Asthma in Children

Asthma is a chronic disease in which the airways become inflamed and narrow, causing wheeze, cough, breathlessness, and chest tightness. Symptoms come and go, and most children with asthma lead full, active lives with the right inhaler routine. Indian city children in particular face a heavy asthma burden because of air pollution.

Symptoms

• Wheezing (whistling sound when breathing).
• Cough — especially at night, early morning, with exercise, or with colds.
• Breathlessness on exertion.
• Chest tightness.
• Triggered by colds, pollen, dust, smoke, cold air, pollution, exercise, emotions, pets.

Red flags — dial 112 or go to hospital

• Severe breathlessness at rest; struggling to speak a sentence.
• Blue lips or fingertips.
• Ribs sucking in with breathing; nostrils flaring.
• Drowsy, confused, or very quiet.
• Reliever inhaler not working.
• Use the inhaler while heading to hospital.

Diagnosis

• History is the main tool — recurrent wheeze/cough with triggers; family history of asthma/allergy/eczema.
• Spirometry / peak flow in older children.
• Allergy tests, chest X-ray, FeNO — selected cases.
• TB must be actively considered in chronic cough — particularly in Indian settings — before labelling it asthma.

Treatment — inhalers are the main treatment

• Reliever inhaler (short-acting bronchodilator) — used when symptoms flare.
• Preventer inhaler (inhaled steroid; sometimes with a long-acting bronchodilator) — used daily to keep airways calm. Does not cause the side-effects of oral steroids at preventer doses — common and unfounded parental worry.
• Spacer device — always use with children; massively improves effectiveness of inhalers.
• Demonstrate correct inhaler technique every visit — a large share of "difficult asthma" in India is actually poor technique.
• Action plan — written plan for what to do when symptoms change; every asthmatic child should have one.
• Oral steroids — short course for severe flares.
• Newer biologic therapies — for severe asthma, at specialist centres.

Reduce triggers — India context

• No tobacco smoke in the house or car (second-hand smoke) — no exceptions.
• Dust-proof bedding, damp-mop floors if dust-mite allergy.
• Close windows, use N95 masks on high-AQI days, indoor air purifiers if affordable.
• Avoid burning incense or open cooking smoke indoors.
• Keep pets out of bedrooms if allergic.
• Annual flu vaccine.
• Treat rhinitis / sinusitis — untreated upper-airway allergy worsens asthma.

School and sports

A well-controlled asthmatic child can and should play and do sport. Pre-exercise reliever inhaler use may help. Notify the school; keep a reliever inhaler accessible. Asthma is not a reason to sit out PE.