Recognizing the signs, symptoms and triggers of childhood asthma is necessary to help children lead a healthier and more comfortable life.

Story by: Norton Children’s Reviewed by Matthew D. Kinney, M.D pediatrician with Norton Children’s Medical Group, affiliated with the UofL School of Medicine on September 1, 2023

Asthma is a common chronic respiratory condition that involves inflammation and narrowing of the airways, causing symptoms like wheezing, coughing and shortness of breath. Childhood asthma affects many children in the United States. According to the Centers for Disease Control & Prevention (CDC), 1 in 12 children in the U.S. are diagnosed with asthma. In Louisville specifically, the city’s historically poor air quality has contributed to or exacerbated cases of childhood asthma, according to health care providers with Norton Children’s.

There is no cure for asthma, but treatments and an action plan can help avoid asthma triggers. Recognizing the signs, symptoms and triggers of childhood asthma is necessary to help children lead a healthier and more comfortable life.

Asthma can be considered a type of reactive airway disease. Reactive airway disease (RAD) is a set of symptoms that are similar to asthma, in that it is a restrictive respiratory condition that impacts breathing. RAD may or may not be associated with an asthma diagnosis; medical providers may use it when investigating asthma-like symptoms.

Signs and symptoms of childhood asthma

• Wheezing, coughing, and shortness of breath
  • These are the most common symptoms of asthma. Wheezing sounds like a higher-pitched whistling noise when the child’s breath is going out. Coughing and shortness of breath are associated with narrowed airways caused by inflammation.
• Chest tightness and pain
  • A child may feel a sensation of tightness, pressure or squeezing.
• Rapid breathing or breathing difficulties
  • This feels like taking a full or deep breath is not possible. Breathing may sound short or shallow.
• Fatigue or lethargy
  • Difficulty breathing also can deplete a child’s energy levels.
• Recurrent respiratory infections
  • Asthma symptoms can worsen with an infection such as a cold or bronchitis. Respiratory infections also can trigger asthma symptoms. 

Asthma triggers in children

• Allergies
  • Pollen, dust mites, pet dander, mold, etc.
• Respiratory infections
  • Viral infections such as cold, flu, COVID-19, etc.
• Physical activity or exercise
  • Intense physical activity can exacerbate symptoms.
• Air pollution
  • Vehicle exhaust, smoke, industrial emissions, etc.
• Tobacco smoke exposure
  • Smoking, vaping, secondhand smoke, etc.
• Strong emotions
  • Intense reactions to sadness, worry or anxiety can impact breathing patterns.
• Certain medications
  • Check with your child’s doctor about any medications they are taking and potential concerns about making the child’s asthma worse.

How asthma is diagnosed in preschool-age children

• Physical examination and medical history
  • Your child’s pediatrician will conduct a full exam and review your child’s symptoms, medical history and family history involving asthma and/or allergies. They also will check for any wheezing or abnormal breathing during the exam.
• Asthma predictive index (API) or similar predictive tool
  • This is a tool used by health care providers to evaluate the likelihood of asthma in young children. It analyzes family history, wheezing episodes, allergies and more.

Additional asthma testing may include:

• Lung function tests
  • Spirometry: This test measures how much air your child can exhale and may be used at rest, during exercise or after taking asthma medications. This test is accurate only in children ages 5 and older. For younger children, your provider will rely on symptoms and information from the family.
• Allergy testing
  • If allergy-induced asthma is suspected, a skin test involving exposure to different allergens may be conducted.

Managing asthma and breathing issues in children

Although there is no cure for childhood asthma, it can be managed effectively with help from a health care provider and lifestyle changes. Understanding how to control asthma symptoms and implementing a plan for coping strategies greatly can improve the quality of life for children with asthma and help them thrive. Ways to manage asthma may include: 

• Medications
  • Asthma medications can include “quick-relief” or rescue medications as needed, such as bronchodilators and corticosteroids.
  • “Controller” medications, which are taken regularly, include inhalers, inhaled corticosteroids or leukotriene receptor antagonists, which are taken by mouth. Some children with severe asthma may be eligible for a newer medication called a “biologic” injection.
• Inhalers and nebulizers
  • Inhalers deliver medication directly to the airways. Nebulizers also deliver medication for younger children who may struggle with inhalers.
• Avoidance of triggers
  • Minimizing exposure to triggers can help reduce asthma symptoms and avoid asthma attacks. Work with your child’s health provider to determine their triggers, including environmental allergies and air pollution.
• Asthma action plans
  • This plan includes a full outline for medications, managing symptoms in different scenarios and when to seek emergency care.
• Follow-up appointments with health care providers
  • Regular check-ups with your child’s provider are a necessary part of asthma management to control symptoms, adjust medications and offer ongoing support. Visits at least every three months often are needed to help keep asthma under control (and reduce the risk of an emergency department visit or hospitalization).

Coping strategies for parents and preschoolers

• Educating parents and children about asthma
  • Be your child’s best advocate by familiarizing yourself with their asthma action plan and ensuring that copies are on hand at their school, in their classroom and during any extracurricular activities. Learn your child’s triggers, medications and best techniques for dispensing medications. Also, teach and empower your child to manage their condition!
• Building a support network
  • Your child’s pediatrician and treatment team serve as a great resource for support and guidance. Additionally, any support groups or Norton Children’s Prevention & Wellness classes may be a great way to meet families managing similar conditions.
• Encouraging physical activity and a healthy lifestyle
  • Physical activity and a healthy lifestyle are crucial for a kid with asthma. Work with your child’s provider to determine what types of activities are best for them and their condition. Healthy eating and sleeping habits also can also help keep symptoms in check. A healthy lifestyle includes avoiding exposure to smoke, which includes tobacco and marijuana.

For children with asthma, early detection and management can make a massive impact on their life. This is why regular check-ups, including the annual well-child visit with the pediatrician, are crucial. Your child’s provider can check for symptoms of asthma and begin intervention to provide relief, which can greatly affect the child’s life. If your child is experiencing symptoms of asthma, contact their health care provider right away.

This article was reviewed by Matthew D. Kinney, M.D, pediatrician with Norton Children’s Medical Group, affiliated with the UofL School of Medicine.