Coughing is one sign of asthma, a treatable condition.

child with asthma inhaler

What It Is

Learning that their child has asthma is enough to knock the wind out of parents. But with childhood asthma on the rise, more families are facing this challenge. Twelve percent of American children have been diagnosed with it, according to the Centers for Disease Control and Prevention (CDC), making it likely that you have, or know, at least one child with this chronic inflammatory lung disease.

No doubt you have many questions about detection and treatment. Here's help so your family can breathe easier.

What is asthma, and why does it seem as if so many young children have it nowadays?

It's a chronic condition in which the lungs overreact to triggers, typically allergens (such as dust mites or pollen), and also viruses, exercise, cold air, cigarette smoke, or strong fragrances. During an attack, the bronchial airways become swollen and inflamed, the cells lining the airways produce excess mucus, and the muscles surrounding them constrict, making breathing difficult. Repeated attacks may cause permanent lung damage; severe, acute ones can be life-threatening.

For unclear reasons, asthma rates in children ages 4 and younger increased 160 percent between 1980 and 1994 alone. The numbers continue to climb, and scientists aren't sure why. Some speculate that poor indoor or outdoor air quality may be to blame, explains Martha White, MD, research director at the Institute for Asthma and Allergy in Wheaton, Maryland.

Others point to the "hygiene" theory: Better vaccinations and increased sanitation have left our immune systems idle and ready to run amok, spurring a rise in immune disorders such as asthma.

Wheezing and Colds

My 8-month-old wheezes, but my pediatrician won't give me a firm diagnosis. Why?

"Pediatricians are reluctant to diagnose children under 2 with asthma, because frequently babies who wheeze with respiratory infections stop wheezing after 2 years old," says Dr. White.

What does wheezing sound like? "Look for high-pitched whistling, especially when your child exhales," says Asriani Chiu, MD, assistant professor of allergy at the Medical College of Wisconsin, in Milwaukee. "If you hear a lower-pitched grunting, particularly when the child inhales, that is more likely a stuffy nose than asthma."

Your daughter's wheezing is more likely to be transient if it occurs only with colds and if neither Mom nor Dad has allergies, eczema, or asthma. Conversely, her symptoms are more likely to prove chronic if she wheezes between colds and has a family history of asthma or allergies, notes Dr. White.

But only time will tell if your daughter's symptoms will persist or go the way of her bottles and binkies. In the meantime, however, your pediatrician may treat your daughter's symptoms with asthma medications (even without the official diagnosis), since these drugs will help her breathe more easily, regardless of the cause.

Whenever my 2-year-old catches a cold, his cough lingers for weeks. Should I be worried?

If your child regularly has a dry, persistent cough after a cold, or if he coughs without a cold, especially at night or after a burst of activity, tell your pediatrician, says Dr. White. Another warning sign: shortness of breath (notice if your child's nostrils flare or if the muscles between his ribs retract when he breathes).

Children who are old enough to verbalize their symptoms may complain about a funny or tight feeling in the chest. It's important to report these symptoms to your child's doctor, particularly if there's a family history of allergies or asthma, says Dr. White.

If your son has asthma and were to experience a serious attack, he might begin to breathe very rapidly or have difficulty crying or speaking. If this happens, or if he is wheezing and suddenly stops (which could indicate a closed airway), or if his skin, lips, or fingernails begin to turn blue, call 911.

Inhalers & Nebulizers

I've heard some asthma medications may stunt growth. How do these drugs work, and are they safe?

The two most common types are fast-acting bronchodilators and inhaled corticosteroids.

Bronchodilators are used during asthma attacks to relax the muscles surrounding the airways. These "rescue medications" work quickly, usually within 20 minutes, to relieve wheezing, coughing, breathlessness, and other acute symptoms of asthma. They're usually delivered through a metered-dose inhaler or a nebulizer.

Bronchodilators can make your child irritable or restless, so if she does not respond well to them, ask your pediatrician about switching to a newer bronchodilator called Xopenex, suggests Dr. Chiu. It's an improved form of the widely used albuterol that should cause fewer effects. Some brochodilators are available as syrups, but they tend to be the least effective and produce stronger side effects, including fussiness, jitteriness, rapid heart rate, and insomnia.

If your daughter's asthma is mild and her symptoms are infrequent, she may be prescribed only a bronchodilator to be used as needed to relieve her occasional wheezing or coughing. But if she has even mild flare-ups two or more times weekly, she'll need to take a daily anti-inflammatory medication such as inhaled corticosteroids or leukotriene modifiers, says Dr. Chiu.

"Bronchodilators calm the symptoms of asthma but don't touch the underlying inflammation," she explains. "Unless you control the inflammation on a daily basis, your child's symptoms may flare whenever she encounters an allergic trigger, has a virus, or is very active."

Inhaled corticosteroids such as Pulmicort, Azmacort, and Flovent are the most effective drugs for reducing airway inflammation to prevent asthma attacks. Many parents worry about giving their child a daily drug, especially a steroid, but corticosteroids should not be confused with anabolic steroids, which are used to build muscle. Long-term studies have shown that in proper doses, inhaled corticosteroids do not adversely affect a child's growth or bone development, says Dr. Chiu. And they produce far fewer side effects than the oral versions like prednisone, used to control inflammation in acute attacks brought on by not taking a daily inhaled anti-inflammatory, she assures.

"Inhaled cortisone medicine is topically applied to the lungs with minimal risk," Dr. Chiu explains. "It's like applying an over-the-counter hydrocortisone cream on a rash."

Leukotriene modifiers (such as the chewable tablet Singulair, taken once daily) are nonsteroidal anti-inflammatories that may work for younger children.

"If a child has mild asthma, and if the parents are very nervous about steroids, it may be reasonable to start with a leukotriene modifier," says Dr. Chiu. "But if after a short trial a child is no better, we'll need to switch her to an inhaled cortisone."

I give my 2-year-old asthmatic son two nebulizer treatments a day. How can we get him to sit still for the 12 minutes it takes each time?

For babies and toddlers, doctors often recommend a nebulizer, which delivers the medications as a mist through a mask that fits over the child's mouth and nose. The downside, as you've realized, is that it may be difficult to persuade a squirming toddler to sit still for the 10 to 15 minutes it takes to deliver a dose.

"Many parents end up chasing their child around the room with the mask, and most of the medication is lost in the air," says Tina Tolomeo, an advanced practice registered nurse at the Yale School of Medicine, section of pediatric respiratory medicine, and president of the National Association of Asthma Educators.

You may want to try an inhaler with a spacer, she suggests. The spacer is essentially a tube, one end of which fits over the child's nose and mouth, while the other fits snugly around the inhaler. When you depress the inhaler, medication is released into the tube, where it's held, allowing the child to breathe it in over several breaths. The whole process takes about three minutes, says Tolomeo, and studies show that the metered-dose inhaler with spacer, when used correctly, is equivalent to or better than a nebulizer.

What Makes It Worse?

Can my child with asthma play with kids who have colds?

Colds can exacerbate asthma. "It's best to keep young children with asthma away from people who are sick," Tolomeo advises. "Wash their hands frequently, and ask your healthcare provider about receiving the flu vaccine."

A recent CDC study showed the flu vaccine reduces asthma flare-ups in children 6 and younger by up to 41 percent -- and that vaccinating all children with asthma could prevent as many as three-quarters of asthma-related trips to emergency rooms and hospitalizations during flu season.

Our 2-year-old daughter was just diagnosed with asthma, and my husband wants to get rid of our dog. Do we really need to find Rex a new home?

Only if Rex is a trigger for your daughter's asthma. "If you know that your child is not allergic to pets, you don't need to remove the pet," says Dr. Chiu. "An allergist can help you to pinpoint your child's specific asthma triggers," she adds.

Viruses are the most common trigger in infants, because they have typically had limited exposure to allergens. But as babies get older and become more mobile, many allergens become more common:

  • pet dander
  • dust mites
  • mold
  • cockroach droppings
  • foods
  • pollens

Once you know the culprits, talk to your pediatrician or allergist about ways to minimize your child's exposure. If dust mites are the offenders, for example, your doctor may recommend special dust-mite-proof bedding, a dehumidifier, or a special air filter to remove dust mite particles from the air.

My 4-year-old son was just diagnosed with asthma. Should I limit his activity?

With proper treatment, your son's asthma shouldn't limit his physical activity. In fact, as long as the asthma is well controlled, you should encourage him to exercise to strengthen his lungs.

"The medications available today are effective, safe, and well tolerated by most children, so kids really should be able to do anything they want to," assures Dr. Chiu, adding that there are Olympic athletes with asthma.

Cold, dry air can trigger symptoms, so if your child's asthma is serious, you may want to steer him toward swimming rather than ice hockey. But if he insists on lacing up the skates, the proper medications should allow him to do even that, says Dr. Chiu.

If exercise triggers asthma symptoms in your child, you can use a bronchodilator preventively, adds Dr. Chiu. Giving your child a dose 15 minutes before his gymnastics class or playgroup (if things tend to get wild) can help ward off a flare-up, allowing your child to take full part in the fun and lead a normal life.

Marguerite Lamb is a mother of two in Glastonbury, Connecticut.

Originally published in American Baby magazine, April 2005. Updated 2010

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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