Asthma in Kids: Symptoms, Causes and Prevention Tips

Asthma is the most common chronic disease in children, which is when the airways are twitchy, inflamed, and obstructed by mucus making it difficult to breathe. About one in 12 children in the U.S. has asthma. Here in the Kansas City metro, more than 31,000 kids under the age of 18 suffer from the lung disease.

We spoke with Dr. Nadine Mokhallati and Dr. Jade Tam-Williams, both in Pulmonology, about what causes asthma and how to prevent triggers.

What are the symptoms of asthma?

Dr. Mokhallati: There are three main symptoms - chronic coughing, wheezing and shortness of breath.

It’s important for parents to understand that while wheezing is a prevalent indication of asthma, 50% of children will wheeze before the age of six. Young children tend to have breathing issues when fighting a cold, so wheezing doesn’t necessarily mean the child has asthma. However, risk factors for asthma increase if the child has a personal history of physician diagnosed Eczema, if he or she has a history of allergies, if he or she continues to wheeze when not sick, and if mom or dad has asthma.

Dr. Tam-Williams: I also let parents know they may not even hear the wheezing, which is a whistling sound that comes from the chest when the child is breathing out. Wheezing can also be a sign of something else, so it’s important to be properly diagnosed by a physician.

What causes asthma?

Dr. Mokhallati: A combination of genetics and environmental factors cause asthma. Sometimes early viral infections, such as RSV and Rhinovirus infections in babies, can also cause asthma.

Dr. Tam-Williams: Most likely the child has a predisposition to asthma. So, for instance, if the child is in the right environment, exposed to the right virus or has allergies, then the child is more likely to develop asthma.

Can someone have asthma and not know it?

Dr. Mokhallati: Yes, especially teenagers. We see a lot of teens who lead busy lives and have lived with asthma symptoms for so long they think what they’re feeling is just normal. When these kids start treatment they feel so much better.

Dr. Tam-Williams: On the flip side there are also parents who under-appreciate symptoms and believe the child is just coughing because it's cold and flu season or recurrent bronchitis. A child that doesn’t smoke should not have recurrent bronchitis. Children should not have a daytime cough more than two times a week and should not cough more than two times a night per month.

What triggers asthma?

Dr. Mokhallati: What makes the disease so difficult is there’s many things that can set off an asthma attack or exacerbation. Viruses are definitely a major trigger, especially for younger kids. Environmental allergies is a big one for the older kids, so things like dust, pollen, grass, trees, cat and dog dander, and mold. Exercise can prompt asthma along with mere changes in the weather.

Dr. Tam-Williams: Air quality is another big trigger, so cigarette smoke exposure and baseline irritants - those strong pungent smells parents don't realize. For instance, a parent may use bleach to deep-clean the house to keep their child healthy and free of viruses, but the smell of bleach can actually be making things worse for the child. Dirty air vents is another big one parents don’t usually think about, so it’s important to change air filters regularly and clean the venting system throughout the house.

How do you prevent triggers?

Dr. Mokhallati: Trigger control is a big part of asthma management and something we talk about with our families frequently. In addition to changing filters as Dr. Tam-Williams mentioned, parents need to vacuum rugs often, minimize the number of stuffed animals in the child’s bedroom, don’t let cats or dogs sleep in the child’s bed or room, wash pets once every two weeks to minimize dander and make sure children wash hands after playing with animals.

Dr. Tam Williams: Managing triggers is important because the biggest predictor of whether a child is going to have a severe asthma attack is if the child had a previous asthma attack in the last 12 months. The level of intervention needed for the second asthma attack will be higher than the first asthma attack, especially if families haven't taken preventive steps at home.

Is asthma a life-threatening condition?

Dr. Mokhallati: Asthma is a serious disease that is categorized as either intermittent or persistent.

Intermittent is when kids have episodic symptoms, which means they don’t have symptoms day-to-day and only use an inhaler when needed.

Persistent asthma means the child has more frequent symptoms, which can be mild, moderate or severe. These children typically use a daily inhaler regardless of whether feeling good or feeling bad.

Any asthma attack can be life-threating, which is why immediate treatment is required.

What are the treatments?

Dr. Tam-Williams: Inhalers are the main treatment and there are two types - slow-action and fast-action.

A slow-action inhaler or a maintenance controller is designed to get at the baseline inflammation and works slowly over time. The analogy I like to use is think about it like you’re unclogging a pipe. When a pipe is clogged you pour down the cleaner and let it set for a while before running water through the pipes. Slow-action controllers take time, but provide continued relief when used on a regular basis.

Fast-action inhalers or rescue inhalers help release the muscles around the airways to provide quick relief. These inhalers work within 10-20 minutes, but only last for four hours and are not meant to be used on a daily basis.

Sometimes asthma cannot be controlled with inhalers alone and that is when we think about medications such as allergy shots, Xolair, Nucala, Fasenra and Dupixent.

What is the right way to use an inhaler?

Dr. Tam-Williams: A spacer should be used with an inhaler each and every time. One end of the spacer connects to the inhaler and the other ends goes in the mouth. The spacer allows the particles of the medication to slow down, so that it can be properly be inhaled in the lungs. When an inhaler is used by itself, most of the medicine ends up in the mouth and throat. I like to tell my patients – slow down, use the spacer, so you can breathe it, not eat it.

What advice do you have for parents?

Dr. Mokhallati: Children and families should have an asthma action plan, which goes over what needs to be done in different scenarios. There are three zones of the action plan. Green means no asthma signs or symptoms and continue to follow the day-to-day treatment routine. The yellow zone means the child is starting to get sick and is coughing and wheezing, and the child should start to take medication specified for that zone. The red zone is when the child is having trouble breathing and emergency medication should be started immediately.

Dr. Tam-Williams: If you don't have an asthma action plan, ask your doctor for one. Another thing I think is beneficial for people who are caring for kids with asthma is to know the signs of asthma- cough and wheezing, and recurrent dry cough. Know the difference between a controller and a rescue inhaler and when to use which one.

The Children’s Mercy AAIR (Advanced Asthma Interdisciplinary Respiratory) Clinic helps patients living with severe asthma and their families work toward an improved quality of life by providing greater control over asthma.

AAIR team members (standing, from left): Kristin Kramer, Pulmonology; Atenas Mena, Environmental Health; Dr. Bridgette Jones, Allergy & Immunology; Claire Elson, Pharmacy; Stephanie Duehlmeyer, Pharmacy; Julie Schwed, Pulmonology; and Micaela Hill, Social Work. (Seated, from left): Teresa Forth, Sleep Center; Dr. Jade-Tam Williams, Pulmonology; Dr. Nadine Mokhallati, Pulmonology; Kaitlin Gomer, Patient Access; and Beth Roher, Sleep Center.

Download the asthma action plan.

Learn more about asthma education and free online asthma classes at Children’s Mercy.

Learn more about Allergy, Asthma and Immunology at Children’s Mercy.