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Better Health
Asthma is a lung condition that affects 23 million Americans, including 6 million kids. People with asthma may cough, wheeze, or have trouble breathing.
Is Your Child's Asthma Under Control? Take Our Assessment
If your child has asthma, it can seem like you’re fighting an invisible enemy. Youngsters with asthma often seem perfectly healthy, just like any other kid. But things most children can shrug off—a simple cold or a bout of exercise—can land the asthmatic child in the hospital if the respiratory disease is not well controlled by medication.
What’s so maddening, as a parent, is not knowing if you have a lid on asthma. When that trigger comes—be it mold, pollen, dust, a cold, or pet cat—will your child’s asthma escalate out of control?
The bottom line is, it’s hard to tell—but not impossible. Your child may be coughing at night, but there are ways to tell how much coughing is too much. And, sure, your child may need to use a rescue inhaler, but if he or she needs it too often, it’s an indicator that he or she could be edging into the danger zone.
If your child is ages 5 to 11, you can use this assessment tool to help determine if his or her asthma is under control. (This tool, which was adapted from asthma guidelines issued by the National Heart, Lung, and Blood Institute, in 2007, is not designed to replace a consultation with a doctor. Nor should it be used for children under age 5 or 12 and older.)
1 . My child has asthma symptoms such as coughing or wheezing:
A. No more than two days each week and never more than once a day (+1 point)
B. Several times a day on at least two days a week, or more than two days each week (+2 points)
C. Throughout the day (+3 points)
2 . My child has coughing or has wheezing that wakes him or her up at night:
A. Once a month or less (+1 point)
B. Twice a month or more (+2 points)
C. Twice a week or more (+3 points)
3 . My child needs to use his or her rescue inhaler or nebulizer:
A. Two days a week or less (+1 point)
B. More than two days each week (+2 points)
C. Several times per day (+3 points)
4 . When it comes to my child’s daily life, asthma symptoms:
A. Never limit his or her activities (+1 point)
B. Cause some limitation (+2 points)
C. Extremely limit activity (+3 points)
5 . My child has had asthma symptoms so severe he or she needs a course of oral corticosteroids:
A. One time per year or not at all (+1 point)
B. More than twice per year (+3 points)
If your score is 5 points:
Based on symptoms alone, experts would consider your child’s asthma to be under control. You should make sure your child continues to take medication carefully and correctly, and be sure to see your doctor within one to six months. Another way to measure asthma control is to check peak flow, which can be done at home with a peak flow meter. If peak flow is more than 80% of your child’s personal best, asthma is under control. If it’s 80% or less, asthma is not well controlled.
If your score is 6 points or more:
Based on symptoms alone, your score suggests that your child’s asthma is not as well controlled as it could be. Talk with your doctor as soon as possible to see if your child is taking the right amount and type of medication. Another way to measure asthma control is to check peak flow, which can be done at home with a peak flow meter. If peak flow is more than 80% of your child’s personal best, asthma is under control. If it’s 80% or less, asthma is not well controlled.
What’s so maddening, as a parent, is not knowing if you have a lid on asthma. When that trigger comes—be it mold, pollen, dust, a cold, or pet cat—will your child’s asthma escalate out of control?
The bottom line is, it’s hard to tell—but not impossible. Your child may be coughing at night, but there are ways to tell how much coughing is too much. And, sure, your child may need to use a rescue inhaler, but if he or she needs it too often, it’s an indicator that he or she could be edging into the danger zone.
If your child is ages 5 to 11, you can use this assessment tool to help determine if his or her asthma is under control. (This tool, which was adapted from asthma guidelines issued by the National Heart, Lung, and Blood Institute, in 2007, is not designed to replace a consultation with a doctor. Nor should it be used for children under age 5 or 12 and older.)
1 . My child has asthma symptoms such as coughing or wheezing:
A. No more than two days each week and never more than once a day (+1 point)
B. Several times a day on at least two days a week, or more than two days each week (+2 points)
C. Throughout the day (+3 points)
2 . My child has coughing or has wheezing that wakes him or her up at night:
A. Once a month or less (+1 point)
B. Twice a month or more (+2 points)
C. Twice a week or more (+3 points)
3 . My child needs to use his or her rescue inhaler or nebulizer:
A. Two days a week or less (+1 point)
B. More than two days each week (+2 points)
C. Several times per day (+3 points)
4 . When it comes to my child’s daily life, asthma symptoms:
A. Never limit his or her activities (+1 point)
B. Cause some limitation (+2 points)
C. Extremely limit activity (+3 points)
5 . My child has had asthma symptoms so severe he or she needs a course of oral corticosteroids:
A. One time per year or not at all (+1 point)
B. More than twice per year (+3 points)
If your score is 5 points:
Based on symptoms alone, experts would consider your child’s asthma to be under control. You should make sure your child continues to take medication carefully and correctly, and be sure to see your doctor within one to six months. Another way to measure asthma control is to check peak flow, which can be done at home with a peak flow meter. If peak flow is more than 80% of your child’s personal best, asthma is under control. If it’s 80% or less, asthma is not well controlled.
If your score is 6 points or more:
Based on symptoms alone, your score suggests that your child’s asthma is not as well controlled as it could be. Talk with your doctor as soon as possible to see if your child is taking the right amount and type of medication. Another way to measure asthma control is to check peak flow, which can be done at home with a peak flow meter. If peak flow is more than 80% of your child’s personal best, asthma is under control. If it’s 80% or less, asthma is not well controlled.
Why You Need to Take Asthma Medicine, Even if You Feel Fine
Carolyn M. Kercsmar, MD, the director of the asthma center at Cincinnati Children’s Hospital Medical Center, recently had a 10-year-old patient who decided, on his own, to stop taking his asthma medicine—crucial maintenance steroids he was supposed to take regularly.
His reasoning: He felt fine and hadn’t had any asthma attacks for a while, so why bother? Dr. Kercsmar performed a series of tests, and it was clear his lung function was compromised, even though he didn’t have any coughing, wheezing, shortness of breath, or other signs of asthma. She made sure he knew that he needed to start his asthma medication again.
“We were to come into pollen season, which could have triggered his asthma symptoms, possibly leading to an emergency room visit or hospitalization,” she says.
Generally, asthma can be categorized into two classes: intermittent asthma, in which symptoms occur less than three times a week, and chronic asthma.
People with intermittent asthma can often get by using only a short-acting or “rescue” inhaler when symptoms develop. Those with more chronic asthma and more frequent flare-ups (like Dr. Kercsmar’s 10-year-old patient) need to take a maintenance medication to reduce inflammation between attacks. “The goal of asthma treatment is to prevent, prevent, prevent,” Dr. Kercsmar says.
Unfortunately, patients failing to take their maintenance medication is an all-too-common scenario. People may take medication incorrectly, in an erratic stop-and-start fashion, or just flat out skip it. It’s not that people with asthma are trying to dupe their doc. Asthma can be a sneaky foe. Most people feel perfectly fine, until they very quickly don’t. All it takes is a rise in pollen counts, a common cold, a chance encounter with a cat, a change in temperature, or a bout of exercise to send a patient into the danger zone. The problem? It’s hard to predict when that will happen.
“It can be hours, days, weeks, or months, so it’s pretty easy for patients to be lulled into a false sense of security,” says Dr. Kercsmar. “It’s an incredibly variable disease that can be punctuated by flare-ups, but the time between flare-ups can be variable.”
His reasoning: He felt fine and hadn’t had any asthma attacks for a while, so why bother? Dr. Kercsmar performed a series of tests, and it was clear his lung function was compromised, even though he didn’t have any coughing, wheezing, shortness of breath, or other signs of asthma. She made sure he knew that he needed to start his asthma medication again.
“We were to come into pollen season, which could have triggered his asthma symptoms, possibly leading to an emergency room visit or hospitalization,” she says.
Generally, asthma can be categorized into two classes: intermittent asthma, in which symptoms occur less than three times a week, and chronic asthma.
People with intermittent asthma can often get by using only a short-acting or “rescue” inhaler when symptoms develop. Those with more chronic asthma and more frequent flare-ups (like Dr. Kercsmar’s 10-year-old patient) need to take a maintenance medication to reduce inflammation between attacks. “The goal of asthma treatment is to prevent, prevent, prevent,” Dr. Kercsmar says.
Unfortunately, patients failing to take their maintenance medication is an all-too-common scenario. People may take medication incorrectly, in an erratic stop-and-start fashion, or just flat out skip it. It’s not that people with asthma are trying to dupe their doc. Asthma can be a sneaky foe. Most people feel perfectly fine, until they very quickly don’t. All it takes is a rise in pollen counts, a common cold, a chance encounter with a cat, a change in temperature, or a bout of exercise to send a patient into the danger zone. The problem? It’s hard to predict when that will happen.
“It can be hours, days, weeks, or months, so it’s pretty easy for patients to be lulled into a false sense of security,” says Dr. Kercsmar. “It’s an incredibly variable disease that can be punctuated by flare-ups, but the time between flare-ups can be variable.”
Why you may be on a symptom roller coaster
Even patients with the best of intentions may have a hard time taking medications day in and day out, sometimes several times a day, when they feel just dandy. The temptation is to think, “Why not just skip it today since I feel fine?”
“This is a chronic problem that I encounter with many asthmatics,” says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital, in New York City. “Once patients are well controlled on medications, a part of their psyche thinks they’ve been cured and they no longer need medication.”
As a result, patients end up on a “roller coaster,” says Mark H. Moss, MD, an associate professor of medicine and pediatrics at the University of Wisconsin School of Medicine and Public Health. “They have very few symptoms when they take their medicine, but then the symptoms reemerge when they stop taking it.”
But skipping medications, even when you don’t have any symptoms, could mean more flare-ups and worsened asthma down the line.
“It’s important to continue to use anti-inflammatory maintenance medications because there’s an inflammation process that’s occurring within your lungs,” says Amber Watts, PharmD, an assistant professor of pharmacy practice at Texas A&M Health Science Center Rangel College of Pharmacy, in Kingsville. “The steroids in these medications help prevent that inflammation and reduce the chances of an exacerbation. It’s not going to completely prevent an exacerbation, but it does decrease the risk.”
What’s a steroid?
Asthma is a chronic condition that is thought to be driven by inflammation in the airways. That inflammation is pretty much always there, only producing symptoms when a certain threshold is reached; that threshold, as well as individual triggers, is different for each person.
“It’s like having a charcoal fire burning all the time and more fuel comes along, like wind or oxygen, then you have a raging inferno and get symptomatic,” Dr. Kercsmar says.
Anti-inflammatory medications such as corticosteroids (commonly called steroids, but in a different class of drug from anabolic steroids, which are sometimes abused by athletes), leukotriene pathway modifier drugs, and IgE blockers dampen down this ever-burning “charcoal fire.”
When a person has an asthma attack, the lining of the airway swells, secretes more mucus, and, most dramatically, constricts the muscles in the airways. This calls for a different treatment: A person uses a rescue inhaler or nebulizer to administer bronchodilator drugs (such as albuterol) to open the tight airways.
“That works primarily to relax the muscles. It essentially has no effect on inflammation,” says Dr. Kercsmar. And it acts within minutes to provide relief.
Even without maintenance medications, some patients will go weeks or even months without a problem. But doctors can’t always tell which patients fall into this category.
Even patients with the best of intentions may have a hard time taking medications day in and day out, sometimes several times a day, when they feel just dandy. The temptation is to think, “Why not just skip it today since I feel fine?”
“This is a chronic problem that I encounter with many asthmatics,” says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital, in New York City. “Once patients are well controlled on medications, a part of their psyche thinks they’ve been cured and they no longer need medication.”
As a result, patients end up on a “roller coaster,” says Mark H. Moss, MD, an associate professor of medicine and pediatrics at the University of Wisconsin School of Medicine and Public Health. “They have very few symptoms when they take their medicine, but then the symptoms reemerge when they stop taking it.”
But skipping medications, even when you don’t have any symptoms, could mean more flare-ups and worsened asthma down the line.
“It’s important to continue to use anti-inflammatory maintenance medications because there’s an inflammation process that’s occurring within your lungs,” says Amber Watts, PharmD, an assistant professor of pharmacy practice at Texas A&M Health Science Center Rangel College of Pharmacy, in Kingsville. “The steroids in these medications help prevent that inflammation and reduce the chances of an exacerbation. It’s not going to completely prevent an exacerbation, but it does decrease the risk.”
What’s a steroid?
Asthma is a chronic condition that is thought to be driven by inflammation in the airways. That inflammation is pretty much always there, only producing symptoms when a certain threshold is reached; that threshold, as well as individual triggers, is different for each person.
“It’s like having a charcoal fire burning all the time and more fuel comes along, like wind or oxygen, then you have a raging inferno and get symptomatic,” Dr. Kercsmar says.
Anti-inflammatory medications such as corticosteroids (commonly called steroids, but in a different class of drug from anabolic steroids, which are sometimes abused by athletes), leukotriene pathway modifier drugs, and IgE blockers dampen down this ever-burning “charcoal fire.”
When a person has an asthma attack, the lining of the airway swells, secretes more mucus, and, most dramatically, constricts the muscles in the airways. This calls for a different treatment: A person uses a rescue inhaler or nebulizer to administer bronchodilator drugs (such as albuterol) to open the tight airways.
“That works primarily to relax the muscles. It essentially has no effect on inflammation,” says Dr. Kercsmar. And it acts within minutes to provide relief.
Even without maintenance medications, some patients will go weeks or even months without a problem. But doctors can’t always tell which patients fall into this category.
Skipping a child’s medication now may mean stronger drugs later
It is especially important for children and teens to take medicine as directed.
“Through childhood, asthma may periodically become more severe or improve, and that does complicate things because parents may perceive that a child’s asthma is ‘cured,’” says Dr. Moss. “They could continue for months or potentially even years like this only to have the asthma worsen as they get older.”
Often a remission occurs during adolescence, but there is no cure for asthma, and the condition will likely reappear in adulthood, only more chronic, explains Dr. Moss.
Sometimes medications can be stopped or the dose lowered, but a doctor needs to make that decision, Dr. Moss says.
Unexpected triggers such as a cold, allergy, chemical irritant, or air pollution can quickly bring the asthma from the back burner to the front burner, Dr. Horovitz says.
“Not taking maintenance medications makes patients vulnerable,” he says.
Parents can be scared off by the fact that maintenance drugs have a steroid component, thinking it will affect their child’s development, Watts says. But since patients are inhaling the steroids—rather than swallowing them in a liquid—it’s much less likely. While corticosteroids can stunt growth slightly, it’s unlikely with inhaled steroids. But if your child’s asthma is so bad that he or she is at risk for hospitalization, doctors may have no choice but to put him or her on the much stronger oral corticosteroids—at least temporarily—to get the asthma under control. (You can read more about asthma drug safety here.)
Patients should also remember to rinse their mouth after taking inhaled corticosteroids, so as to avoid developing thrush, a yeast infection of the throat, Watts warns.
“Whether you have a child with asthma or have it as an adult, you shouldn’t skip your maintenance medications. You should always take them as prescribed every day and, if you notice more symptoms or a difference in breathing, then you should definitely call a physician so that he or she can adjust your medication,” Watts says.
It is especially important for children and teens to take medicine as directed.
“Through childhood, asthma may periodically become more severe or improve, and that does complicate things because parents may perceive that a child’s asthma is ‘cured,’” says Dr. Moss. “They could continue for months or potentially even years like this only to have the asthma worsen as they get older.”
Often a remission occurs during adolescence, but there is no cure for asthma, and the condition will likely reappear in adulthood, only more chronic, explains Dr. Moss.
Sometimes medications can be stopped or the dose lowered, but a doctor needs to make that decision, Dr. Moss says.
Unexpected triggers such as a cold, allergy, chemical irritant, or air pollution can quickly bring the asthma from the back burner to the front burner, Dr. Horovitz says.
“Not taking maintenance medications makes patients vulnerable,” he says.
Parents can be scared off by the fact that maintenance drugs have a steroid component, thinking it will affect their child’s development, Watts says. But since patients are inhaling the steroids—rather than swallowing them in a liquid—it’s much less likely. While corticosteroids can stunt growth slightly, it’s unlikely with inhaled steroids. But if your child’s asthma is so bad that he or she is at risk for hospitalization, doctors may have no choice but to put him or her on the much stronger oral corticosteroids—at least temporarily—to get the asthma under control. (You can read more about asthma drug safety here.)
Patients should also remember to rinse their mouth after taking inhaled corticosteroids, so as to avoid developing thrush, a yeast infection of the throat, Watts warns.
“Whether you have a child with asthma or have it as an adult, you shouldn’t skip your maintenance medications. You should always take them as prescribed every day and, if you notice more symptoms or a difference in breathing, then you should definitely call a physician so that he or she can adjust your medication,” Watts says.
Lead writer: Amanda Gardner
Asthma Symptoms
While asthma symptoms seem straightforward—coughing, wheezing, and shortness of breath—it’s not always easy for doctors to definitively diagnose the condition. It can be hard to determine if a chronic cough is asthma, a lingering respiratory ailment, or something else. Symptoms like wheezing can come and go, or coughing may only occur at specific times, such as at night or with exposure to pollen or other triggers.
To learn more about the symptoms of asthma in children, check out the following information from our A–Z Health Library. Asthma symptoms in adults are very similar to those in children.
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:
An asthma attack occurs when your child's symptoms suddenly increase. Factors that can lead to an asthma attack or make one worse include:
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 doctor 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.
- 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.
An asthma attack occurs when your child's symptoms suddenly increase. Factors that can lead to an asthma attack or make one worse 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 medicines, such as aspirin (aspirin-induced asthma) or nonsteroidal anti-inflammatory drugs.
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 doctor 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.
