Childhood Asthma

21 March, 2017

Paediatrics

Asthma is a common childhood illness, affecting about 1 in 10 children in Hong Kong. With appropriate care and use of medication, most children with asthma can live a normal life.

What is asthma?

Asthma is an allergic disease with inflammation of the airways. During an acute attack, the airways are narrowed and blocked due to spasm, swelling of the wall, and presence of thick secretions. Many children have associated allergy of the skin, nose, or eyes. Children with a family history of allergy are more likely to have asthma and other allergic diseases.

Signs and symptoms

Symptoms include difficulty in breathing, wheezing, coughing with phlegm and chest tightness. However, some children may only have cough as the presenting symptom.  These symptoms usually come and go, are worse at night or early in the morning, and may wake a child up from sleep.

Avoid allergens/triggers

Exposure to the allergens/triggers can induce asthma attacks.

  • Keep children away from second and third-hand smoke. Parents and household members should quit smoking.
  • Keep home environment clean and reduce dust exposure. Some children with asthmas are allergic to the excreta of house dust mites, which are tiny bugs that are present in areas with dust, such as beddings, curtains and furniture. 
  • Most children with asthma do not require dietary restrictions. Discuss with your doctor if you think the asthma symptoms may be related to food. Maintain a balanced diet and encourage a good eating habit.
  • If the child has exercise-induced symptoms, avoid outdoor activities during cold dry days and in polluted areas. Discuss with a doctor on the use of relievers before exercise.

Medications

There is currently no curative drug for asthma. Appropriate use of medications and good compliance is the key to good control of the disease, and to keep children having usual activities. Most of the drugs for asthma are in the form of inhalers.

  • For children with mild and infrequent attacks, only inhaled bronchodilators are needed as a symptom reliever during attacks. Children with more frequent symptoms will need a daily preventive medication to maintain control. Do not discontinue preventive medication without discussing with the doctor.  
  • Some children with mild asthma may respond to leukotriene antagonists, an oral preventive medication. Side effects are mild, but mood disturbances may occur in some children. 
  • Currently, inhaled corticosteroid is the most effective preventive medication for asthma. Usual dose of inhaled steroids are generally safe and serious side effects are uncommon. A small reduction in final adult height may be seen in children on long-term inhaled steroids. However, this has to be balanced against the risk of poorly controlled asthma.
  • In case symptoms cannot be controlled with inhaled steroids alone, leukotriene antagonist or long-acting bronchodilators may be added.