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Controlling Pediatric Asthma Symptoms

May 21st, 2024

Asthma, a common childhood respiratory disease involving both airway inflammation and impaired airflow. Asthma places a tremendous pressure on health systems across the globe [1]. It is estimated that one in eleven children in the UK are currently being prescribed treatment for asthma. Despite many of these children feeling satisfactory symptom control with low to moderate doses of asthma medications, approximately five percent are being prescribed higher doses suggesting difficult to control asthma [2]. 


Asthma is a treatable disease and with good adherence to prescribed medications most children can go on to enjoy a “normal” and happy life. Consequently, it is important for children and parents/caregivers to educate themselves, on the basics of asthma, including it symptoms, what to do in the event of an asthma attack and the variety of available treatments (both pharmaceutical, such as an appropriate inhaler, and non-pharmaceutical, such as the 4-7-8 breathing technique) [3]. 

The most important symptom when identifying if a child has asthma is wheezing, which can be described as “breathing with a whistling or rattling sound in the chest” [4]. If the wheezing continues into school years, there is also a high chance that the disease will persist into adulthood [5]. Other symptoms to look out for include coughing, breathlessness and chest tightness. In severe cases, particular  symptoms  of concern may include  difficulty breathing, rapid breathing or a brief blue skin colour [6].


Reducing symptoms of asthma

When treating asthma, the most common and preferred route for most is an inhaler because it offers speedy results, requires smaller doses, and reduces the symptoms in other areas of the body [7]. However, it is important for parents/carers and children to understand the different purposes of each inhaler and when they should and shouldn’t be used, in order to prevent or relieve an asthma attack.


There are three main types of inhaler: relievers (blue), preventers (orange, yellow or brown) and symptom controllers (green). 


  • The blue inhaler (reliever) is to be used when immediate relief is needed, such as when your symptoms are getting worse or when an asthma attack is occurring. It usually works within a few minutes and should only be given when needed. It helps relax the muscles of the airway, enabling them to open up, which gives speedy relief from coughing, wheezing and shortness of breath. Common side effects which last a few hours after using the blue inhaler, include the ‘shakes’, a rapid heartbeat, and hyperactivity.


  • The orange, yellow and brown inhaler (preventer) is used to prevent further attacks. This inhaler works slowly, and it is crucial that it is taken daily, in order for it to work properly. These inhalers help reduce inflammation and mucus production by the lungs, which in turn helps keep the airways open. Common side effects include a hoarse, raspy voice or a sore throat. These side effects can be reduced if you use a spacer, and by the patient rinsing their mouth out after using the inhaler. A spacer is a plastic tube which fits into the mouthpiece of the inhaler. This type of inhaler often seems to benefit children whose asthma is allergy or exercise based.


  • The green inhaler (symptom controller) is a slow-acting medication used to achieve long term control of asthma symptoms . This inhaler works in a similar way and is often used at the same time as the preventer, typically as a combination inhaler. Just like the blue inhaler (reliever), common symptoms include the ‘shakes’, a rapid heartbeat, and hyperactivity [9].


The physician in charge may order a breathing test called spirometry which measures airway obstruction and can be used to monitor response to medication. It can be done by most children from about 6 years of age [9]. 


In the event of an asthma attack, the child should sit up straight and try to keep calm. They then need to take one puff of their reliever inhaler (blue), every thirty to sixty seconds up to ten puffs. If, at any point, their symptoms get worse, or they do not feel better after 10 puffs, call 999 for an ambulance. If, after 10 minutes, the ambulance has not arrived and the symptoms are not improving, continue to take one puff of the reliever inhaler (blue), every thirty to sixty seconds up to ten puffs. If the symptoms are no better after repeating this and the ambulance has still not arrived, contact 999 again immediately [10]. 


Never be afraid of calling for help in an emergency. 


When the child is experiencing asthma symptoms, you can help the child by practicing breathing exercises with them, to help them calm down [8]. The aim of these breathing exercises is to reduce hyperventilation as well as reducing anxiety, particularly in association with their asthma symptoms [4]. Breathing techniques may also help the child psychologically by helping them gain a better understanding of their condition and enable them to feel more in control of their symptoms.

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1. Bacharier, L. B., Boner, A., Carlsen, K. H., Eigenmann, P. A., Frischer, T., Götz, M., ... & European Pediatric Asthma Group. (2008). Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy, 63(1), 5-34. 

2. Cook, J., Beresford, F., Fainardi, V., Hall, P., Housley, G., Jamalzadeh, A., ... & Saglani, S. (2017). Managing the pediatric patient with refractory asthma: a multidisciplinary approach. Journal of Asthma and Allergy, 20(10), 123-130. 


3. Kelada, L., Molloy, C. J., Hibbert, P., Wiles, L. K., Gardner, C., Klineberg, E., ... & Jaffe, A. (2021). Child and caregiver experiences and perceptions of asthma self-management. Npj Primary Care Respiratory Medicine, 31(1), 42. 


4. Rush University Medical Center. Chronic Cough in Kids.


5. Powell, J. (2007). Asthma: Feeling ill?. Evans Brothers. 


6. Patel, M., Pilcher, J., Reddel, H. K., Qi, V., Mackey, B., Tranquilino, T., ... & SMART Study Group. (2014). Predictors of severe exacerbations, poor asthma control, and β-agonist overuse for patients with asthma. The Journal of Allergy and Clinical Immunology: In Practice, 2(6), 751-758. 


7. De Benedictis, F. M., & Selvaggio, D. (2003). Use of inhaler devices in pediatric asthma. Pediatric Drugs, 5(9), 629-638. 


8. Macêdo, T. M., Freitas, D. A., Chaves, G. S., Holloway, E. A., & Mendonça, K. M. (2016). Breathing exercises for children with asthma. Cochrane Database of Systematic Reviews, 4(4). 


9. Healthywa. Asthma medications and inhaler devices, 


10. asthma + lung UK. Asthma attacks,

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