5 Answers to Childhood Asthma Questions

Asthmatic child

Watching your child struggle to breathe can be heartbreaking, but take heart — if it’s asthma, it can be controlled.

Below, pediatric pulmonologist John Carl, MD, answers common questions from concerned parents.

How do I know if it’s asthma?

Does your child have trouble breathing during or after exercise? That might be a sign, because exercise is a common asthma trigger.

Other signs include wheezing or a nagging cough that won’t go away after the other symptoms of a cold — such as fever or runny nose — resolve. Some children describe tightness or pain in their chest or neck. If you suspect asthma, talk to a doctor about treatment and management options.

What medications can help manage asthma?

Options for preventing attacks include:

  • Inhaled steroids such as Flovent®,Pulmicort®, Asmanex® and QVAR®
  • Singulair®, a daily controller that is not a steroid

For short-term relief during attacks:

  • Albuterol (ProAir®, Ventolin® and Proventil®)
  • Levalbuterol (Xopenex®)

The recommendations about when to use controller — preventive — medications don’t vary much between age groups, Dr. Carl says. Parents should seek preventive therapies if children experience daytime symptoms more than twice a week or wake up because of respiratory symptoms more than twice a month.

What can I do at home to improve asthma? 

You can eliminate exposure to known irritants such as cigarette smoke. If your child appears to have sensitivity to indoor allergens, such as pets or dust mites, you can help by taking the following steps:

  • Make the bedroom a “safe space” by keeping pets out
  • Control dust mite exposure by using zippered pillow and mattress covers
  • Cover air duct vents
  • Remove carpet from the bedroom
  • Use HEPA filters on vacuum cleaners

How often should my child use a rescue inhaler?

In general, children shouldn’t need to use Albuterol more than a couple times per week. Using Albuterol over many days or multiple doses in a single day without seeking medical care can be very dangerous. If your child is still experiencing significant coughing or wheezing after two or three doses of Albuterol at one time, contact your doctor or emergency department.

Remember that a rescue inhaler only provides short-term relief of asthma symptoms, Dr. Carl says, and doesn’t make a next episode less likely. If your child needs to be treated with multiple doses of Albuterol, it is time to consider the use of daily controller medications.

Should I be concerned about prolonged exposure to steroids?

It’s important to separate concern about possible side effects of oral steroids from inhaled steroids. There is good data demonstrating safety of long-term inhaled steroids. First, inhaled steroids are typically given at much lower doses. Second, the inhaled steroids work by locally decreasing inflammation in airway lining tissue, not by reaching significant levels in the bloodstream.

The large U.S. Childhood Asthma Management Program (CAMP) study followed children who received low-dose inhaled steroids for four years and saw marked improvement in asthma but few side effects. That has been reassuring information for many parents.