The most common question that UNC Health pediatric pulmonologist Ceila Loughlin, MD, hears is also the hardest to answer: Does my child have asthma?
“People want a definite answer, and it’s not black and white. Diagnosing asthma requires looking at the whole picture,” says Dr. Loughlin, who is director of the UNC Children’s Allergy & Asthma Center.
Asthma is a condition that can cause airways to become swollen and inflamed, making breathing in and out difficult. Symptoms may include wheezing, coughing, shortness of breath and difficulty breathing. It is not contagious, but it often runs in families. Asthma flare-ups (attacks) can be serious—even life-threatening—so controlling the condition is crucial.
How Doctors Diagnose Asthma
To diagnose asthma, doctors review the health history of the child and their family and whether the child has allergies or eczema, because these conditions often occur with asthma.
Sometimes, asthma symptoms are hard to differentiate from allergies or a bad cold. Plus, allergies and germs can trigger asthma flare-ups—but not everyone who coughs or wheezes has asthma. So when seeing a child in the clinic, doctors will test for allergies, ask questions about the child’s symptoms and try inhaled medications to see if they improve the child’s breathing. Lung function tests may be used to see how much air a person can hold but aren’t always easy for children to perform.
You will need to work with your child’s doctor over time to understand what triggers asthma flare-ups and what medication plan works best at preventing symptoms.
Develop an Asthma Action Plan
For parents and caregivers, understanding asthma and what to do when symptoms flare is key. If your child is diagnosed with asthma, you should work with your child’s doctor to develop an asthma action plan specific to your child. This plan may include:
- Avoiding things that trigger an asthma flare-up
- Learning your child’s early warning signs
- Knowing what medicines to take, when to take them, and how to take them
By sticking to a consistent asthma action plan, a child should be able to do all his or her normal activities, including exercise and sports, without having asthma flare-ups.
Identifying Asthma Triggers
One of the first steps in developing an asthma action plan is to identify triggers that lead to flare-ups in your child.
These may include things like tobacco smoke, e-cigarette vapors, odors (from cleaning supplies, paint, air fresheners, perfumes, etc.), tree pollens, cockroaches, animals (including dogs and cats), dust mites, and some foods.
For many children with asthma, allergies and viral illness are major culprits. An allergy test will help pinpoint what your child is allergic to and should avoid. You can reduce the risk of getting sick by teaching children to wash their hands thoroughly and often, especially before and after eating, playing and going to the bathroom.
Of course, even the most careful children get sick.
“Kids in daycare get sick about once a month,” Dr. Loughlin says. “Kids with uncontrolled asthma tend to cough and wheeze longer than others.”
For example, most children with a cold will have symptoms for seven to 10 days. A child with asthma may have cold symptoms for 14 to 18 days.
“It seems like, just when they get well, they get sick again,” she says. “That can be frustrating for families. A lot of parents are afraid their child has an immune problem, but they usually don’t. It’s just that the airways (in a child with asthma) are already primed and ready to swell, so when cold germs are going around, they get sick immediately and take longer to recover.”
Cold weather and high humidity also can trigger flare-ups, as can high pollen counts. If your child can stay inside during extreme weather, it may reduce the risk of flare-ups.
Learn the Warning Signs of a Flare-Up
Often, a parent can predict when a flare-up is coming on in their child by watching for specific warning signs. These could include wheezing, chest tightness, cough, trouble sleeping, sneezing, itchy throat, watery eyes, stuffy or runny nose, or ear pain. Some children will feel tired, have a change in mood or experience a rapid heartbeat.
Knowing that a flare-up is coming gives you time to prepare by making sure you have rescue medicines ready.
Understand Your Child’s Medicines and How to Use Them
Most asthma medicines either help prevent flare-ups or provide relief (rescue) when a flare-up happens. It’s critical to understand which medicine is which—ask your doctor to explain. The medicine your child takes every day will not help him or her breathe during a flare-up.
Make sure all asthma medicines are getting into your child’s lungs, not just into their mouths. Inhalers sometimes take more coordination than most young children have. Your doctor may recommend a spacer that allows you to spray the medicine into a mouthpiece or a mask that the child then breathes in. Others may use a nebulizer, a small machine that turns medicine into a mist that your child will inhale.
Know When to Call Your Doctor
Make sure to contact your doctor or nurse if your child is displaying these symptoms:
- Doesn’t improve with rescue medications or needs them more than four times a day or more often than every four hours
- Is coughing or breathing hard
- Has no energy to play or do normal activities
- Has problems seeing, thinking clearly, speaking in sentences or playing
- Has a fast heartbeat
- Has a temperature of 101 degrees or higher
- Feels pain or tightness in the chest
- Has shortness of breath
- Has a bluish tint to fingernails or lips
- Is missing school because of asthma
While there is no way to avoid all flare-ups, following your asthma action plan will help minimize them. You will feel more in control when you know your child’s asthma triggers and can avoid them; you have daily medicine to prevent most flare-ups and rescue medicines when asthma symptoms appear; and you know when to call your doctor for help.
Dr. Loughlin recommends that parents make use of resources, like the videos, booklets and other patient education materials available from UNC Health Children’s Hospital.
If your child has symptoms of asthma, talk to your doctor. Need a doctor? Find one near you.