Managing Asthma in Children

Unfortunately Australia has one of the world’s highest incidences of childhood asthma. No one knows the exact reason for this. Many theories have been put forward but none have been proven to be true. Almost all childhood asthma is caused by viral upper respiratory tract infections. That is why asthma is so much more common in the cooler winter months. Young children, in particular get a viral respiratory tract infection and then pass it on to other youngsters.

There is also a strong genetic component. Asthma is often seen in children with eczema and hay fever. The so called allergy “atopic” triangle .

Asthma is caused by a narrowing of the small airways in a child’s chest. This leads to smooth muscle tightening and excess mucous production which in turn leads to the signs and symptoms of asthma. The most frequent sign of asthma is wheezing. This is a high pitched sound which the child makes when they are breathing out. It is often accompanied by shortness of breath, rapid breathing and sucking in of the chest around the ribs and airway.

In severe cases the child becomes drowsy and unconscious. This is as a result of the brain not getting enough oxygen from the airways and lungs. Obviously we would prefer to see kids and treat them long before drowsiness occurs.

There are two main stays of treatment, prevention of the asthma attacks and treatment of the acute presentation. When children are really unwell they will need to see their GP urgently or go to their nearest hospital’s emergency department. In the acute attack we treat asthma with short bursts of Ventolin via a spacer or via a nebuliser in a life threatening emergency. We also prescribe 3 days of oral prednisone “ Redipred” to try and reduce the inflammation of the airways.

The most frequent preventer used is an inhaled steroid such as Flixotide or Seretide. It should be given once or twice a day as per your doctor’s instructions. The idea is that the inhaled steroid stops a viral respiratory tract infection from triggering a full blown asthma attack. That is why it is called a preventer. We also prescribe Ventolin via a spacer to treat the milder symptoms. Generally children weighing less than 20 kg should be given 4-6 puffs via a spacer. If the symptoms have not improved or a child is deteriorating within the next 4 hours we recommend a further 4-6 puffs of Ventolin and parents to get a GP or emergency doctor to take a look. It is better to be safe rather than sorry. If in doubt, get medical help early. I have seen many occasions when mild asthma becomes life threatening in a few hours!