Asthma control in children

Overview

Asthma is a long-term condition that affects the airways (the tubes that carry air in and out of the lungs). In children with asthma, these airways can become swollen, sticky with mucus, and tight, making it hard to breathe. 'Asthma control' means keeping these symptoms to a minimum so your child can run, play, and sleep well.

Yes, asthma is one of the most common long-term conditions in children. It affects about 1 in 11 children in the UK.

It can affect children of all ages, but it often starts in early childhood. It is more common in boys than in girls before puberty, and in families with a history of asthma, eczema, or allergies.

Symptoms

Common symptoms

• Coughing (especially at night, early morning, or during exercise)
• Wheezing (a whistling sound when breathing out)
• Shortness of breath
• Feeling tight in the chest

Symptoms in children

• Coughing that won't go away
• Trouble sleeping because of coughing or wheezing
• Getting tired quickly during play or sports
• Breathing faster than usual or using tummy muscles to breathe

Symptoms in older adults

• Similar symptoms as in children, but may be less obvious
• Feeling breathless after activity that was easy before
• Persistent cough that may be mistaken for other conditions

Causes

Main causes

• The exact cause is unknown, but it is linked to a mix of genes and the environment.
• Airway inflammation (swelling) and narrowing in response to triggers.

Risk factors

• Family history of asthma, eczema, or allergies (like hay fever)
• Having eczema or allergies yourself
• Exposure to tobacco smoke, especially during pregnancy or early childhood
• Viral infections (like colds) early in life
• Living in areas with poor air quality

When to see a doctor

See a doctor urgently if:

• If your child has any emergency symptoms (see above) – call emergency services immediately.
• If they are using their reliever inhaler very often (more than every 4 hours) without improvement.

Book a routine appointment if:

• If your child is coughing, wheezing, or short of breath more than once a week
• If they have trouble sleeping because of chest symptoms
• For regular check-ups, even if they feel fine – at least every 6 months or as recommended by your doctor

Diagnosis

Doctors diagnose asthma by asking about symptoms, family history, and doing simple breathing tests. For younger children, diagnosis may be based on pattern of symptoms and response to treatment.

Tests that may be done

• Spirometry: breathing into a machine to measure how much air you can blow out and how fast
• Peak flow meter: a simple handheld device to measure how fast your child can breathe out
• Allergy tests (skin or blood) to check for allergens that may trigger asthma
• FeNO test: a breath test that measures airway inflammation

What to expect at your appointment

The doctor will ask you and your child about symptoms, triggers, and family health. They may ask your child to do breathing tests, which are painless and take a few minutes. For very young children, the doctor may rely on symptoms and try a treatment to see if it helps.

Treatment

Treatment aims to control symptoms and prevent asthma attacks. Most children with asthma use two types of inhalers: a preventer (taken daily to keep airways calm) and a reliever (used only when symptoms occur). Your doctor will help you find the right inhaler and dose for your child.

Self-care at home

• Learn to recognize your child's early warning signs of an asthma attack
• Keep a diary of symptoms and triggers
• Make sure your child uses their preventer inhaler daily, even when they feel well
• Follow your child's written asthma action plan from their doctor
• Avoid known triggers, such as smoke, dust mites, pet fur, and cold air

Medical treatments

Your child may be prescribed inhalers (puffers). Preventer inhalers are used regularly to reduce airway swelling, while reliever inhalers are used only when symptoms happen. Sometimes a combined inhaler or a drug in tablet form may be recommended. All treatments should be reviewed regularly by a healthcare professional.

When is surgery considered?

Surgery is not a treatment for asthma itself. In very rare cases, surgery may be considered for related conditions like severe nasal polyps, but this is not common for asthma control in children.

Living with this condition

Most children with asthma can lead a normal life, including school, sports, and sleepovers – as long as they follow their treatment plan and have quick access to their reliever inhaler when needed.

Lifestyle tips

• Keep your home free of tobacco smoke
• Use dust-mite covers on pillows and mattresses
• Avoid strong perfumes or cleaning sprays that can irritate airways
• Encourage regular exercise – it’s good for the lungs and overall health
• Teach your child to carry their reliever inhaler and use it properly

Diet and exercise

No special diet is proven to treat asthma, but a balanced diet with plenty of fruits and vegetables supports overall health. Exercise is safe and encouraged – just make sure your child uses their reliever inhaler before activity if the doctor advises it.

Mental health and emotional wellbeing

Living with a chronic condition can be stressful for both child and parent. Children may feel anxious about attacks or left out. It’s important to talk openly and seek support from school nurses, counsellors, or parent groups.

Prevention

Asthma cannot be completely prevented, but you can reduce the risk of attacks. Avoiding tobacco smoke during pregnancy and after birth, breastfeeding, and reducing exposure to allergens may help. Vaccinations are also important to prevent infections that can trigger asthma.

Vaccines

Make sure your child gets all recommended vaccinations, including the annual flu vaccine and the COVID-19 vaccine if eligible. These help prevent respiratory infections that can worsen asthma.

Screening programmes

There is no routine screening test for asthma in children. However, if your child has symptoms or a strong family history, talk to your doctor early.

Complications

If left untreated

• Frequent asthma attacks that interfere with school, play, and sleep
• Slower growth or missed school days due to illness
• Lung function that may not fully develop to its potential
• Severe asthma attacks requiring hospitalization
• In very rare cases, life-threatening attacks

Long-term outlook

With the right treatment and regular review, most children with asthma have excellent control and can enjoy a full, active childhood. Asthma often improves as children get older, and some children even outgrow it. The key is to stay on top of symptoms and follow a plan with your healthcare team.

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