Asthma is one of the most common chronic illnesses in children. It occurs when small air passages in the lungs easily get inflamed and overreact to allergens and respiratory viral infections. When the muscles in the walls of the small air passages are stimulated by environmental allergens or infections, they release inflammatory agents that result in narrowing of the airways (bronchoconstriction). This obstructs airflow and leads to the symptoms of asthma. The January 25, 2012, issue of JAMA includes an article on the treatment of children with asthma.
Family history of asthma
Personal history of atopic dermatitis (skin allergies) or allergic rhinitis (such as hay fever)
Exposure to air pollutants, especially cigarette smoke
Intermittent dry cough that can wake children at night
Expiratory wheezes (a whistling sound when exhaling)
Shortness of breath and chest tightness
Less physical activity than usual because exercise can induce asthma
Lung function tests involve breathing into a machine that measures how quickly the child can exhale.
Because exercise can often trigger asthma, the child may be tested before and after exercise to look for changes. Sometimes, the child will be tested before and after getting a medication.
While chest x-rays are not helpful to diagnose asthma, they are often used to look for other illnesses that may resemble asthma.
Asthma is classified as intermittent or persistent and as mild, moderate, or severe based on
Frequency of nighttime awakenings in 1 month
Frequency of quick-relief medication use in 1 week or in 1 day
Whether a child's symptoms interfere with normal activity
Frequency of asthma attacks that have required systemic corticosteroids
Lung function test results
Treatment with the different types of asthma medications depends on asthma classification as well as the minimum amount of medication required to control asthma symptoms.
Quick-relief medications that treat sudden exacerbations or “asthma attacks,” such as short-acting inhaled beta-agonists to open up airways. They are given as an inhaled aerosol using either a nebulizer or a handheld inhaler.
Long-term controller medications used daily to control asthma symptoms. These commonly include • Inhaled corticosteroids —steroids that can be nebulized or given as a dry powder inhaler • Long-acting inhaled beta-agonists also open up airways. Although their effects last longer than the short-acting form, they do not act fast and should not be used for quick relief.
In addition to medication, patients with asthma should avoid conditions that trigger the symptoms, which may include cigarette smoke, cold air, house dust, pollens, fur-bearing animals, and household pests such as cockroaches or mice.
American Academy of Pediatrics Healthy Children www.healthychildren.org
Centers for Disease Control and Prevention www.cdc.gov/asthma/children.htm
National Heart, Lung, and Blood Institute www.nhlbi.nih.gov/health/health-topics/topics/asthma/
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at www.jama.com. Many are available in English and Spanish. A Patient Page on respiratory syncytial virus was published in the January 11, 2012, issue of JAMA.
Sources: Centers for Disease Control and Prevention; National Heart, Lung, and Blood Institute
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Punnoose AR, Burke AE, Golub RM. Childhood Asthma. JAMA. 2012;307(4):421. doi:10.1001/jama.2011.2001