Asthma in children: symptoms, inhalers and what to do in an attack

The NHS describes asthma as a common condition affecting breathing, in which the airways swell and narrow. It usually starts in childhood. Asthma and Lung UK adds that it is the most common long-term condition affecting children, with around 1 in 11 children in the UK affected, and that some children find it improves or disappears as they grow.

The NHS says children are more likely to develop asthma if they have eczema, hay fever or food allergies, if other family members have asthma or allergies, if they were born prematurely or with a low birth weight, if they were exposed to high levels of air pollution or cigarette smoke, or if they had breathing illnesses such as bronchiolitis or croup.

The main symptoms are wheezing, coughing, shortness of breath and chest tightness. They tend to come and go and may be worse at night or in the early morning. Triggers include exercise, air pollution, cold air, viral infections and allergens such as pollen, dust, mould or animals.

• A cough that is worse at night or after exercise.

• Wheezing or a whistling sound when breathing out.

• Complaining of a tight chest, or running out of breath when playing.

• Symptoms that wake your child at night or stop them doing usual activities, which the NHS says is a reason to see a GP.

A GP or nurse asks questions and listens to the chest. The NHS says breathing tests, peak flow monitoring at home for a few weeks, and sometimes blood tests may be used, and that asthma can take time to diagnose because symptoms vary and breathing problems have other causes. Asthma and Lung UK says children can take longer to diagnose, especially under five. If asthma is likely, your child may be offered asthma medicine to see whether it helps symptoms.

The NHS says the main treatment is inhaled medicines, which work well for most people to reduce or prevent symptoms. Depending on severity a child may use a preventer inhaler daily and a reliever when symptoms occur, or other approaches such as a maintenance and reliever (MART) inhaler for older children and teenagers. A spacer is recommended with some inhalers; the NHS says shake the inhaler between puffs and use a spacer if you have one. A doctor, nurse or pharmacist should show you how to use each device, and technique is checked at annual reviews.

If inhalers are not enough, tablets such as montelukast or a stronger inhaler may be added. Asthma medicines for children are prescription medicines chosen by a clinician; do not adjust doses without advice.

The NHS says your care team should record how and when to use medicines, how to monitor asthma, triggers and what to do if symptoms worsen in a personal asthma action plan, a printed or digital copy, which should be brought to each appointment. Asthma and Lung UK provides a child-specific action plan and a poster about what to do at school if a child has an asthma attack.

In an attack, the NHS says to sit up, stay calm and use the reliever as the plan states. With a blue reliever, 1 puff every 30 to 60 seconds up to 10 puffs, using a spacer if available. Call 999 if symptoms get worse at any time, do not improve after the maximum dose, or there is no inhaler. After an attack, arrange a GP visit within 2 days even if your child seems better.

Asthma and Lung UK reports that about 9 in 10 people with asthma get airway tightening with exercise, and that when asthma is well controlled children should be able to join in and keep fit. Make sure the school has a copy of the action plan, knows where the reliever is kept and how to use it. The NHS also advises keeping up to date with vaccinations such as the flu vaccine, as viruses can make asthma worse, and keeping children away from smoke.

Children with asthma are usually looked after by the GP practice with a practice nurse and a paediatric team for difficult cases. Private paediatric respiratory consultations can offer extra testing and specialist advice. Keep your GP informed about any private prescriptions so there is one agreed plan and one set of inhalers.