyperreactive, to certain asthma triggers.

When exposed to these triggers, the muscles surrounding the airways tend to tighten, which makes the already clogged airways even narrower. Things that trigger flare-ups differ from person to person. Some common triggers are exercise, allergies, viral infections, and smoke.

So an asthma flare-up is caused by three important changes in the airways:

1. swelling of the lining of the airways
2. excess mucus that causes congestion and mucus “plugs” that get caught in the narrowed airways
3. bronchoconstriction, the tightening of the muscles around the airways

Together, the swelling, excess mucus, and bronchoconstriction narrow the airways and make it difficult to move air through (like breathing through a straw). During an asthma flare-up, kids may have coughing, wheezing (a breezy whistling sound in the chest when breathing), chest tightness, an increased heart rate, sweating, and shortness of breath.

How Is Asthma Diagnosed?

Diagnosing asthma can be tricky and time-consuming because kids with asthma can have very different symptoms. For example, some kids cough constantly at night but seem fine during the day, while others seem to get a lot of chest colds that linger. It’s common for kids to have symptoms like these for months before being seen by a doctor.

When considering a diagnosis of asthma, a doctor rules out other possible causes of the symptoms. He or she asks questions about the family’s asthma and allergy history, performs a physical exam, and might order a chest X-rays or lung function tests.

During this process, parents will give the doctor such detailed information as:

• symptoms: how severe they are; when, where, and how often they happen; and how long they last
• allergies: the child’s and the family’s allergy history
• illnesses: how often the child gets colds, how severe they are, and how long they last
• triggers: exposure to allergens and things in the air that can irritate the airways, recent life changes or stressful events, or other things that seem to lead to a flare-up

This information helps the doctor understand the pattern of symptoms, which can help determine what type of asthma the child has and how best to treat it.

To confirm the diagnosis of asthma, a breathing test may be done with a spirometer, a machine that analyzes airflow through the airways. A spirometer also can be used to see if the child’s breathing problems can be helped with medicine, which is a primary sign of asthma.

The doctor may take a spirometer reading, give the child an inhaled medication that opens the airways, and then take another reading to see if breathing improves. If the medicine eases airway narrowing significantly, then there’s a strong possibility that the child has asthma.

If your child is diagnosed with asthma, it’s important to learn how to manage asthma so it won’t control your family. Educate yourself about asthma and learn to identify and eliminate triggers.

Help your child keep an asthma diary, develop and follow an asthma action plan, and take medicines as prescribed. Also, a peak flow meter — a handheld tool that measures breathing ability — can be used at home. When peak flow readings drop, it’s a sign of increasing airway inflammation.

Exercise-Induced Asthma

Kids who have exercise-induced asthma (EIA) develop asthma symptoms after being very active (running, swimming, biking, etc.). Some develop symptoms only after physical activity, while others have additional asthma triggers.

With the proper medicines, most kids with EIA can play sports like other kids. In fact, asthma affects more than 20% of elite athletes, and 1 in every 6 Olympic athletes, according to the American Academy of Allergy, Asthma, and Immunology.

Usually, a doctor can diagnose EIA after taking a medical history. But sometimes more tests, including an exercise challenge in a lung function laboratory, are done confirm the diagnosis. The doctor might want to focus on a child’s tolerance for a particular exercise, as not every type or intensity of exercise affects kids with EIA the same way.

If exercise is the only asthma trigger, the doctor may prescribe a medicine to be taken before exercising to prevent airways from tightening up. Even after kids take a preventive medicine, though, asthma flare-ups can still happen. So parents or older kids should carry the proper quick-relief medicine (also called rescue or fast-acting medicine) to all games and activities. Quick-relief medicines work immediately to relieve asthma symptoms.

Tell the school nurse, coaches, club leaders (Boy Scouts, Girl Scouts, etc.), teachers, and any other caregivers about your child’s asthma care plan so that he or she can take medication as needed when away from home.

Allergy-Triggered Asthma

About 75% to 85% of people with asthma have some type of allergy. Even if the main triggers are colds or exercise, allergies can sometimes play a minor role in making asthma worse.

How do allergies cause flare-ups in kids with asthma? Kids inherit the tendency to have allergies from their parents. With any kind of allergy, the immune system overreacts to normally harmless allergens. Those substances (such as pollen) can cause allergic reactions in some people. As part of this overreaction, the body produces an antibody — called immunoglobulin E (IgE) — that recognizes and attaches to the allergen when the body is exposed to it.

When this happens, it starts a process that ends in the release of certain substances in the body. One of them is histamine, which causes allergic symptoms that can affect the eyes, nose, throat, skin, gastrointestinal tract, or lungs. When the airways in the lungs are affected, symptoms of asthma can happen.

The released histamine is what causes the familiar sneezing, runny nose, and itchy, watery eyes associated with some allergies — ways the body attempts to rid itself of the invading allergen. In kids with asthma, histamine also can trigger asthma symptoms and flare-ups.

An allergist can usually pinpoint allergies. Once they’re identified, the best treatment is to avoid exposure to them whenever possible, such by taking environmental control measures inside the home.

When triggers can’t be avoided, antihistamine medicines (to block the release of histamine in the body) or nasal steroids (to block allergic inflammation in the nose) might be prescribed. In some cases, an allergist can prescribe immunotherapy, a series of allergy shots that gradually make the body unresponsive to specific allergens.

Asthma Categories

The severity of a child’s asthma symptoms will fall into one of four main categories of asthma, each with different characteristics and requiring different treatment approaches:

1. Intermittent asthma
   A child who has brief episodes of wheezing, coughing, or shortness of breath no more than twice a week is said to have mild intermittent asthma. Symptoms between flare-ups are rare, with one or two instances per month of mild symptoms at night.
2. Mild persistent asthma
   Kids with episodes of wheezing, coughing, or shortness of breath more than twice a week but less than once a day are said to have mild persistent asthma. Symptoms usually happen at least twice a month at night and flare-ups may affect normal physical activity.
3. Moderate persistent asthma
   Kids with moderate persistent asthma have daily symptoms and need daily medicine. Nighttime symptoms happen more than once a week. Flare-ups occur more than twice a week, last for several days, and usually affect normal physical activity.
4. Severe persistent asthma
   Kids with severe persistent asthma have symptoms continuously. They tend to have frequent flare-ups that may require emergency treatment and even hospitalization. Many kids with severe persistent asthma have symptoms at night and can handle only limited physical activity.

Asthma severity can both worsen and improve over time, placing a child in a new asthma category that needs different treatment.

All kids with asthma should follow a custom asthma action plan to control symptoms. And even mild asthma should never be ignored because airway inflammation is present even in between flare-ups.

You might remember a time when kids with asthma were discouraged from playing sports and told to take it easy. That’s no longer the case. Being active, working out, and playing sports not only help kids with asthma stay fit, maintain a healthy weight, and have fun but also can strengthen their breathing muscles and help the lungs work better.

For these reasons, your doctor may recommend exercise as part of your child’s asthma treatment plan. If you have doubts about whether sports and asthma mix, the American Academy of Allergy, Asthma, and Immunology reports that asthma affects more than 20% of elite athletes and 1 in every 6 Olympic athletes.

Game On!

Two important things that kids who have asthma should know about sports participation:

1. Their asthma must be under control in order for them to play sports properly.
2. When their asthma is well controlled, they can — and should — be active and play sports just like anyone else.

Of course, some sports are less likely to pose problems than others for people with asthma. Swimming, leisurely biking, and walking are less likely to trigger asthma flare-ups, as are sports that require short bursts of activity like baseball, football, gymnastics, and shorter track and field events.

Endurance sports, like long-distance running and cycling, and sports like soccer and basketball, which require extended energy output, may be more challenging. This is especially true for cold-weather sports like cross-country skiing or ice hockey. But that doesn’t mean kids can’t participate in these sports if they truly enjoy them. In fact, many athletes with asthma have found that, with proper training and medication, they can participate in any sport they choose.

Staying in the Game

To keep asthma under control, it’s important that kids take their medicine as prescribed. Skipping long-term control medicine (also called controller or maintenance medicine) can make symptoms worse, and forgetting to take a prescribed medication before exercise can lead to severe flare-ups and even emergency department visits.

Your child should carry quick-relief medicine (also called rescue or fast-acting medicine) at all times, even during workouts, in case of a flare-up.

It’s also a good idea to keep triggers in mind. Depending on their triggers, kids with asthma may want to:

• Skip outdoor workouts when pollen or mold counts are high.
• Wear a scarf or ski mask when training outside during the winter.
• Breathe through the nose instead of the mouth while exercising.
• Make sure they always have time for a careful warm up and cool down.

These recommendations should be included in the asthma action plan you create with your child’s doctor.

Also make sure that the coach knows about your child’s asthma and the asthma action plan. For a young child, you might want to provide the coach with a copy. Older kids should keep a copy with them, as well as any medication that could be needed to treat a flare-up.

Most important, your child and the coach need to understand when it’s time for your child to take a break from a practice or game so that flare-ups can be managed before they become emergencies.

Weather and Asthma

The effect of weather on asthma symptoms isn’t fully understood, but clearly there is a link. Numerous studies have shown a variety of connections, such as increases in asthma-related emergency department visits when certain weather conditions are present. Some people find that their asthma symptoms get worse at specific times of year. For others, a severe storm or sudden weather change may trigger an attack.

Exposure to cold, dry air is a common asthma trigger and can quickly cause severe symptoms. People with exercise-induced asthma who participate in winter sports are especially susceptible. Dry, windy weather can stir up pollen and mold in the air, leading to problems for some people.

Hot, humid air also can trigger asthma symptoms, and wet weather encourages the growth of mold spores, another asthma trigger. In certain areas, heat and sunlight combine with pollutants to create ground-level ozone, which is also an asthma trigger.

Studies have shown that thunderstorms can trigger asthma attacks. One study showed that during thunderstorms, the daily number of emergency department visits for asthma increased by 15%. The study concluded that the problem was caused by the number of fungal spores in the air, which almost doubled. It wasn’t rain, but the wind, that caused this increase. Changes in barometric pressure may also be an asthma trigger.

Avoiding Allergy Triggers

If you suspect weather is playing a role in your child’s asthma, keep a diary of asthma symptoms and possible triggers and discuss them with your doctor.

Once you know what kind of weather triggers asthma symptoms, try these tips to protect your child:

• Watch the forecast for pollen and mold counts as well as other conditions (extreme cold or heat) that might affect your child’s asthma.
• Limit your child’s outdoor activities on peak trigger days.
• Make sure your child wears a scarf over his or her mouth and nose outside during very cold weather.
• Keep windows closed at night to keep pollens and molds out. If it’s hot, use air conditioning, which cleans, cools, and dries the air.
• Keep your child indoors early in the morning (before 10 AM) when pollen is at its highest levels.
• Your child shouldn’t mow the lawn or rake leaves, and should be kept away from freshly cut grass and leaf piles.
• Dry clothes in the dryer (hanging clothes or sheets to dry can allow mold or pollen to collect on them).
• Make sure your child always has quick-relief medicine (also called rescue or fast-acting medicine) on hand.

Your child’s written asthma action plan should list weather triggers and ways to manage them, including any seasonal increases in medication. A child whose asthma seems to be allergy-related may also need to see an allergist for medication or allergy shots.

If your child has asthma, you can create the best home environment possible by knowing which asthma triggers are at work and eliminating or minimizing exposure to them.

Your doctor can help you identify the triggers, which might include common stuff like dust mites and pollen.

Improving Indoor Air

Maintaining good indoor air quality in your home is an important aspect of asthma management. Irritants such as tobacco or wood smoke, perfumes, aerosol sprays, cleaning products, and fumes from paint or cooking gas can trigger flare-ups. Even scented candles or fresh newsprint are triggers for some people with asthma.

To maintain good air quality inside your home:

• Don’t allow people to smoke in your home. If you smoke, quit or smoke outside.
• Avoid wood fires.
• Avoid scented products. Wash and dry clothes with unscented laundry detergent, fabric softeners, and dryer sheets. Use unscented or nonaerosol versions of household cleaning products and avoid scented candles or room fresheners.
• Make sure that all gas appliances vent to the outdoors.
• Choose an artificial tree for the holidays.
• Run the air conditioning, especially on days with high pollen or mold counts or ozone or pollution warnings.
• When buying a home, consider one with baseboard or radiant heating. Forced-air systems can foster mold and dust mites. If your home has a forced-air system, consider sealing off the vents in your child’s bedroom with aluminum covers and tape.
• Clean all air ducts in the house and change the filters in your furnace and/or air conditioning system regularly.
• If you must open windows on days when the pollen count is high, do so after midmorning because counts are usually highest from 5 a.m. to 10 a.m. If air quality is the problem, open doors and windows early, before pollution has a chance to build up.

If you take these steps, but are still concerned about your home’s air quality, consider buying an air cleaner with a HEPA (high efficiency particulate air) filter for your child’s bedroom or playroom. Central air filtration systems are also an option, but are much more expensive.

Dealing With Dust Mites

Dust mites, a very common asthma trigger, are microscopic bugs that live in household dust. Their diet consists primarily of shed human skin cells. They’re especially plentiful in upholstered furniture, on some kinds of bedding, and in rugs. The highest concentration of dust mites in the home is usually found in bedrooms.

To reduce dust mites:

• Vacuum and dust your home (especially your child’s room) often — at least once a week. Use a special small-pore filter bag on your vacuum or buy a vacuum with a HEPA filter. When you dust, use a damp cloth to avoid spreading dust mite particles in the air.
• Avoid feather or down pillows or comforters; choose bedding made with synthetic materials instead.
• Every few weeks, wash all of your child’s bedding in hot water (higher than 130°F or 54.4°C) and then dry it on a high setting.
• Cover mattresses, pillows, and box springs with mite-proof covers (available at many large retail stores and also online). Also, be sure to regularly wipe down the covers.
• Remove any carpeting, especially wall-to-wall carpeting, from your child’s room and other spaces where he or she spends a lot of time.
• If you have area rugs, make sure they’re washable and clean them weekly in hot water.
• Make sure window coverings in your child’s room can be washed or cleaned easily. Stay away from blinds, which have lots of horizontal surfaces that catch dust, or fancy curtains with lots of folds, which have to be dry cleaned. Wash all window coverings regularly.
• Avoid upholstered furniture and pillows.
• Clean up the clutter in your home. Clear away knickknacks, picture frames, and plants that collect dust.
• Store most of your child’s books in a room other than his or her bedroom or playroom.
• Keep your child’s collection of stuffed animals to a minimum. Any plush toys that your little one just can’t live without should be washed often in hot water (if they don’t contain batteries) and then dried on your dryer’s highest setting. You also can seal these toys in a plastic bag and put them in the freezer for at least 5 hours or overnight (dust mites can’t survive more than 5 hours of freezing temperatures).
• Avoid using a humidifier, especially in your child’s room.
• Run a dehumidifier in the basement or other damp areas of your home. But make sure you empty and clean the water pan often.

Minimizing Mold

Molds are microscopic plant-like organisms. They can grow on many surfaces, and flourish in damp places like bathrooms and basements. Molds reproduce by sending spores into the air; inhaled mold spores are a common asthma trigger.

To reduce moisture and mold:

• Fix leaky pipes, faucets, or roofs. Clean and repair roof gutters regularly.
• Make sure your bathrooms and basement are well ventilated. Install and use exhaust fans to help lower moisture in these areas.
• If you have any damp closets, clean them well and leave a 100-watt bulb on all the time to increase the temperature and dry out the air.
• Run a dehumidifier in the basement or other damp areas. Again, it’s important to empty and clean the water pan often.
• Remove wallpaper and wall-to-wall carpeting from bathrooms and basement rooms.
• Run the air conditioning (this is especially helpful if you have central air), making sure to change the filter monthly.
• Avoid houseplants, which may harbor mold in their soil.
• Clean any visible mold or mildew with a solution that’s one part chlorine bleach to 10 parts water. Don’t paint or caulk over moldy surfaces without cleaning them first.
• When painting bathrooms or other damp areas of your house, use anti-mildew paint.
• If there’s visible mold on ceiling tiles, remove and replace them. Also check to see if there’s a leaky pipe that may be causing the problem.
• Replace or wash moldy shower curtains.

Reducing Triggers From Animals and Cockroaches

Animals are a significant asthma trigger — as many as 30% of people with asthma are allergic to one or more animals. Allergic symptoms are caused by the body’s reaction to a specific protein found in the animal’s saliva, urine, or dander (tiny flakes of dead skin).

Animal hair itself does not cause allergies, but it can collect mites, pollen, and mold. And any animal that lives in a cage, from birds to gerbils, will produce droppings that can attract mold and dust. If you have a pet and your child is allergic to it, your best bet is to find the animal another home.

Short of getting rid of a pet, try these steps (though they’re less effective):

• Keep pets outside. If you can’t, at least keep them out of your child’s bedroom and playroom.
• Wash and brush your pet every week.
• Make sure your child doesn’t play with or touch your pet and keep him or her away from the litter box if you have a cat.
• Wash your hands after touching your pet.
• If you have a pet that lives in a cage, keep it in a room that your child doesn’t spend time in regularly. Also, have someone other than your child clean the cage daily.

Cockroaches are another major asthma trigger that can be difficult to avoid in multifamily dwellings, especially in urban areas.

To avoid cockroaches:

• Have your home professionally exterminated every few months. Between professional treatments, use bait traps to catch roaches (avoid aerosol sprays, which can aggravate asthma).
• Avoid saving boxes, paper bags, or newspapers in piles around your home.
• Don’t leave open food or dirty dishes lying around your kitchen.
• Keep counters free of crumbs or spills.
• Keep garbage containers closed.
• Wash recyclables before putting them in the bin.

More on Asthma Management

Trigger-proofing your home can seem overwhelming, especially if your child has multiple triggers. And the fact is, you won’t be able to eliminate all triggers. Although you want your home to be safe for your child, you can’t wrap it in a bubble.

Your doctor can help you decide which steps are necessary. But here are five tips to try to reduce asthma triggers:

1. Put mattress covers on any bed your child sleeps in.
2. Get rid of carpeting.
3. Reduce dust.
4. Get rid of any pest infestations.
5. Don’t permit smoking anywhere in your home.

Reducing triggers in your home — when combined with the rest of your child’s asthma action plan (which might involve regular medicine and allergy shots) — can help your child breathe better and have fewer flare-ups.

Indeed, one study showed that when steps were taken to eliminate dust mites, kids with this trigger had fewer asthma symptoms, needed their quick-relief medicine (also called rescue or fast-acting medicine) less often, and were generally less sensitive to their other triggers.

Asthma causes chronic inflammation of the airways in the lungs, which is aggravated by asthma triggers that bring on asthma symptoms.

Triggers are substances, weather conditions, or activities that are harmless to most people, but can lead to coughing, wheezing, and shortness of breath in those with asthma. They don’t cause asthma, but they can lead to asthma symptoms and flare-ups.

Triggers vary from person to person. They’re sometimes seasonal and may even stop affecting kids with asthma as they grow older.

Common asthma triggers include:

• allergens
• irritants and pollutants in the air
• respiratory infections, like colds or flu
• weather conditions
• exercise
• gastroesophageal reflux

Triggers and Asthma Management

Asthma can’t be cured, but it can be managed. The goal of asthma management is to reduce symptoms on a day-to-day basis and to maintain normal activity levels, including the ability to exercise and participate in sports.

One way to do this is by minimizing exposure to triggers. If exposure isn’t controlled, triggers can cause severe flare-ups, chronic symptoms between flare-ups, and even reduced lung function.

Because triggers are different for each person, you’ll need to work with your doctor to determine your child’s specific triggers. The doctor may suggest that you keep an asthma symptoms/trigger diary, using symptoms, peak flow meter readings, and a record of circumstances during which symptoms occurred to help you identify possible triggers. Once triggers are identified, they can be included in the overall asthma action plan you develop with the doctor.

Your child may also need allergy skin testing if the doctor suspects that allergens are triggers. Some kids may need to take allergy medication or have allergy shots. Your doctor will determine if this is necessary.

Allergens and Irritants

Allergens, one of the most common asthma triggers, include:

• mold
• dust mites
• cockroaches
• pollen
• animal dander (tiny flakes of dead skin), saliva, or urine
• feathers

It isn’t possible to avoid all allergens, but you can help minimize them in your home. Focus on the rooms where your child sleeps and plays:

• Keep these areas as clean and dust free as possible. This means vacuuming and dusting weekly, eliminating clutter, getting rid of unnecessary stuffed animals, and routinely washing other stuffed animals in hot water.
• Wash sheets weekly in hot water, and get rid of feather pillows and comforters.
• Purchase hypoallergenic covers for the mattress, box spring, and pillows.
• Eliminate rugs and carpeting whenever possible.
• Clean curtains (which should be washable) often.
• Make sure damp areas like bathrooms, basements, and laundry rooms are cleaned often and properly ventilated so that mold and mildew don’t form.
• Avoid using humidifiers, and use dehumidifiers in damp parts of your house.
• Check your local mold and pollen count readings and plan indoor activities for windy days, which can lead to high counts.
• Use bait traps or professional extermination to rid your home of cockroaches, and keep your kitchen clean and your house free of stacks of paper.

Irritants are different from allergens. People who don’t have allergies or asthma can be affected by irritants, though they’re not usually a serious problem. But for kids with asthma, irritants can lead to airway inflammation and flare-ups.

Common irritants include:

• perfumes
• aerosol sprays
• cleaning products
• wood and tobacco smoke
• paint or gas fumes
• air pollution

Even things that may seem harmless, like scented candles or fresh newsprint, are triggers for some kids. Here are some ways to reduce household irritants:

• If you notice that a household product triggers your child’s asthma, switch to an unscented or nonaerosol version of it.
• Don’t have wood fires in your home.
• Keep your child away from areas where painting or carpentry work is being done.
• If you cook on a gas stove, make sure your kitchen is well ventilated — to the outside, if possible.
• Forbid smoking in your home and car, and make sure your child avoids smoky environments (like restaurants or parties).

Weather and External Factors

If outdoor air pollution is a problem, you might want to purchase an air cleaner for your home or run the air conditioning year-round (clean the filter regularly). Also check air quality reports. On days when the quality is especially bad, keep your child indoors with the air conditioning on.

Respiratory infections, such as colds or the flu, are harder to avoid. In fact, viral respiratory infections are among the most common childhood illnesses and may cause breathing problems even in kids who don’t have asthma. They usually last several days and cause airway swelling and mucus production. In kids with asthma, breathing problems triggered by colds can last days or even weeks after the cold has gone away.

Teach your child the importance of hand washing, and ask your doctor about an annual flu shot. Health experts now recommend that everyone 6 months of age and older get vaccinated against influenza. This is especially important in people with asthma, who are at greater risk for serious complications if they get the flu. Because respiratory illnesses are an inevitable part of childhood, be sure that your doctor specifies what to do if your child gets a cold or the flu (this information should be in the asthma action plan).

Weather conditions can also play a role, depending on where you live. Windy conditions may stir up pollens and molds. Rain can wash pollen from the air, decreasing the pollen count right after a rainfall. Yet lots of rain can stimulate the trees and grasses to produce more pollen later on in the season.

Extremes of cold or heat can also trigger asthma and so can humidity or very dry air. If you know that certain weather conditions aggravate your child’s asthma, keep an eye on the forecast and limit his or her time outdoors on problem days. If cold weather is the trigger, cover your child’s nose and mouth with a scarf.

If hot, humid weather triggers symptoms, keep your child in an air-conditioned environment. Guidance for handling weather-related triggers should also be included in the asthma action plan. This may include increasing the dosage of your child’s medications.

Exercise

Exercise may be the only trigger for some kids with asthma. Along with allergens, this is one of the more common triggers. In fact, 80%-90% of people with asthma develop symptoms when they exercise. It can be a particular problem in someone whose asthma isn’t well managed. But this is one trigger that your child should not avoid because exercise is important for overall health.

Instead of discouraging strenuous play or sports, talk with your doctor about what your child should do before, during, and after exercise. This may include taking medicine prior to working out or playing a sport.

Gastroesophageal reflux is when the contents of the stomach flow backward into the esophagus. Some kids also inhale these contents into the lungs, where they can make inflamed airways even more swollen. Treating reflux can lead to improvement in asthma symptoms in these kids.

Your child won’t be able to avoid all triggers all the time, and it’s unrealistic to expect your child to do so. But minimizing exposure helps keep asthma symptoms under control.

Just because a child has asthma doesn’t mean he or she shouldn’t travel, play sports, go to parties, or do any of the things that other kids do. Taking sensible precautions, like following the asthma action plan, carrying quick-relief medicine (also called rescue or fast-acting medicine), and taking allergy medicines before visiting friends with pets can help kids with asthma do everything they enjoy.

Exercise-Induced Asthma

Some people have exercise-induced asthma, which means that their asthma symptoms (such as coughing, wheezing, or shortness of breath) are triggered by exercise or physical activity. A person may have exercise as his or her only asthma trigger, or it may be one of many triggers. These symptoms are usually noticed during or shortly after exercise. When they are properly treated, most people with exercise-induced asthma can play sports like anyone else. In fact, more than 10% of Olympic athletes have exercise-induced asthma that they’ve learned to control.

Up to 80% of kids with asthma have symptoms when they exercise. It makes sense that cigarette smoke and pollen could trigger asthma symptoms, but why exercise?

Cold, dry air that’s inhaled during exercise is believed to be the main cause of these symptoms. When kids exercise or play strenuously, they tend to breathe quickly, shallowly, and through the mouth. So the air reaching their lungs misses the warming and humidifying effects that happen when they breathe more slowly through the nose.

The cool, dry air causes the airways in the lungs to become narrower, which blocks the flow of air and makes it harder to breathe. This narrowing, called bronchoconstriction, occurs in up to 20% of people who don’t have asthma, which is why it’s sometimes referred to as “exercise-induced bronchoconstriction (EIB)” rather than “exercise-induced asthma (EIA).”

Symptoms

Symptoms of exercise-induced asthma include wheezing, tightness or pain in the chest, coughing, and in some cases, prolonged shortness of breath. Some symptoms are more noticeable than others, which means exercise-induced asthma can sometimes go undiagnosed.

Someone may have exercise-induced asthma if he or she:

• gets winded or tired easily during or after exercise
• coughs after coming inside from being active outdoors
• can’t run for more than a few minutes without stopping

Kids with exercise-induced asthma often begin having symptoms 5 to 10 minutes after starting to exercise. Symptoms usually peak 5 to 10 minutes after stopping the activity and may take an hour or longer to end. Some people with EIA even have symptoms for hours after exercise. Although symptoms often appear while kids are active, sometimes they can appear only after the activity has stopped.

Of course, there’s a difference between someone with exercise-induced asthma and someone who’s out of shape and is simply winded. Out-of-shape people can catch their breath within minutes, whereas it takes much longer for someone with EIA to recover. And extremes of temperature, especially cold weather, can make it even worse.

Diagnosing EIA

A doctor who suspects exercise-induced asthma will ask about the family’s asthma and allergy history and about the symptoms and what has triggered them in the past.

After taking a detailed history and performing a physical exam, the doctor may ask your child to perform a breathing test after exercising. This can be done in the office on a treadmill, after your child has run outside for 6 to 8 minutes, or after participating in whatever activity has triggered flare-ups in the past.

Treating EIA

Doctors sometimes recommend pretreatment, which means taking medication before exercise or strenuous activity, for kids with exercise-induced asthma. This medication is often the same short-term medication used during flare-ups, known as quick-relief medicine (also called rescue or fast-acting medicine), although in this case its function is preventative. By taking this medication before exercise, the airway narrowing triggered by exercise can be prevented.

If pretreatment isn’t enough to control symptoms, the doctor may recommend that someone also use long-term control medicine (also called controller or maintenance medicine), which is usually taken regularly over time to reduce airway inflammation.

If, despite medication, your child still has breathing trouble during exercise, let the doctor know. The medication dosages may need to be adjusted for better control. Also, contact the doctor if there are any changes with your child’s breathing problems.

Recommended Activities for Kids With EIA

Exercise is a great idea for everyone, including kids with exercise-induced asthma. Try to encourage your child to be active while also keeping asthma symptoms under control by following the doctor’s instructions.

In addition to keeping kids fit, exercise can improve lung function by strengthening the breathing muscles in the chest. Ask your doctor about exercise and what kinds of precautions your child should take.

Of course, some sports are less likely to cause problems for kids with exercise-induced asthma, such as:

• walking
• jogging
• hiking
• golf
• baseball
• football
• gymnastics
• shorter track and field events

Endurance sports (like long-distance running and cycling) and those requiring extended energy output (like soccer and basketball) may be more challenging, as can cold-weather endurance sports like cross-country skiing or ice hockey.

But that doesn’t mean your child can’t participate in these sports if he or she truly enjoys them. In fact, many athletes with asthma have found that with proper training and medication, they can participate in any sport they choose.

Tips for Kids With Exercise-Induced Asthma

For the most part, kids with exercise-induced asthma can do anything their peers can do. But be sure to follow the suggestions given by your child’s doctor.

Here are some of the tips often recommended:

• Warm up before exercise to prevent chest tightening. (Warm-up exercises can include 5 to 10 minutes of walking or any other light activity, in addition to stretching or flexibility exercises.)
• Take quick-relief medicine as close to the start of exercise as possible.
• Breathe through the nose during exercise.
• Take brief rests during exercise and use quick-relief medicine, as prescribed, if symptoms start.
• Cool down after exercise to help slow the change of air temperature in the lungs.

In addition, someone experiencing symptoms shouldn’t start exercising until the symptoms stop.

It’s also wise for kids with EIA to avoid exercising outside during very cold weather. If your child will be playing outside when it’s cold, wearing a ski mask or a scarf over the mouth and nose should help.

If air pollution or pollen also trigger asthma symptoms, your child may want to exercise indoors when air quality is poor or pollen counts are high. And exercise should be avoided during any upper respiratory infection.

You can help by ensuring your child takes all medicine prescribed by the doctor, even on days when he or she feels fine. Skipping long-term control medicine can make symptoms worse, and forgetting to take quick-relief medicine before exercise can lead to severe flare-ups and even emergency department visits.

Kids should always have access to their quick-relief medicine. Keep extras on hand and be sure to regularly check all supplies so your child isn’t carrying around an empty inhaler.

Asthma flare-ups (also called “asthma attacks”) can be dangerous, so if your child has them often and uses quick-relief medicine (also called rescue or fast-acting medicine) more than a couple of times a week, talk to your doctor. It’s possible that your child’s asthma action plan needs to be adjusted.

Predicting Flare-Ups

The severity and duration of asthma flare-ups vary from person to person and even from attack to attack. They might happen without warning, with sudden coughing, shortness of breath, and wheezing. But because people with asthma have inflamed airways that worsen with gradual exposure to triggers, flare-ups can also build up over time, especially in those whose asthma isn’t well controlled.

Flare-ups can and should be treated at their earliest stages, so it’s important to recognize early warning signs. These clues are unique to each child and might be the same or different with each asthma flare-up. Early warning signs include:

• coughing, even if your child has no cold
• throat clearing
• rapid or irregular breathing
• unusual fatigue
• trouble sitting or standing still
• restless sleep

Preventing Flare-Ups

Managing your child’s asthma includes doing all you can to avoid flare-ups. That means working with your child to:

• take all medication as the doctor prescribed
• keep quick-relief medicine on hand at all times
• avoid triggers, such as allergens

If Your Child Has a Flare-Up

Not all flare-ups can be prevented, and because they can be life threatening, they demand immediate attention. Your child might need to take quick-relief medicine, visit the doctor, or even go to the hospital. For that reason, you should have an asthma action plan.

Work with the doctor to write this plan, which provides instructions on how to handle changes in your child’s breathing. This will help you know exactly what to do, even in an emergency.

Only about 10% of people have pet allergies, but at least 30% of people with asthma are allergic to animals. So if your child has asthma, consider whether your pet could be producing allergens that are triggering asthma symptoms.

Despite what you might have heard, your pet’s fur probably isn’t to blame. Allergies are caused by the body’s reaction to a protein found in the animal’s dander (dead skin flakes), saliva, urine (pee), and feathers. Though pet hair itself isn’t the problem, this protein can cling to the fur when an animal licks itself.

Also, an animal’s fur can collect dust mites, pollen, mold, and other allergens. And any animal that lives in a cage (from birds to gerbils) will produce droppings that can attract mold and dust mites.

You may hear people say that certain breeds of dogs or cats, particularly those that don’t shed, won’t trigger asthma. But all warm-blooded animals shed allergy-causing proteins and are capable of causing an allergic reaction.

If you’re wondering whether your child is allergic to a pet, consider having him or her tested for allergies. If your child turns out to be allergic to your pet, you’ll have to decide whether to keep it or find it a new home. The best course is to remove the pet from your home, though this isn’t usually the easiest or happiest solution. Your child, other kids in the family, and even adults in the family may have a tough time with this decision.

In some cases, your doctor may say that it’s OK to keep a pet if your child receives medicine or allergy shots. If you go this route, you’ll still want to limit your child’s exposure to the animal, such as by keeping the pet out of your child’s bedroom and play areas. Hard as this is to enforce, try to teach your child not to hug or kiss the animal. Vacuum and dust regularly and avoid rugs and wall-to-wall carpeting, especially in your child’s room.

Unfortunately, such measures may not be enough. Because animal allergens are airborne, heating and ventilation systems will spread allergens throughout the house, even if the pet is kept out of bedrooms. Keeping the pet in the yard isn’t an ideal solution either because some allergens will eventually be carried in on clothing, and it’s not always safe for or fair to the pet.

If you decide to keep your pet, you might want to:

• Buy an air cleaner. HEPA air cleaners can really help, especially for cat allergies. Vacuums are available with HEPA filters as well.
• Keep your child away from the cat’s litter box, and place the box away from air vents.
• Have someone other than your child wash and brush your pet every week (this is advisable for cats as well as dogs).
• Encourage everyone in the family to wash their hands after playing with your pet.
• Keep your pet out of the child’s bedroom and away from rugs and upholstered furniture. You may need to shut the doors to certain rooms or use baby safety gates to keep cats and dogs out.

If you have a bird, gerbil, or other small caged animal, keep the cage in a room other than your child’s bedroom. Make sure the pet stays in its cage and clean it daily — without your child’s help. You’ll also want to let teachers know about your child’s allergies if there’s a caged pet in the classroom.

If you do decide to find another home for your pet, be sure to discuss this with your child. Assure your child it’s not his or her “fault” — and make sure siblings don’t blame the child. Losing a pet, even to a friend’s home, can be hard for everyone in the family.

Remember, too, that even if you remove the pet from your home, you may not see improvements in asthma symptoms for a while. It can take up to 6 months to reduce the allergen levels to those of a home without pets. Even if the pet is removed, your child might still need the asthma or allergy medications used previously.

When going to a house with a pet, your child should first take any prescribed allergy medicine and (as always) bring along his or her quick-relief medicine (also called rescue or fast-acting medicine).

Some kids who need asthma medicine start out using a nebulizer. Others are given an inhaler with a spacer and face mask. Some older kids use only an inhaler, with no spacer attached. So which is the best way to deliver asthma medicine to the lungs?

Studies show that the device used really doesn’t matter, as long as it’s used properly. All methods work just as well when the correct technique is used.

Of course, there are pros and cons to each type of device. Inhalers are smaller and require no power source. And because they deliver the medicine much more quickly than a nebulizer, they may be preferred by some parents.

The age of the child also makes a difference in how an inhaler is used. Metered dose inhalers (MDI) are the most widely used, but they require coordination. The child must be able to activate the device and breathe in at the same time. This can be a bit tough and can generally only be mastered by older kids. That’s why many doctors recommend attaching the metered dose inhaler to a spacer.

Almost anyone (from infants to the elderly) can use a metered dose inhaler when it’s attached to a spacer. Some experts say that everyone with asthma, even adults, would benefit by using a spacer with their metered dose inhaler.

Dry powder inhalers (DPI) are easier to use than metered dose inhalers because they don’t require coordination. The force of the child’s inhaled breath delivers the aerosolized powder into the lungs. Most kids over 5 or 6 years old are able to use a dry powder inhaler, although they must be able to inhale quickly and strongly.

However, some people may feel like they get a better treatment from a nebulizer because they can see and feel the mist coming from the machine.

Your doctor will work with you and your child to decide which device is most appropriate. Besides your child’s age and abilities, the decision also will be based on what type of medication is needed. Your child may try several different types of devices before you find the right one.

Used properly, though, any device will be effective. Talk with your doctor if you have any questions, especially if you’re concerned that your child isn’t getting the proper dose of medicine.