Health Library Asthma in ChildrenFrom Healthwise

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This topic provides information about asthma in children. If you are looking for information about asthma in teens and adults, see the topic Asthma in Teens and Adults.

What is asthma?

Asthma makes it hard for your child to breathe. It causes swelling and inflammation in the airways that lead to the lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for your child to breathe. These flare ups are also called asthma attacks or exacerbations.

Asthma affects children in different ways. Some children only have asthma attacks during allergy season, when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.

Even if your child has few asthma attacks, you still need to treat the asthma. If the swelling and irritation in your child’s airways isn't controlled, asthma could lower your child's quality of life, prevent your child from exercising, and increase your child's risk of going to the hospital.

Even though asthma is a lifelong disease, treatment can control it and keep your child healthy. Many children with asthma play sports and live healthy, active lives.

What causes asthma?

Experts do not know exactly what causes asthma. But there are some things we do know:

• Asthma runs in families.
• Asthma is much more common in people with allergies, though not everyone with allergies gets asthma. And not everyone with asthma has allergies.
• Pollution may cause asthma or make it worse.

What are the symptoms?

Symptoms of asthma can be mild or severe. When your child has asthma, he or she may:

• Wheeze, making a loud or soft whistling noise that occurs when the airways narrow.
• Cough a lot.
• Feel tightness in the chest.
• Feel short of breath.
• Have trouble sleeping because of coughing and wheezing.
• Quickly get tired during exercise.

Many children with asthma have symptoms that are worse at night.

How is asthma diagnosed?

Along with doing a physical exam and asking about your child’s symptoms, your doctor may order tests such as:

• Spirometry. Doctors use this test to diagnose and keep track of asthma in children age 5 and older. It measures how quickly your child can move air in and out of the lungs and how much air is moved. Spirometry is not used with babies and small children. In those cases, the doctor usually will listen for wheezing and will ask how often the child wheezes or coughs.
• Peak expiratory flow (PEF). This shows how fast your child can breathe out when trying his or her hardest.
• A chest X-ray to see if another disease is causing your child’s symptoms.
• Allergy tests, if your doctor thinks your child’s symptoms may be caused by allergies.

Your child needs routine checkups so your doctor can keep track of the asthma and decide on treatment.

How is it treated?

There are two parts to treating asthma. The goals are to:

• Control asthma over the long term. To do this, use a daily asthma treatment plan. This is a written plan that tells you which medicine your child needs to take. It also helps you track your child’s symptoms and know how well the treatment is working. Many children take controller medicine—usually an inhaled corticosteroid—every day. Taking controller medicine every day helps reduce the swelling of the airways and prevent attacks.
• Treat asthma attacks when they occur. Use an asthma action plan, which tells you what to do when your child has an asthma attack. It helps you identify triggers that can cause your child’s attacks. Your child will use rescue medicine, such as albuterol, during an attack.

Using an inhaler with a spacer is the best way to get the most medicine to your child’s lungs. But your child has to use the inhaler correctly for it to work well. If you are not sure how to use the inhaler the right way, ask your doctor to show you how.

If your child needs to use the rescue inhaler more often than usual, talk to your doctor. This is a sign that your child’s asthma is not controlled and can cause problems.

Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your child’s asthma treatment and action plans.

What else can you do to help your child's asthma?

You can prevent some asthma attacks by helping your child avoid those things that cause them. These are called triggers. A trigger can be:

• Irritants in the air, such as cigarette smoke or other air pollution. Try not to expose your child to tobacco smoke.
• Things your child is allergic to, such as pet dander, dust mites, cockroaches, or pollen. Taking certain types of allergy medicines may help your child.
• Exercise. Ask your doctor about using an inhaler before exercise if this is a trigger for your child’s asthma.
• Other things like dry, cold air; an infection; or some medicines, such as aspirin. Try not to have your child exercise outside when it is cold and dry. Talk to your doctor about vaccines to prevent some infections, and ask about what medicines your child should avoid.

It can be scary when your child has an asthma attack. You may feel helpless, but having a daily treatment plan and an asthma action plan will help you know what to do during an attack. An asthma attack may be severe enough to need urgent medical care, but in most cases you can take care of symptoms at home if you have a good asthma action plan.

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I take allergy shots (immunotherapy) for allergic rhinitis and allergic asthma?
	Actionsets are designed to help people take an active role in managing a health condition.
	Asthma in children: Helping a child use a metered-dose inhaler and mask spacer
	Asthma: Identifying your triggers
	Asthma: Measuring peak flow
	Asthma: Taking charge of your asthma
	Asthma: Using a dry powder inhaler
	Asthma: Using a metered-dose inhaler
	Asthma: Using an asthma action plan

The cause of asthma is unknown. Health experts believe that inherited, environmental, and immune system factors combine to cause inflammation of the bronchial tubes, which carry air to the lungs. This can lead to asthma symptoms and asthma attacks.

• Asthma may run in families (inherited). If this is the case in your family, your child may be more likely than other children to develop long-lasting (chronic) inflammation in the bronchial tubes.
• In some children, immune system cells release chemicals that cause inflammation in response to certain substances ( allergens) that cause allergic reactions. Studies show that exposure to allergens such as dust mites, cockroaches, and animal dander may influence asthma’s development.¹ Asthma is much more common in children with allergies ( atopic children), though not all children with allergies develop asthma. And not all children with asthma have allergies.
• Environmental factors and today's germ-conscious lifestyle may play a role in the development of asthma. Some experts believe there are more cases of asthma because of pollution and less exposure to certain types of harmful bacteria and other "germs."² As a result, children's immune systems may develop in a way that makes it more likely they will also develop allergies and asthma.

Symptoms of asthma can be mild or severe. Your child may have no symptoms; severe, daily symptoms; or something in between. How often your child has symptoms can also change. Symptoms of asthma may include:

• Wheezing, a whistling noise of varying loudness that occurs when the airways of the lungs ( bronchial tubes) narrow.
• Coughing, which is the only symptom for some children.
• Chest tightness.
• Shortness of breath, which is rapid, shallow breathing or difficulty breathing.
• Sleep disturbance.
• Tiring quickly during exercise.

If your child has only one or two of these symptoms, it does not necessarily mean he or she has asthma. The more of these symptoms your child has, the more likely it is that he or she has asthma.

An asthma attack occurs when your child's symptoms suddenly increase. Factors that can lead to or worsen an asthma attack include:

• Having a cold or another type of respiratory illness, especially one caused by a virus, such as influenza.
• Exercising (exercise-induced asthma), especially if the air is cold and dry.
• Exposure to triggers, such as cigarette smoke, air pollution, dust mites, or animal dander.
• Changes in hormones, such as during the start of a girl's menstrual blood flow at puberty.
• Taking medications, such as aspirin (aspirin-induced asthma) or nonsteroidal anti-inflammatory drugs.

Most asthma attacks result from a failure to successfully control asthma with medications. By strictly following the doctor's recommendations and taking all medications correctly, it is possible to prevent these attacks from occurring in most cases. While some asthma attacks occur very suddenly, many get worse gradually over a period of several days.

Many children have symptoms that become worse at night (nocturnal asthma). In all people, lung function changes throughout the day and night. In children with asthma, this often is very noticeable, especially at night, and nighttime cough and shortness of breath occur frequently. In general, waking at night because of shortness of breath or cough indicates poorly controlled asthma.

It can be difficult to know how severe your child's asthma attack is. Symptoms are used to classify asthma by severity. Talk with your health professional about how to evaluate your child's symptoms.

Symptoms are also used along with peak expiratory flow to help define the green, yellow, and red zones of your child's asthma action plan. You use this to decide on treatment during an asthma attack.

Other conditions with symptoms similar to asthma include sinusitis and vocal cord dysfunction.

Asthma often begins during childhood or the teen years and may last throughout your child's life.

At times, the inflammation found in asthma causes your child's airways to narrow and produce mucus, resulting in asthma symptoms such as shortness of breath.

The airways narrow when they overreact to certain substances. These are known as asthma triggers and may include:

• Substances your child is allergic to (allergens, such as dust mites or animal dander). Allergens cause long-term (chronic) inflammation and may cause asthma symptoms.
• Environmental factors, such as smoke or cold air. Environmental factors may lead to a tightening of the muscles that line the bronchial tubes (bronchospasm), which can trigger asthma symptoms.

What triggers asthma symptoms varies from child to child. When asthma is triggered by an allergen, it is known as allergic asthma.

When asthma symptoms suddenly occur, it is known as an asthma attack (also called an acute episode, flare-up, or exacerbation). Asthma attacks can occur rarely or frequently and be mild to severe.

It can be difficult to know how severe your child's asthma attack is; this is important, because severe attacks may require emergency treatment. However, in most cases you can take care of your child's symptoms at home with an asthma action plan, which is a written plan that tells you which medication your child needs to use and when you should call a health professional or seek emergency treatment.

Asthma is classified as mild intermittent, mild persistent, moderate persistent, and severe persistent. Children with:

• Mild intermittent, mild persistent, and frequently, moderate persistent asthma often have symptoms only after being around a trigger.
• Mild intermittent asthma usually need medications only during an asthma attack. In intermittent asthma, the child is well and without symptoms in between infrequent attacks with symptoms.
• Mild persistent or moderate persistent asthma need to take medications daily to control the long-term inflammation in their airways. These children are at risk of asthma attacks that may become severe.
• Severe persistent asthma have symptoms almost all of the time. Their symptoms need to be treated daily. These children are at increased risk for severe, life-threatening asthma attacks known as status asthmaticus.

Asthma can have a great impact on your child's life. Even mild asthma may result in changes to the airway system (airway remodeling) and speed up and worsen the natural decrease in lung function that occurs as we age.³ Loss of lung function in asthma appears to start early in childhood.⁴ Asthma also may increase the risk of a partial collapse of lung tissue ( atelectasis) or a collapsed lung ( pneumothorax).

Sometimes asthma does not respond to treatment because children are not taking their medications, not taking them correctly, not avoiding triggers, and otherwise not following their daily treatment plan or asthma action plan. It is very important that you and other caregivers make sure your child is following his or her treatment and action plans to prevent worsening asthma and an increased risk of death.

By following asthma plans, most children with asthma can live a healthy, full life.

Many factors may increase the risk of a child developing asthma. Some of these are not within your control; others you can control.

Asthma risk factors that you cannot control

• Gender. Among children, boys have asthma more often than girls.
• Race. Asthma is more common in black children than in white children.⁵
• Inherited tendency (genetic predisposition) to overreaction of the bronchial tubes. Children who inherit a tendency of the bronchial tubes (which carry air to the lungs) to overreact often develop asthma.
• A history of allergies. Children with an allergy are more likely than other children to develop asthma. Most children with asthma have allergic rhinitis, atopic dermatitis, or both. Studies indicate that 40% to 50% of children with atopic dermatitis develop asthma. Having atopic dermatitis as a child may also increase the risk of a person having more severe and persistent asthma as an adult.⁶
• A family history of allergies and asthma. Children who have an allergy and asthma usually have a family history of allergies or asthma.
• Respiratory syncytial virus (RSV) and wheezing at a young age. Early infection with respiratory syncytial virus (RSV) that causes a lower respiratory infection is a risk factor for wheezing.⁷ Young children who wheeze have a greater risk of developing asthma than children who do not wheeze.

Asthma risk factors that you can control

You may be able to change some factors to reduce your child's risk of developing asthma or of making the condition worse.

• Cigarette smoking. Children who smoke are more likely to develop asthma when they become teenagers. A large study found that children who smoked at least 300 cigarettes in a year were almost 4 times more likely to get asthma.⁸
• Cigarette smoking during pregnancy. Women who smoke during pregnancy increase the risk of wheezing (a symptom of asthma) in their babies. Babies whose mothers smoked during pregnancy also have worse lung function than babies whose mothers did not smoke.⁹
• Exposure to secondhand cigarette smoke. Children who are exposed to secondhand cigarette smoke are at increased risk for developing asthma.⁹ If children already have the disease, exposure to secondhand smoke increases the severity of their symptoms.
• Obesity. Studies have found an association between obesity in children and a higher-than-average asthma prevalence. However, the reason for the association is unclear. Experts don't know whether one condition contributes to the other or whether some unknown mechanism contributes to both.⁵ Also, symptoms caused by obesity are sometimes thought to be asthma symptoms.
• Dust mites. Exposure to dust mites may increase your child's risk for developing asthma.⁹
• Cockroaches. In one study, children who had a high level of cockroach droppings in their home were 4 times more likely to have a new diagnosis of asthma than children whose homes have a low level.⁹

No one is sure if breast-feeding affects a child's risk of getting asthma. Some studies show that breast-feeding protects a child from getting asthma.^{10, 11} Other studies show that breast-feeding, especially when mothers with asthma breast-feed, may actually increase a child's risk of getting asthma.¹² Two large studies found that breast-feeding had no effect on the development of asthma.^{13, 14} Mothers are still encouraged to breast-feed their children for all the other proven health benefits that come from breast-feeding.

Experts are also not sure about the effect that pets in the home have on getting asthma. Some research shows that having cats or dogs in the home increases an adult's risk of getting asthma.¹⁵ But other research has seemed to show that being around pets early in life might actually protect a child against getting asthma.¹⁶ If your child already has asthma and allergies to pets, having a pet in the home may make his or her asthma worse.

Risk factors that may make asthma worse and may lead to asthma attacks

Your child may be at increased risk for severe asthma attacks if he or she:

• Is an infant.
• Has a history of severe symptoms, such as asthma attacks that worsen quickly and frequent nighttime symptoms, or if he or she has had to go to the hospital or emergency room in the past because of an attack.
• Has difficulty taking medications or often has to use short-acting beta2-agonists.
• Has frequent changes in peak expiratory flow.
• Has symptoms that last for a long time.
• Does not use oral corticosteroids quickly enough during an attack.
• Does not have good support from families and friends.

Triggers that may make asthma worse and may lead to asthma attacks in your child include:

• Infections, such as severe upper respiratory infections (URI), sinusitis, and influenza (flu).¹⁷
• Allergens, such as dust mites, mold, or pet dander.⁹

If your child has been diagnosed with asthma and has an asthma action plan (which tells you what medications to take during an asthma attack), do the following.

Call 911 or other emergency services immediately if your child has severe asthma symptoms (in the red zone of the asthma action plan) and you have followed the plan, but:

• Your child is still having severe difficulty breathing.
• 20 to 30 minutes after taking the extra quick-relief medication, your child does not feel better and/or his or her peak expiratory flow (PEF) is still less than 50% of the personal best measurement.

Call your health professional immediately if your child:

• Has asthma symptoms that get worse and you feel there is nothing else you can do at home.
• Has had an asthma attack in the red zone, and 6 hours after taking the extra medication the following are true:
  • The child still requires inhaler medication every 1 to 3 hours.
  • The peak expiratory flow is below 70% of the personal best measurement.
• Is in the yellow zone of the asthma action plan and continues to have a peak expiratory flow below 70% of the personal best measurement in spite of home treatment using the asthma action plan.
• Is having a first attack of asthma symptoms, and they include wheezing, chest tightness, and moderate difficulty breathing.
• Is coughing up yellow, dark brown, or bloody mucus.

Call your health professional if your child:

• Has asthma symptoms, you do not have an action plan, and the symptoms are mild (chest tightness, cough, and slight shortness of breath or tiring easily during exercise).
• Is having symptoms in the yellow zone almost every day, but inhaler medication is providing quick relief.
• Has asthma and his or her PEF has been getting worse for 2 to 3 days.

If your child has not been diagnosed with asthma but has asthma symptoms, call your health professional and make an appointment for an evaluation. Many children and teens with frequent wheezing have asthma but are not diagnosed with the disease. Children and teens who are less likely to be diagnosed with asthma include:¹⁸

• Girls, especially teenage girls.
• Smokers or those exposed to household cigarette smoke.
• Those with low socioeconomic status.
• Those who have allergies.
• African Americans, Native Americans, or Mexican Americans.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your child's symptoms or condition without using medical treatment.

If you think your child has asthma, watchful waiting is not appropriate. See your health professional.

If your child has been getting treatment for 1 to 3 months and is not improving, ask your health professional whether the child needs to see a specialist (allergist or pulmonologist).

Watchful waiting may be appropriate if your child follows his or her daily asthma treatment and action plans and stays within the green zone. Monitor your child's symptoms, and continue to avoid asthma triggers.

Who to See

Health professionals who can diagnose and treat asthma include:

• Pediatricians.
• Family medicine physicians.
• Nurse practitioners.
• Physician assistants.
• Internists.

Your child may need to see a specialist (an allergist or pulmonologist) if he or she has:

• Unusual symptoms, or it is unclear whether the child has asthma.
• Other medical conditions that make it hard to treat asthma.
• Need for additional education or difficulty following the daily asthma treatment and action plans.
• Not made progress toward achieving the goals of treatment after 4 to 6 weeks of therapy.
• Not met the goals of treatment in 3 to 6 months.
• Had a life-threatening asthma attack.

Your child also needs to see a specialist if he or she:¹⁹

• Has moderate persistent to severe persistent asthma.
• Needs to take continuous oral corticosteroid medications or high-dose inhaled corticosteroids, or has had more than two treatments with corticosteroid medications by mouth in 1 year.
• Needs skin testing for allergy.
• Is thinking about starting treatment with allergy shots (immunotherapy).

Diagnosis of asthma is based on medical history, physical examination, and simple lung function tests such as spirometry.

Diagnosing asthma in babies and toddlers is often very difficult. Symptoms may be the same as those of other diseases, such as infection with respiratory syncytial virus (RSV) or inflammation of the lungs ( pneumonia), sinuses ( sinusitis), and small airways ( bronchiolitis). If you have a very young child, spirometry is not practical, so the diagnosis is made based on your report of symptoms.

Repeated wheezing is the key symptom in children with asthma; however, asthma is not the most common cause of wheezing. Still, if your child wheezes frequently, he or she should be checked for asthma, especially if cough and shortness of breath are also present. Many children and teens with frequent wheezing may have asthma but are not diagnosed with the disease.

To make a diagnosis of asthma in your child, the doctor may look for factors associated with asthma:

• Wheezing, which is a high-pitched whistling sound when breathing out.
• Coughing, especially if it gets worse at night.
• Problems breathing, especially if they occur often.
• Symptoms that occur or get worse when a possible asthma trigger is present. Some common asthma triggers include animal fur, pollen, weather changes, and strong emotions.
• A parent with asthma.

In an older child, lung function tests can diagnose asthma, determine its severity, and check for complications.

• Spirometry is the most common test to diagnose asthma in older children. It measures how quickly a child can move air in and out of the lungs and how much air is moved. The test helps your health professional decide whether airflow is decreased because of inflamed bronchial tubes and whether the tubes can return to their usual size in a short time after using medication. The test is recommended at least every 1 to 2 years after asthma treatment has begun.
• Testing of daytime changes in peak expiratory flow (PEF) is done over 1 to 2 weeks. This test is needed when your child has symptoms off and on but has normal spirometry test results.
• An exercise or inhalation challenge may be used if the spirometry test results have been normal or near normal but asthma is still suspected. These tests measure how quickly your child can breathe in and out after exercise or after using a medication. An inhalation challenge also may be done using a specific irritant or allergen.
• A bronchoscopy involves using a flexible scope called a bronchoscope to examine the airways. Occasionally airway problems such as tumors or foreign bodies will create symptoms that mimic those of asthma. The test might be done if there is unequal wheezing in the lungs or a poor response to asthma therapy. Biopsies of the airways can be done to look for changes characteristic of asthma.

A newer test to monitor asthma is the NIOX nitric oxide test system. This test measures nitric oxide in exhaled air. A decrease in nitric oxide suggests that treatment may be reducing inflammation caused by asthma.

Regular checkups

You need to monitor your child's condition and have regular checkups to keep asthma under control and to review and possibly update your child's daily treatment and action plans. The frequency of checkups depends on how your child's asthma is classified. Checkups are recommended:

• About every 6 to 12 months for children with mild intermittent or mild persistent asthma that has been under control for at least 3 months.
• Every 3 to 4 months for children with moderate persistent asthma.
• Every 1 to 2 months for children with uncontrolled or severe persistent asthma.

During checkups, your health professional will ask you and your child whether symptoms and peak expiratory flow have held steady, improved, or become worse, and about asthma attacks during exercise, at night, or after laughing or crying hard. You and your child track this information in an asthma diary. Your child may be asked to bring the peak expiratory flow meter to an appointment so your health professional can see how he or she uses it. Based on the results, your child's asthma category may change, and your health professional may change the medications your child uses or how much medication he or she uses.

Tests for other diseases

Asthma sometimes is hard to diagnose because symptoms vary widely from child to child and within each child over time. Symptoms may be the same as those of other conditions, such as influenza or other viral respiratory infections. Tests that may be done to determine whether diseases other than asthma are causing your child's symptoms include:

• A chest X-ray. A chest X-ray may be used to see whether something else, such as a foreign object, is causing symptoms.
• A sweat test, which measures the amount of salt in sweat. This test may be used to see whether cystic fibrosis is causing symptoms.

Tests to identify triggers

If your child has persistent asthma and takes medication every day, your health professional may ask about his or her exposure to substances (allergens) that cause an allergic reaction. For more information about the following tests, see the topic Allergic Rhinitis.

Allergy tests include:

• Skin tests. The skin on the back or arms is pricked with one or more small doses of allergens that might cause an allergy. The amount of swelling and redness at the sites of the skin pricks is measured to see which allergens cause a reaction. Skin tests are quick, simple, and relatively safe. Skin tests are necessary if you feel your child may need allergy shots (immunotherapy).
• Enzyme-linked immunosorbent assay (ELISA). A blood sample is taken from a vein and tested for immunoglobulin E (IgE) antibodies, which are produced in response to particular allergens.

Other tests may be done to see whether other conditions such as sinusitis, nasal polyps, or gastroesophageal reflux disease are present.

Although your child's asthma cannot be cured, you can manage the symptoms with medications, especially inhaled corticosteroids and beta2-agonists. You and your child will usually work with your health professional to develop a management plan consisting of a daily treatment plan and an asthma action plan. These plans help you and your child meet treatment goals:

• Increase lung function by treating the underlying inflammation in the lungs.
• Decrease the severity, frequency, and duration of asthma attacks by avoiding triggers.
• Treat acute attacks as they occur.
• Use quick-relief medicine less (ideally on not more than 2 days a week).
• Have a full quality of life—the ability to participate in all daily activities, including school, exercise, and recreation—by preventing and managing symptoms.
• Sleep through the night undisturbed by asthma symptoms.

For more information, see:

Asthma: Taking charge of your asthma.

Babies and small children need early treatment for asthma symptoms to prevent severe breathing problems. They may have more serious problems than adults because their bronchial tubes are smaller. Although it may appear that occasional treatment with medications for children with mild asthma is enough, one review has noted that one-third of fatal asthma attacks occurred in children with mild asthma.²⁰ Even if your child's asthma does not appear severe, work with your health professional to develop the right plan for your child.

The National Asthma Education and Prevention Program (NAEPP) recommends treatment with long-term medications for infants and young children who:²¹

• Consistently need treatment for symptoms on more than 2 days a week for longer than 4 weeks.
• Have severe attacks more than once every 6 weeks.
• Have had wheezing 4 or more times in the past year lasting longer than 1 day and affecting sleep and who have atopic dermatitis or a parent with asthma.
• Have had wheezing 4 or more times in the past year lasting longer than 1 day and affecting sleep and two of the following four symptoms:
  • Wheezing not associated with colds.
  • Allergic rhinitis.
  • Evidence of sensitivity to some foods.
  • A high eosinophil count. Eosinophils are a type of white blood cell often present in allergic reactions.

Emergency treatment

If your child has a severe asthma attack (the red zone of the asthma action plan), give him or her medication based on the action plan and talk with a health professional immediately about what to do next. This is especially important if your child's peak expiratory flow (PEF) does not return to the green zone or stays within the yellow zone after he or she takes medication. You and your child may have to go to the hospital or an emergency room for treatment.

At the hospital, your child will probably receive inhaled beta2-agonists and corticosteroids. He or she may be given oxygen therapy. Doctors will assess your child's lung function and condition. Depending on the response, further treatment in the emergency room or a stay in the hospital may be necessary.

Medical checkups

Your child needs to monitor his or her asthma and have regular checkups to keep asthma under control and to ensure correct treatment. The frequency of checkups depends on how your child's asthma is classified. Checkups are recommended:

• About every 6 to 12 months for children with mild intermittent or mild persistent asthma that has been under control for at least 3 months.
• Every 3 to 4 months for children with moderate persistent asthma.
• Every 1 to 2 months for children with uncontrolled or severe persistent asthma.

During checkups, your health professional will check to see that all your goals are being met. He or she will ask you and your child whether symptoms and peak expiratory flow have held steady, improved, or become worse, and about asthma attacks during exercise, at night, or after laughing or crying hard. You track this information in an asthma diary. Your child may be asked to bring the peak expiratory flow meter to an appointment so your health professional can see how he or she uses it.

Initial treatment

There are many components to managing asthma. Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, no one plan will be effective for all children. After your child's diagnosis, your health professional may only discuss the components you need to know immediately. These include:

• Oral or injected corticosteroids (systemic corticosteroids). These medications may be used to get your child's asthma under control before he or she starts taking daily medication. In the future, your child also may take oral or injected corticosteroids to treat any sudden and severe symptoms, such as shortness of breath ( asthma attacks). Oral corticosteroids are used more than injected corticosteroids. Systemic corticosteroids include prednisone and dexamethasone.
• Inhaled corticosteroids. These are the preferred medications for long-term treatment of asthma. They reduce the inflammation of your child's airways and are taken every day to keep asthma under control and to prevent asthma attacks. Inhaled corticosteroids include beclomethasone dipropionate, triamcinolone acetonide, fluticasone propionate, budesonide, and flunisolide.
• Short-acting beta2-agonists. These medications are used for asthma attacks. They relax the airways, allowing your child to breathe easier. Short-acting beta2-agonists include albuterol and pirbuterol.
• Basic education about asthma. The more you and your child know about asthma, the more likely it is you will control symptoms and reduce the risk of asthma attack. Keep in mind that even severe asthma can be controlled, and cases where the condition cannot be controlled are unusual.
• Instruction on how to use a metered-dose inhaler (MDI) or dry powder inhaler (DPI). An MDI delivers inhaled medications directly to the lungs. If your child uses the inhaler correctly, he or she can control the symptoms and avoid asthma attacks that can result in emergency care. Most health professionals recommend using a spacer with an MDI. A DPI medicine is a dry powder. Your child breathes in sharply to inhale the medication. How well the DPI works may depend on how well your child inhales. A dry powder inhaler should not be used with a spacer. For more information, see:

  Asthma: Using a metered-dose inhaler.

  Asthma: Using a dry powder inhaler.

The short-term goal is to control your child's current symptoms. Long-term, your goal is to prevent your child's symptoms so that asthma does not impact your child's daily activities.

Special considerations in treating asthma include:

• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you and your child can take to reduce the risk of this include using medication immediately before exercising.
• Managing asthma before surgery. Children with moderate to severe asthma are at higher risk of developing problems during and after surgery than children who do not have asthma.

Ongoing treatment

After your child's initial treatment for asthma, it is important for you and your child to learn more about the condition and develop an overall plan to manage the disease. You, your child, and your health professional will work together to do this. Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, no one management plan is effective for everyone.

Asthma management consists of:

• A daily asthma treatment plan. A daily asthma treatment plan outlines in writing how to treat inflammation in your child's lungs. The plan helps prevent or slow the development of the long-term effects of asthma and tells you which medications to take every day. A daily treatment plan may include an asthma diary where your child records peak expiratory flow (PEF), symptoms, triggers, and quick-relief medication used for asthma symptoms. This valuable tool helps you and your child and your health professional manage your child's asthma. A daily asthma treatment plan is often combined with an asthma action plan.
• An asthma action plan. An asthma action plan contains directions to help you and your child better control asthma attacks at home. It helps you identify triggers that can be changed or avoided, be aware of your child's symptoms, and know how to make quick decisions about medication and treatment. For more information, see:

  Asthma: Using an asthma action plan.

  An example of an asthma action plan(What is a PDF document?).

• Monitoring peak expiratory flow. It is easy to underestimate the severity of your child's symptoms. You may not notice them until his or her lungs are functioning at 50% of the personal best peak expiratory flow (PEF). Measuring PEF is a way to keep track of asthma symptoms at home; it can help you and your child know when lung function is becoming worse before it drops to a dangerously low level. This is done with a peak flow meter. For more information, see:

  Asthma: Measuring peak flow.

• A plan to deal with factors that can make asthma worse (triggers). Being around triggers increases symptoms. Try to avoid situations that expose your child to irritants (such as smoke or air pollution) or substances (such as animal dander) to which he or she may be allergic. See information on:

  Asthma: Identifying your triggers.

• A plan to treat other health problems. If your child also has other health problems, such as inflammation and infection of the sinuses (sinusitis) or gastroesophageal reflux disease (GERD), he or she will need treatment for those conditions.
• Using the prescribed medications correctly. Your health professional may adjust your child's medications depending on how well your child's asthma is controlled. Medications include:
  • Inhaled corticosteroids. These are the preferred medications for long-term treatment of asthma. Inhaled corticosteroids include beclomethasone dipropionate, triamcinolone acetonide, fluticasone propionate, budesonide, and flunisolide.
  • Long-acting beta2-agonists (such as salmeterol and formoterol), which are sometimes used along with inhaled corticosteroids.
  • Oral or injected corticosteroids (systemic corticosteroids) to treat any sudden and severe symptoms, such as shortness of breath ( asthma attacks). Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and dexamethasone.
  • Quick-relief medication, such as short-acting beta2-agonists and anticholinergics (ipratropium ) for asthma attacks. If your child is using quick-relief medication on more than 2 days a week (other than to prevent exercise-induced asthma), he or she probably needs more long-term treatment. Overuse of quick-relief medication can be harmful.
• Education. Continue to learn about asthma. This questionnaire can help you and your child determine what you already know about asthma and what you may need to discuss with your health professional.

If your child has persistent asthma and reacts to allergens, he or she may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful. For more information, see:

Should I take allergy shots (immunotherapy) for allergic rhinitis and allergic asthma?

Your child can expect to live a normal life if he or she controls symptoms by following the daily treatment and action plans. If asthma symptoms are not controlled, the disease may progress, permanently damaging the bronchial tubes that carry air to the lungs.

Special considerations in treating asthma include:

• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medication immediately before exercising.
• Managing asthma before surgery. People with moderate to severe asthma are at higher risk than people who do not have asthma of developing problems during and after surgery.

Treatment if the condition gets worse

If your child's asthma is not improving, talk with your doctor and:

• Review your child's asthma diary to see if he or she has a new or previously unidentified trigger, such as animal dander. Talk to your health professional about how best to avoid triggers.
• Review your child's medications, to be sure he or she is using the right ones and using them correctly.
• Review your child's asthma plans, to be sure they are suitable for his or her condition.
• Determine whether your child has a condition with symptoms similar to asthma, such as sinusitis.

If your child's medication is not working to control airway inflammation, your health professional will first check to see whether your child is using the inhaler correctly. If your child is using it correctly, your health professional may increase the dosage, switch to another medication, or add a medication to the existing treatment. You can work with your health professional to educate your child about the importance of taking medications correctly and to encourage your child's teachers, babysitters, and other adults to help your child follow his or her plan.

Your doctor may suggest other medications, such as leukotriene pathway modifiers (zafirlukast, zileuton, or montelukast sodium). Less commonly, your doctor may recommend mast cell stabilizers (cromolyn sodium or nedocromil) or theophylline (Theo-Dur, Slo-bid, Uniphyl, or Uni-Dur).

If your child's asthma does not improve with treatment, he or she may require more intensive treatment, including larger doses of corticosteroids or other medications. An asthma specialist generally prescribes these medications.

If your child has persistent asthma and reacts to allergens, he or she may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful.

What to think about

If your child has been diagnosed with asthma, it is important that you treat it. He or she may feel good most of the time—so much so that it may be hard to believe your child has a long-lasting condition. But all asthma—even mild asthma—may result in changes to the airways that speed up and worsen the natural decrease in lung function that occurs as we age.³

While there is no certain way to prevent asthma, you can take steps to reduce your child's airway inflammation and the likelihood of asthma attacks.

No one is sure if breast-feeding affects a child's risk of getting asthma. Some studies show that breast-feeding protects a child from getting asthma.^{10, 11} Other studies show that breast-feeding, especially when mothers with asthma breast-feed, may actually increase a child's risk of getting asthma.¹² Two large studies found that breast-feeding had no effect on the development of asthma.^{13, 14} Mothers are still encouraged to breast-feed their children for all the other proven health benefits that come from breast-feeding.

Preventing asthma attacks

The main focus of prevention is on reducing the number, length, and severity of asthma attacks. The best way to prevent asthma attacks in your child is to follow your doctor's recommendations and make sure your child takes asthma control medications as directed. By doing this, it is possible, in most cases, to prevent asthma attacks. Also, by avoiding triggers, your child may be able to prevent or reduce the severity of symptoms. For more information on identifying your child's triggers, see:

Asthma: Identifying your triggers.

Below is a list of specific triggers. If you know that any of these triggers cause your child's symptoms to become worse, you should avoid or limit your child's exposure to them.

Upper respiratory infections

Upper respiratory infections, including the common cold, cause 85% of asthma attacks in young children.²² Basic preventive measures include the following:

• Avoid contact with other people who are ill. If there is an ill child in the home, separate him or her from other children, if possible. Put the child in a room alone to sleep.
• If you have a respiratory infection, such as a cold or the flu, or if you are caring for someone with a respiratory infection, wash your hands before caring for your child. Hand-washing eliminates the germs on your hands and the spread of germs to your child when you touch your child or touch an object he or she might touch.
• Do not smoke. Secondhand smoke irritates the mucous membranes in your child's nose, sinuses, and lungs and increases his or her risk for respiratory infections.
• Children with asthma and their family members should have a flu shot (influenza vaccine(What is a PDF document?)) every year.

Irritants in the air

Common irritants in the air, such as tobacco smoke and air pollution, can trigger asthma symptoms in some children.

Controlling tobacco smoke is important because it is a major cause of asthma symptoms in children and adults. If your child has asthma, try to avoid being around others who are smoking, and ask people not to smoke in your house.

• Pregnant women who smoke cigarettes during pregnancy increase the risk for wheezing in their newborn babies.
• Exposure of young children to secondhand tobacco smoke increases the likelihood that the children will develop asthma and increases the severity of symptoms if they already have the disease.

Consider keeping your child inside when air pollution levels are h