Childhood Asthma

In asthma the airways in your child's lungs are inflamed and easily irritated. When something sets them off, the muscle in the airway wall tightens, the lining swells and mucus builds up, so the passage narrows and the air has to be forced out through it. That narrowing is reversible, and treatment works by settling the inflammation underneath and by opening the airway when it tightens.

Triggers differ from child to child. In younger children, viral colds are by far the commonest, so the pattern is often a cough and wheeze arriving with every infection and taking a fortnight to clear. Dust, smoke from cooking fuel or cigarettes, strong smells, pets, pollen, cold air, exercise and a change of weather all feature. Asthma runs in families and often sits alongside eczema and an allergic nose in the same child.

How it behaves over years varies. Many children wheeze only with infections in their pre-school years and stop as their airways grow. Others carry it into adult life, and children with allergic triggers and a strong family history are more likely to. Your paediatrician will not be able to tell you which group your child is in at the first visit, and the answer emerges over time.

Your paediatrician is building a pattern across weeks and months. Expect questions about when the cough comes, whether it wakes your child at night or in the early morning, whether running or playing brings it on, what happens with colds, how often a reliever is needed, and how many school days have been lost. Keeping a simple note of those before the appointment makes the visit far more useful.

The examination includes listening to the chest during and between episodes, checking how hard your child is working to breathe, looking at the nose and the skin for the conditions that travel with asthma, and plotting height and weight, since growth is monitored throughout.

From around six years of age, most children can perform breathing tests that measure how much air they can blow out and how much that improves after a reliever. In younger children the tests are not reliable, so the diagnosis rests on the pattern, the examination, and how your child responds to a trial of treatment. That response is part of the assessment, so your paediatrician will want to see your child again after a few weeks to judge it.

Asthma is controlled instead of cured, and the goal is a child who sleeps through the night, plays and runs with everyone else, and rarely needs a reliever.

A preventer inhaler works on the inflammation and takes time. Expect some improvement within two weeks and the full effect at six to eight weeks, and expect your paediatrician to review at about that point before changing anything. Treatment is then stepped up or down at each review according to how the last few months have gone, and many children spend long stretches on the lowest dose that keeps them well.

After an attack, the chest usually feels normal within a week, though the cough may linger for two to three weeks. Your child can return to school once the breathing is comfortable and the reliever is lasting the full interval between doses. Inhaler technique is checked at every visit, because a device used incorrectly delivers very little to the lungs and is the commonest reason treatment appears to have stopped working.