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

Asthma + Lung UK describes four main symptoms: coughing, wheezing, chest tightness and breathlessness. Children get coughs all the time, so the pattern matters. A cough that happens at night, in the early morning, after exercise, or when a child is excited, laughing or crying, or that goes on for a long time without clearing, makes asthma more likely. A wheeze is a whistling sound, usually on breathing out, that can be hard to hear, and the charity says a child with other symptoms should still see a GP even if no wheeze is heard.

Young children often cannot describe a tight chest. The charity says they may say they have a tummy ache or sore tummy and may rub their chest or tummy. Behaviour can change too: children may become quiet, worried, angry or more distracted, lose their appetite, seem tired or breathe faster or more shallowly. The NHS notes that symptoms usually come and go and may be worse at night and early in the morning.

The NHS says symptoms can be triggered by exercise, high levels of air pollution, cold air, or contact with something a child is allergic to such as pollen, dust, mould or animals. NHS inform adds colds and flu, cigarette smoke, mould or damp, emotions, certain weather and foods containing sulphites. What causes asthma is not fully understood, but NHS pages list allergies such as eczema, hay fever or food allergy, a family history of asthma or allergies, premature birth or low birth weight, exposure to smoke or air pollution in childhood, and illnesses such as bronchiolitis or croup as raising the chance.

The NHS says a GP or nurse will ask questions and listen to the chest, and may use a simple breathing test, sometimes a blood test, and a peak flow meter at home for a few weeks. Diagnosis can take time because symptoms vary and breathing problems can have different causes, and the NHS says that if asthma is likely, medicines may be offered to see whether they help.

NHS inform lists the tests that may be offered: measuring airway inflammation with a blood sample or nitric oxide level, spirometry, peak flow, allergy tests and airway responsiveness. Asthma + Lung UK suggests keeping a symptom diary, with dates, times, triggers and how long symptoms last, and filming symptoms on a phone if the child is well at the appointment.

The NHS says the main treatment is medicines breathed in through an inhaler. Depending on severity, a child may be offered an anti-inflammatory reliever (AIR) inhaler used only when symptoms occur, a maintenance and reliever therapy (MART) inhaler used every day and when symptoms occur, or two separate inhalers: a daily preventer and a blue reliever. The NHS says a blue reliever should not be given to use on its own. NHS inform says AIR may be prescribed for children aged 12 and over and MART for children aged 5 and over.

Asthma + Lung UK says a child with a pressurised metered dose inhaler (pMDI) should use a spacer, which helps the medicine reach the lungs and lowers the risk of side effects. The NHS says stronger inhalers, tablets such as montelukast, or injected biological therapies may be considered if inhalers are not enough. Doses and device choice are decided by the child's clinician.

A personal asthma action plan sets out daily medicines, how to recognise worsening asthma and what to do. The NHS says check-ups should be at least once a year, including inhaler technique and updating the plan. Asthma + Lung UK suggests keeping a copy where it is easily seen and sharing it with family, friends and school, and says a child should always have their reliever inhaler with them.

The NHS suggests avoiding triggers, staying active with advice on safe exercise if exercise brings on symptoms, keeping to a healthy weight, having vaccinations such as the flu vaccine and not smoking. Asthma + Lung UK adds that breathing in smoke raises a child's risk of an asthma attack.

Asthma + Lung UK advises: sit the child up, do not let them lie down, keep them calm, and if they have a blue reliever inhaler, help them take one puff every 30 to 60 seconds up to a total of 10 puffs, using their spacer if they have one. Call 999 if the reliever is not helping after 10 puffs, if they do not have it, or if you are worried at any time. If an ambulance has not arrived after 10 minutes and symptoms are not improving, repeat the puffs, and contact 999 again if there is no improvement. For a MART inhaler in children aged 12 and over the advice is one puff every 1 to 3 minutes up to 6 puffs.

The charity says to call 999 if a child has difficulty breathing, their chest, tummy or the front of their throat is sucking in, their ribs stand out, they cannot talk or eat because of breathlessness, they are quieter or more agitated than usual, or their reliever is not working. It adds that it is safe for a child to use a blue reliever inhaler in an emergency even if it is not their own.

The NHS says an attack can be life-threatening but good treatment reduces the risk, and that asthma is often lifelong though in young children it sometimes goes away by the teenage years. After an attack, Asthma + Lung UK says to see the GP or asthma nurse for an urgent follow-up even if the child seems better, to review medicines, inhaler and spacer technique and the action plan. Hospital treatment for a severe attack may include oxygen, nebulised medicine and steroid tablets or injections, according to the NHS.