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 We all know that children will cough. It just happens. But when is it more than just a cough? How is asthma diagnosed? How is treated? These are all important questions to have answered.

Asthma is one of the most common chronic disorders in childhood, currently affecting an estimated 7.1 million children under 18 years; of which 4.1 million suffered from an asthma attack or episode in 2009.1

No one really knows why more and more children are developing asthma. Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution, and second-hand smoke. These factors all are triggers of asthma. Others suspect that children are not exposed to enough childhood illnesses to build up their immune system. It appears that a disorder of the immune system where the body fails to make enough protective antibodies may play a role in causing asthma.

And still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.

What Is Asthma?

Asthma is a chronic disease that causes the airways – the tubes that carry air in and out of your lungs – to become sore and swollen. In the United States, about 20 million people have asthma. Nearly 9 million of them are children. Children have smaller airways than adults, which makes asthma especially serious for them.

Risk Factors Associated With Asthma

  • Presence of allergies


  • Family history of asthma and/or allergies


  • Frequent respiratory infections


  • Low birth weight


  • Exposure to tobacco smoke before and/or after birth – even if you smoke outside the house, or when your child is not around, they are still being exposed to smoke!


  • Being male


  • Being black

Symptoms of Asthma

  • Wheezing – When inflammation is present in the bronchioles (passageways that air passes through in the lungs) it causes wheezing. Wheezing is when the air flowing into the lungs makes a high-pitched whistling sound. It may or may not be heard.
  • Coughing – Inflammation in the lungs makes it difficult to get air into and out of the lungs. This may cause an increase in coughing. Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma. Cough due to nocturnal asthma (nighttime asthma) usually occurs during the early hours of morning, from 1 a.m. to 4 a.m. Usually, the child doesn’t cough anything up so there is no phlegm or mucus. Coughing may also occur with wheezing.
  • Chest Tightness – The child may feel like the chest is tight or won’t expand when breathing in, or there may be pain in the chest with or without other symptoms of asthma, especially in exercise-induced or nocturnal asthma. Obviously, small children cannot tell you there are experiencing chest tightness.
  • Trouble Breathing (especially early in the morning or at night) – You may note that your child’s breathing is increased or if you look at their chest – you may notice an actual “pull” in the middle of their chest when they take a breath. Normal respiratory rates are dependent on the age of the child. Here are the normal respiratory rates of children:
  Their ages Normal respiratory rates
Newborns and infants Up to 6 months old 30-60 breaths/min
Infants 6 to 12 months old 24-30 breaths/min
Toddlers and children 1 to 5 years old 20-30 breaths/min
Children 6 to 12 years 12-20 breaths/min

Diagnosing Asthma In Children

To establish a diagnosis of asthma, your healthcare provider must rule out every other possible cause of a child’s symptoms. Your child’s healthcare provider asks questions about the family’s asthma and allergy history, performs a physical exam, and possibly orders laboratory tests. Be sure to provide the healthcare provider with as many details as possible, no matter how unrelated they might seem. In particular, keep track of and report the following:

  • Symptoms: How severe are the attacks, when and where do they occur, how often do they occur, how long do they last, and how do they go away?
  • Allergies: Does the child or anyone else in the family have any history of allergies?
  • Illnesses: How often does the child get a cold, how severe are the colds, and how long do they last?
  • Triggers: Has the child been exposed to irritants and allergens, has the child experienced any recent life changes or stressful events, and do any other things seem to lead to a flare?

Test To Diagnose Asthma:

Peak Flow can be helpful in diagnosing asthma, as well as, keeping track on how well the treatment for asthma is working. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your healthcare provider will give you instructions on how to track and deal with low peak flow readings.

Oxygen Saturation: This is attached to your child’s finger, toe or ear lobe. It tells how much oxygen is circulating in their body. Ideally, oxygen saturation should be between 95%-100%.

Treatment for Asthma

Treatment of asthma is based on the severity, and the causes of the asthma. If a child has exercise-induced asthma, they may only require the use of an inhaler before or during exercise.

Prevention and long-term control is the key to preventing asthma attacks. Treatment usually involves learning to recognize your triggers and taking steps to avoid them, and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler such as albuterol.

In order to relieve the symptoms of asthma, you need to know how to correctly use an inhaler.  Here are step by step instructions for using your inhaler:

Ways to hold your inhaler


A. Open your mouth. Hold inhaler 1 to 2 inches away.


B. Use spacer attached to inhaler.


C. Hold inhaler in your mouth.

How do I use a metered-dose inhaler correctly?

1) Remove the cap and hold the inhaler upright.

2)  Shake the inhaler.

3)  Tilt your head back slightly and breathe out.

4)  Hold the inhaler as in one of the pictures to the right. A or B are the most effective, but C is okay for people who are unable to use A or B.

5)  Spacers are useful for all patients, especially young children and older adults (see picture B).

6)  Press down on the inhaler to release the medicine as you start to breathe in slowly.

7)  Breathe in slowly for 3 to 5 seconds.

8)  Hold your breath for 10 seconds to allow medicine to go deeply into your lungs.

9)  Repeat puffs as directed. Wait 1 minute between puffs to allow the second puff to get into the lungs better.

NOTE: These instructions are for a metered-dose inhaler only. Inhaled dry powder capsules are used differently. To use a dry powder inhaler, close your mouth tightly around the mouthpiece of the inhaler and breathe in quickly. Talk to your doctor if you have any questions about how to take your medicine.

Deciding on the right treatment for your child’s asthma is a conversation to have with your health care provider. There are many medications, including inhalers and oral that can treat asthma and asthma-related symptoms.

While asthma can be a frightening diagnosis, it is very treatable. Learning to pick up on your child’s first symptoms will help you to be proactive in the treatment.