A Common Problem
Take a long, deep breath - right now. Inhale slowly, until your
lungs can't hold anymore . . . now let the air out gradually .
. . ahhh. Breathing feels so natural that it's easy to take for
granted, isn't it?
Normally, the air you breathe travels effortlessly through your
nose and mouth, down the trachea (also called the
"windpipe"), through the bronchial tubes into the lungs,
and finally to tiny clusters of air sacs, called alveoli. Here,
oxygen is exchanged for carbon dioxide in your blood.
Now try something different: run in place for 3 minutes. Then
place a straw in your mouth, close your lips around it, and try to
breathe in and out - but only through the straw. Not so easy
anymore, is it? Now, narrow the straw by pinching it in the
middle. Even more difficult to breathe?
That's what it feels like when someone tries to breathe
(also called an asthma attack, flare, episode, or exacerbation).
During a flare-up, the airways narrow and become obstructed, making
it difficult for air to move through them. Asthma can be very scary
- and when not controlled, it can be life-threatening.
More than 20 million people have asthma in the United
States. In fact, it's the No. 1 reason for kids
chronically missing school. And asthma flare-ups are the most
common cause of pediatric emergency room visits due to a chronic
Some kids have only mild, occasional symptoms or only show
symptoms after exercising. Others have severe asthma that, left
untreated, can dramatically limit how active they are and cause
changes in lung function.
But thanks to new medications and treatment strategies, kids
with asthma no longer need to sit on the sidelines, and parents no
longer need to worry incessantly about their child's well
With patient education and the right asthma management plan,
families can learn to control symptoms and asthma flare-ups more
independently, allowing kids and parents to do just about anything
About Asthma Flare-Ups
Asthma is a chronic lung disease that causes airways to become
inflamed, leading to symptoms such as coughing, wheezing, and
shortness of breath. Anyone can have asthma, including infants and
adolescents. The tendency to develop asthma is often inherited.
Many kids with asthma can breathe normally for weeks or months
between flare-ups. When flare-ups do occur, they often seem to
happen without warning. Actually, an asthma flare-up usually
develops over time, involving a complicated process of increasing
All children with asthma have airways that are inflamed, which
means that they swell and produce lots of thick mucus. In addition,
their airways are also overly sensitive, or
, to certain asthma
When exposed to these triggers, the muscles surrounding the
airways tend to tighten, which makes the already clogged airways
even narrower. Things that trigger flare-ups differ from person to
person. Some common triggers are exercise, allergies, viral
So an asthma flare-up is caused by three important changes in
of the lining of the airways
that results in congestion and mucus "plugs" that get
caught in the narrowed airways
, which refers to the tightening of the muscles surrounding the
Together, the swelling, excess mucus, and bronchoconstriction
narrow the airways and make it difficult to move air through (like
breathing through a straw). During an asthma flare-up, kids may
experience coughing, wheezing (a breezy whistling sound in the
chest when breathing), chest tightness, increased heart rate,
sweating, and shortness of breath.
How Is Asthma Diagnosed?
Diagnosing asthma can be tricky and time-consuming because kids
with asthma can have very different patterns of symptoms. For
example, some kids cough constantly at night but seem fine during
the day, while others seem to get frequent chest colds that
don't go away. It's not uncommon for kids to have symptoms
like these for months before being seen by a doctor.
When considering a diagnosis of asthma, a doctor rules out other
possible causes of a child's symptoms. He or she asks questions
about the family's asthma and allergy history, performs a
physical exam, and possibly orders laboratory tests such as chest
X-rays, blood tests, or
lung function tests
During this process, parents must provide the doctor with
detailed information, such as:
how severe they are, when and where they occur, how frequently
they occur, how long they last, and how they go away
the child's and the family's allergy history
how often the child gets colds, how severe they are, and how long
and things in the air that can irritate the airways, recent life
changes or stressful events, or other things that seem to lead to
This information helps the doctor understand the pattern of
symptoms, which can help determine what type of asthma the child
has and how best to treat it.
To confirm the diagnosis of asthma, a breathing test may be
performed using a
, a machine that analyzes airflow through the airways. A spirometer
can also be used to see if the child's breathing problems can
be helped with medication, a primary characteristic of asthma.
The doctor may take a spirometer reading, give the child an
inhaled medication that opens the airways, and then take another
reading to see if breathing improves with medication. If medication
reverses airway narrowing significantly, as indicated by improved
airflow, then there's a strong possibility that the child has
If your child is diagnosed with asthma, it's important to
learn how to
so it won't control your family. Educate yourself about
asthma and learn to identify and eliminate triggers.
Help your child keep an asthma diary, develop and follow an
asthma action plan, and take medications as prescribed. In
peak flow meter
- a hand-held tool that measures breathing ability - can be used at
home. When peak flow readings drop, it's a sign of increasing
Kids who have
exercise-induced asthma (EIA)
develop asthma symptoms after vigorous activity, such as running,
swimming, or biking. Some kids with EIA develop symptoms only after
physical exertion, while others have additional asthma triggers.
With the proper medications, most kids with EIA can play sports
like any other child. In fact, more than 10% of Olympic
athletes have exercise-induced asthma they've learned to
Usually, a doctor can diagnose EIA after taking a history alone.
But sometimes further tests, including an exercise challenge in a
lung function laboratory, are needed to confirm the diagnosis. The
doctor may want to target a child's tolerance for a particular
exercise, as not every type or intensity of exercise affects kids
with EIA the same way.
If exercise is the only asthma trigger, the doctor may prescribe
a medication for the child to take before exercising to prevent
airways from tightening up. Of course, even after taking a
preventive medication, asthma flare-ups can still occur.
Parents (or older kids) must carry the proper
to all games and activities, and the school nurse, coaches, scout
leaders, and teachers must be informed of a child's asthma,
especially so kids who need to can take medication at school as
Not every child with asthma has allergy-triggered asthma, but an
estimated 75% to 85% of people with asthma have some type of
allergy. Even if the primary triggers are colds and
or exercise, allergies can sometimes play a minor role in
aggravating the condition.
How do allergies cause flare-ups in kids with asthma? Children
inherit the tendency to have allergies from their parents. With any
kind of allergy, the immune system overreacts to normally harmless
allergens. Those substances, such as pollen, can cause allergic
reactions in some people. As part of this overreaction, the body
produces an antibody of the
immunoglobulin E (IgE)
type, which specifically recognizes and attaches to the allergen
when the body is exposed to it.
If that happens, it sets a process in motion that results in the
release of certain substances in the body. One of them is
, which causes allergic symptoms that can affect the eyes, nose,
throat, skin, gastrointestinal tract, or lungs. When the airways in
the lungs are affected, symptoms of asthma can occur.
The released histamine is what causes the familiar sneezing,
runny nose, and watery eyes associated with some allergies - ways
the body attempts to rid itself of the invading allergen. In kids
with asthma, histamine can also trigger asthma symptoms and
An allergist can usually pinpoint allergies and, once
identified, the best treatment is to avoid exposure to allergens
Environmental control measures
for the home can help reduce exposure to allergens. When avoidance
isn't possible, antihistamine medications may be prescribed to
block the release of histamine in the body.
Nasal steroids may be given to block allergic inflammation in
the nose. In some cases, an allergist can prescribe
, a series of allergy shots that gradually make the body
unresponsive to specific allergens.
A child's asthma symptoms will fall into one of four
main categories of asthma, each with different characteristics and
requiring different treatment approaches:
Mild intermittent asthma
A child who has brief episodes of wheezing, coughing, or
shortness of breath occurring no more than twice a week is said
to have mild intermittent asthma. Symptoms between flare-ups are
rare, with the exception of one or two instances per month of
mild symptoms at night.
Mild persistent asthma
Kids with episodes of wheezing, coughing, or shortness of breath
that occur more than twice a week but less than once a day are
said to have mild persistent asthma. Symptoms usually occur at
least twice a month at night and flare-ups may affect normal
Moderate persistent asthma
Kids with moderate persistent asthma have daily symptoms and
require daily medication. Nighttime symptoms occur more than once
a week. Flare-ups occur more than twice a week, last for several
days, and usually affect normal physical activity.
Severe persistent asthma
Kids with severe persistent asthma have symptoms continuously.
They tend to have frequent flare-ups that may require emergency
treatment and even hospitalization. Many children with severe
persistent asthma have frequent symptoms at night and can handle
only limited physical activity.
Every child needs to follow a custom asthma management plan
(known as an
asthma action plan
) to control symptoms. Even mild asthma should never be
ignored, since in between flare-ups, airway inflammation exists.
Asthma severity can both worsen and improve over time, placing the
child in a new asthma category that requires different
Elana Pearl Ben-Joseph, MD
Date reviewed: May 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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