Asthma factsheet

Introduction

Asthma is a life-long lung condition that makes breathing hard due to inflammation and excess mucus in the airways. Asthma can happen to anyone and is more common in children. 

Asthma makes the airways sensitive and inflamed, which makes breathing more difficult. Things in the environment can make asthma worse. These are called triggers.

Asthma triggers can:

  • cause more mucus to be produced
  • narrow the airways
  • tighten the muscles in the airways.

There is no cure for asthma, but your child can lead an active life with proper care.

 Signs and symptoms

Symptoms of asthma include:

  • shortness of breath and difficulty breathing
  • a sore tummy in young children
  • wheezing, especially at night or early morning
  • dry coughing, worse at night and when waking up
  • tightness in the chest.

Your child may be unable to do their usual activities without wheezing, coughing, or shortness of breath.

Symptoms of severe asthma include:

  • distress and anxiety around breathing
  • sucking in at the throat and ribs when breathing
  • a bluish tinge to the lips
  • inability to talk due to breathlessness
  • needing to use asthma medication more than every two hours.

Call Triple Zero (000) or go to the nearest emergency department if your child has severe asthma.

Diagnosis

Take your child to their local doctor for ongoing breathing issues like wheezing or coughing.

Your local doctor can check your child for asthma by:

  • looking at their symptoms
  • taking a medical history, including any allergies
  • confirming whether any other family members have asthma.

Your child’s doctor may also give them some asthma medication to try and see if their symptoms improve.

If your child is above five, they can do a spirometry lung function test to check whether they have asthma. This test measures the amount of air they can breathe in and out and the ease and speed of their breathing.

Children under three can have coughing and wheezing issues unrelated to asthma. These children need to be monitored for longer to see if they:

  • respond well to asthma medication for wheezing 
  • grow out of their breathing issues by the time they are school-aged.

Reactive airway disease (RAD) is the name used when children have asthma symptoms but are too young to be diagnosed properly.

Treatment

Asthma is a life-long condition. Treatment focuses on keeping asthma under control with medication and avoiding triggers.

A child's asthma is considered under control when:

  • there are no symptoms in the morning after waking up
  • symptoms happen less than twice a week
  • reliever medicine is used less than twice a week, except when exercising
  • symptoms go away quickly after taking medication
  • they do their usual activities without asthma symptoms.

Medications

Asthma medications are usually breathed into the airways. Children may find it easier to take some medications using a spacer. A spacer is a device with a mask or mouthpiece that attaches to the inhaler. Spacers give children more time to breathe in the medicine and lower the amount of medicine that is wasted.

Asthma medications are split into four types

Reliever medication

Common reliever medications include:

  • Ventolin®
  • Asmol®
  • Airomir®
  • Bricanyl®

These medications relax tight muscles to open the airways. This provides quick relief for several hours. 

Make sure your child always has access to their reliever medicine during school, childcare, and sports, as asthma symptoms can happen without warning. 

Side effects are different for every child but can include:

  • fast heart rate
  • shaky hands
  • hyperactivity
  • excitability.

Preventer medication

Preventer medications can be steroid-based:

  • Flixotide®
  • Pulmicort®
  • Alvesco®
  • Qvar®

Or non-steroid based:

  • Montelukast®
  • Singulair®
  • Lukair®
  • Intal® Forte

These medications can be prescribed if children need to use their reliever medicine more regularly to control asthma.

Preventer medicine helps to make the airways less sensitive to triggers and reduces swelling in the airways.

Preventive asthma medication must be taken daily, even without symptoms. It may take days or weeks to see improvement. Do not stop medication without speaking to your child’s doctor. 

Side effects are different for every child but can include:

  • a bad taste in the mouth
  • coughing
  • oral thrush
  • a change in their voice
  • changes in mood and behaviour.

To reduce the risk of side effects, your child should rinse their mouth with water or clean their teeth after taking the medication.

See your local doctor as soon as possible If your child is taking Montelukast and you notice they are:

  • agitated
  • irritable
  • anxious
  • experiencing tremors
  • hallucinating
  • having sleep disturbances
  • depressed
  • experiencing suicidal thoughts.

Inhaled medication

Common inhaled medications include:

  • Symbicort®
  • Seretide®
  • Flutiform®

These are long-acting, inhaled medications that are combined in a device with a steroid-based preventer.

Side effects from inhaled medications are different for every child but can be like preventer medication side effects.

Rescue medication

Common rescue medications include:

  • Prednisone
  • Predmix®
  • Redipred®

These medications are sometimes used for short periods of 3-5 days during an asthma flare-up when inhaled reliever medication is not working.

Rescue medications reduce airway inflammation and can be given in the hospital or by a doctor. They're often part of a child's asthma action plan. Symptoms are unlikely when medication is only used for short periods but can include:

  • hunger
  • a puffy face
  • weight gain
  • mood swings.

Avoiding asthma triggers

Asthma triggers can be different for every child. Some children may have multiple triggers, and some are worse than others.

Knowing your child’s triggers can help manage their asthma by helping you limit exposure and be prepared with medicine.

Keep a record of anything that worsens your child’s asthma and share the information with your child’s daycare, school, and any places they go regularly.

Common asthma triggers include:

  • cigarette and tobacco smoke
  • vapour from e-cigarettes
  • exercise
  • changes in weather and air quality
  • illnesses like the common cold and influenza
  • allergies.

 Management

Asthma episodes

If your child is having an asthma episode, follow the advice in your child’s asthma action plan or follow the below first aid steps:

  1. remain calm
  2. sit your child comfortably upright
  3. shake a blue reliever puffer, give one puff at a time for a total of four puffs through a spacer, if available
  4. ask your child to take four breaths from the spacer after each puff
  5. wait four minutes
  6. if your child’s asthma symptoms do not get better, repeat steps 3 and 4
  7. if your child’s asthma symptoms still do not get better, call Triple Zero (000) for an ambulance and tell them your child is having an asthma emergency
  8. continue steps 3 and 4 while you wait for the ambulance to arrive.

Asthma action plans

An asthma action plan is written for your child by their doctor to help them manage their asthma. The plan will include:

  • your child’s current asthma control level
  • information about the medicine they take for asthma
  • how much medicine they need
  • how often they need to take medicine
  • when to call the doctor or go to the emergency department.

Your child’s asthma plan should be updated every six months. Take it with you whenever your child sees their local doctor or specialist.

Maintaining good asthma control

Giving asthma medication properly is important for good asthma control. Using the inhaler or medication incorrectly can:

  • give your child too much medication
  • give your child, not enough medication
  • lead to poor asthma control.

Ask the doctor to watch you and your child giving the medication to make sure it is being used properly. 

To help your child maintain good asthma control:

  • update your child's asthma plan every six months or whenever changes are made.
  • make an appointment with your child's asthma doctor every three to six months, even if they have been well.
  • take your child's asthma medication and action plan to every doctor visit. 
  • keep an asthma symptom diary to record the type of symptoms your child has, when they happen, and how often reliever medicine is needed 
  • ensure that your child takes their asthma medications as prescribed.
  • do not stop your child's asthma medications unless directed by your doctor.

See your local doctor immediately if your child's asthma symptoms get worse or if you have concerns about their asthma control.

Asthma, school, and childcare

All Australian schools and after-school care services must have at least one staff member with asthma management training approved by the Australian Child and Education Care Quality Authority. 

You will need to:

  • tell your child's school or service that your child has asthma 
  • give them a copy of the asthma action plan
  • label your child's reliever medication and asthma devices with their name, dosage, and expiration date.

Asthma and allergens

An allergen is a substance that is not usually dangerous but causes an allergic reaction in some people.

Common allergens can include:

  • foods like eggs and nuts
  • pollen and mould
  • insect stings
  • animal dander - fur and feathers
  • plants.

Some allergic reactions can also trigger an asthma episode.

Allergic reactions can be fast and happen within minutes of exposure to an allergen.

Reactions can include:

  • hives or welts on the skin
  • redness of the skin
  • vomiting and stomach ache
  • tingling and swelling of the mouth, lips, face, and eyes.

Some children can have a more severe allergic reaction called anaphylaxis.

Signs of anaphylaxis include: 

  • wheezing, difficult, or noisy breathing 
  • swelling of the tongue
  • swelling or tightness in the throat
  • a persistent cough
  • difficulty talking or a hoarse voice
  • dizziness
  • becoming pale and floppy in young children
  • collapsing.

If your child has signs of anaphylaxis, you should:

  • follow your child’s ASCIA action plan for anaphylaxis if you have one
  • use an EpiPen or Anapen, if available
  • call Triple Zero (000) for an ambulance.

It's important to determine if your child has any allergies and what type of reactions they cause. Talk to your child's doctor if you have any concerns about allergies.

Follow the tips below to manage different allergens and asthma for your child.

Mould and dust mites:

  • wipe down dusty surfaces like floors, shelves, and blinds with a damp or anti-static cloth
  • wash sheets, pillowcases, and soft toys regularly in hot water
  • use "dust mite resistant," "hypoallergenic," or "allergy-friendly" products
  • avoid clutter, sheepskin, and woollen bedding
  • vacuum carpets and couches, and remove mould as soon as you notice it is growing
  • regularly clean the refrigerator trays, ventilation fans, and air conditioners
  • use ventilation fans in the kitchen and bathroom regularly
  • keep your home 5 degrees warmer than the outside in cool weather to avoid moisture build-up.

Animal dander:

  • groom pets regularly, including bathing and trimming.
  • keep up with flea and tick treatments.
  • keep pets off furniture or outside.
  • wash hands after handling pets.
  • if your child has allergies or asthma, talk to your doctor about pets less likely to trigger their condition.

Managing allergens like pollen:

  • learn to spot which grasses and plants have pollens that spread through the wind and try to avoid them where possible.
  • consult with your local hardware store or plant nursery to find low-allergy plants, flowers, and grass for your garden.
  • keep your child away from outdoor activities that involve a large amount of pollen or grass in the air, such as lawn mowing.
  • avoid using the clothesline for drying laundry on days when there is a high pollen count in the air.

Food allergens:

  • store food in sealed containers and clean up crumbs and spills quickly.
  • be aware of your child's food allergies when eating out.
  • talk to your child’s doctor about common food additives that can trigger asthma:
    • metabisulphite/sulphur dioxide (220-228)
    • tartrazine (synthetic yellow dye [102])
    • monosodium glutamate (621)
    • acetylsalicylic acid (asa).
  • regularly check your child for new food allergies or sensitivities and talk to their doctor about testing.
  • avoid homeopathic or herbal remedies that can trigger asthma, like: 
  • echinacea
  • royal jelly
  • willow tree bark extracts
  • chamomile.

Other triggers:

Anxiety, stress, distress, and laughter can trigger asthma as they can affect breathing. Encourage your child to learn relaxation techniques and breathing exercises to prevent asthma attacks.

Asthma, cigarette smoke and vaping

Smoke and vapour from cigarettes, vapes and e-cigarettes can cause lung issues, including asthma episodes. 

Don't smoke or vape around your child or in places where your child spends time. 

Second-hand smoke can trigger asthma, so parents and carers who smoke should wash their hands and change their clothes before being around children. 

Talk to your child early about smoking and vaping to give them good information and lower the risk of them picking up the habit.

Asthma, play and exercise

If your child has asthma, they may experience an episode while playing or exercising. This is because they quickly breathe in cool, dry air through their mouth. Check your child while they play or exercise to see if their asthma is triggered.

To manage asthma, playing, and exercise for your child, you can:

  • encourage your child to warm up and cool down before and after exercising by doing gentle stretches
  • make sure your child uses reliever medicine before they start exercising
  • help your child recognise the signs of asthma symptoms so they can safely stop exercising and use their reliever medicine.

Your child should avoid active play and exercise when:

  • the air quality is poor, like smoke from a bushfire or pollution
  • there is lots of pollen in your environment
  • your child has cold and flu symptoms.

Speak to your child’s doctor if exercise, play, and asthma become challenging to manage.

Asthma and changes in weather

Changes in the weather can trigger asthma symptoms. This is because moisture, dryness, pollen, and temperature can affect breathing. It's important to keep track of the weather forecast to manage asthma and weather changes. 

Weather changes to look out for include:

  • humidity
  • air temperature
  • wind and wind chill
  • seasonal changes and increase in pollen
  • thunderstorms.

Air pollution, debris, and smoke from bushfires can also trigger asthma episodes. For quick updates on the air quality in your area, check the air quality index through the NSW Department of Planning and Environment, which provides. 

If the air quality is poor, stay inside with windows and doors closed. If you live in an area with a high bushfire risk, ensure that weather and emergencies are included in your child's asthma plan.

Asthma and illness

Viruses that affect the airways are a very common asthma trigger.

This includes:

You can help your child to manage asthma and viruses by encouraging them to:

  • wash their hands with soap and water
  • use tissues and cover their nose and mouth when coughing or sneezing
  • wearing a mask when they are sick and out in the community
  • avoid having contact with other people who are showing cold and flu symptoms like coughing and sneezing.

Include coughs, runny noses, and colds in your child’s asthma plan, and speak to their doctor about immunisation for the flu and other viruses before winter.

Last updated Monday 25th March 2024

Disclaimer

This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024


This factsheet was produced with support from John Hunter Children's Hospital.