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Asthma in Children: What is it

​Bronchial Asthma is a common problem in childhood that affects about 20% of children in Singapore. It is a condition where there is chronic inflammation of the airways.

Causes of Asthma

Various triggers can affect the sensitive airways of children with asthma, and bring on symptoms. However, it is not always possible to pinpoint the exact cause.

Common causes are:

Viral Infections. Asthma is often brought on by viral respiratory infections in young children. Such viral infections are unavoidable and are very common in a young child. As the child grows older and resistance to viral infection improves, asthma attacks also decrease.

Exercise. Symptoms may occur a few minutes after exercise ends, or it may occur many hours later e.g. in the night. This is known as exerciseinduced asthma.

Allergies. Asthmatic children are sensitive to certain substances called allergens, which when inhaled causes asthma. Common allergens are house dust mites and animal dander. Food allergy as a direct cause of asthma is uncommon but occasionally peanuts, citrus fruits, strawberries, egg or milk products, or bird’s nest may provoke asthma symptoms.

Irritants. Air pollution can cause breathing problems. Children with asthma have more symptoms during periods of haze. Strong fumes and odours can also induce asthma. Cigarette smoke is particularly bad for children with sensitive airways and should be avoided at all cost.

Weather Changes. Sudden changes in temperatures and humidity may worsen asthma. Cold, dry air is a trigger to the sensitive bronchial airway. Exercising in cold air may also increase the symptoms of exerciseinduced asthma.

Drug and Chemicals. Aspirin and other anti-arthritic medicines e.g. ibuprofen (Brufen), diclofenac (Voltaren) may cause asthma in some children. Certain cough mixtures, particularly those containing codeine, may sometimes worsen asthma symptoms. Children with asthma also react adversely to artificial coloring (tartrazine dye), food preservatives (metabisulfite) and monosodium glutamate (MSG).

Emotional Factors. Emotional problems on their own do not cause asthma but anxiety, excitement and stress can aggravate the condition.

Symptoms of Asthma

Wheezing. A high-pitched whistling sound that occurs when a child breathes out. This is an important symptom of asthma but may not be present in all cases of asthma.

Cough. Generally troublesome at night or early in the morning. Cough may be the only complaint in a small group of asthmatic children.

Shortness of breath. This may be severe enough to interfere with normal activity, sleep or exercise. In older children, it may occur after exercise.

Chest tightness. A complaint, particularly of older children, after vigorous exercise. The symptoms of asthma vary for each child. Some children are troubled mainly by wheezing, while others may be bothered by a chronic cough.

Diagnosis of Asthma

Diagnosis is made on a detailed history and careful examination. Special tests are usually not required, unless there are certain doubts in the diagnosis. The following tests may be ordered:

Chest x-ray. May be necessary to exclude other medical conditions and reasons causing the narrowing of the airways.

Lung function test. This test gives an indication of the severity of the condition and the response to treatment.

Peak flow rate. This gives an indication of how quickly air can be forced out of the lungs – the lower the reading, the more obstructed the lungs are.

Spirometry. This test allows the doctor to get a detailed assessment of airflow in the smaller airways.

Challenge tests. In children whose history is not definitive and breathing tests are normal, ‘stress’ tests may be used to induce airflow obstruction.

Allergy tests. Allergy tests may be useful to confirm certain suspected allergens.

Treatment for Asthma

There is no cure for asthma. But with effective treatment, asthma can be kept under control and the child can lead a normal life, participate in sports and have normal lung function.

There are two main groups of medicines that can improve the symptoms due to asthma.

Relievers or Bronchodilators.
These medicines act to relax the muscles around the airway, relieving the obstruction to airflow rapidly. They provide relief from asthma symptoms within minutes and are used during an acute asthma attack.

Reliever medications should be carried at all times and be used promptly to treat any asthma symptom. School children should carry reliever medicines in their school bags.

They act to reduce the swelling of the airway lining and reduce mucus production. They do not provide immediate relief of symptoms but treat the underlying disease. Anti-inflammatory medications are now the first line of treatment in many guidelines for managing problematic asthma.

They have to be given over a long period of time in order to modify the disease. Preventive medications should always be used, whether or not there are symptoms of asthma. Never stop preventive medications without medical advice.