Symptoms and diagnosing asthma in children
In children, a persistent dry cough can stem from various factors, and one potential cause is allergic asthma. Allergic asthma is the predominant form of asthma in children, where it is primarily influenced by a specific type of cell called the eosinophil.
An asthma flare is commonly triggered by environmental allergens like house dust mites or grass pollen. Fortunately, this type of asthma typically responds well to standard asthma treatment options commonly prescribed for asthma. Options for treating asthma include:
- Inhaled steroids: They are effective in preventing exacerbations or asthma attacks.
- Reliever inhalers (often blue): These inhalers work by relaxing the muscles in the airways, providing relief from symptoms.
In contrast, adults may experience different types of asthma, which can be associated with factors such as obesity. Effective management of asthma is crucial to safeguard the health of children with asthma and, therefore, it is vital to have a comprehensive understanding of the condition's indicators.
Wheezing is the primary and most frequently observed symptom of asthma in children. It manifests as a distinct high-pitched, whistling sound whilst breathing out. Wheezing is typically noticeable when a child is exposed to sudden cold weather, engages in physical exercise, or experiences an asthma exacerbation.
Note that many parents mistake wheezing for a rattling sound originating from the back of the throat. However, this type of sound is more commonly associated with post-nasal drip resulting from allergic rhinitis.
In addition to wheezing, a persistent dry cough can indicate uncontrolled asthma. This cough tends to occur predominantly at night, although not exclusively. It is crucial to approach the investigation of a chronic cough systematically, considering the various potential causes.
Different types of coughs have distinct characteristics, and their timing is also a crucial factor. For instance, habit coughs never occur at night when the child is asleep whereas asthmatic coughs do, underscoring the significance of both the timing and specific characteristics of the cough in determining its cause.
During an asthma attack in children, symptoms can extend beyond coughing and wheezing to include difficulty breathing. This is characterised by an increased effort in breathing, potentially leading to tugging in or the ribs or neck area, difficulty speaking, eating or walking.
To effectively manage such situations, it is crucial for the child to have a personalised asthma action plan in place. This plan equips the family with the necessary knowledge and instructions to address an asthma attack promptly and appropriately and how to get help.
Asthma is typically diagnosed in children aged five and older due to their developed motor skills, which allow for more advanced breathing tests. One commonly conducted test is spirometry, where the child inhales deeply and exhales forcefully to measure the volume of air expelled from their lungs.
As asthma involves airway obstruction, the inability to exhale rapidly suggests the presence of the condition. If obstruction is detected, a Salbutamol inhaler is administered to determine if the obstruction can be reversed through this treatment.
In addition to spirometry lung function testing, there are other diagnostic tests available for asthma. One such test is fractional exhaled nitric oxide (FeNO), which examines allergic inflammation in the lungs. These diagnostic tools aid in confirming and understanding the nature of asthma in children.
While tests like spirometry and exhaled nitric oxide are integral components of diagnosing asthma in children aged five and above, obtaining a comprehensive medical history and family history is equally crucial. Medical history assessment can begin from an early age, enabling an asthma diagnosis at any point.
When evaluating a child's history of asthma-like symptoms, it is vital to determine the onset of symptoms. Symptoms present from birth may suggest a structural issue, while symptoms that develop later may have different underlying causes.
Furthermore, the diagnostic process involves ruling out other potential conditions. For instance, a thorough examination aims to exclude chest infections or post-nasal drip caused by house dust mite allergies, which can result in a productive cough. By considering the medical history and eliminating alternative explanations, healthcare professionals can effectively diagnose asthma in children.
Recurrent viral infections often lead to a condition known as viral-induced wheeze in children. In such cases, the child experiences wheezing or coughing solely during episodes of cold but does not exhibit any asthma symptoms between these colds.
By considering the clinical history and conducting a thorough examination, we can determine the likelihood of asthma. If asthma is suspected, we may initiate a trial of inhaled steroids to assess if they alleviate or eliminate asthma symptoms.
Additionally, if the child is over five years old, we can employ a monitoring strategy called peak flows. This involves the child exhaling three times in the morning and evening to measure the speed at which they can exhale within one second. These peak flow measurements serve as a valuable tool for self monitoring asthma symptoms and can be integrated into a child's asthma action plan to effectively manage and control their asthma. We continue to review and observe the effects of the prescribed medication to ensure the best management approach for the child's asthma symptoms.
Even during the diagnostic phase, it is crucial to provide comprehensive inhaler device training to the child. Alongside this, a prescription for Salbutamol or another reliever inhaler should be given to the child, ensuring they are prepared in the event of an asthma exacerbation. This proactive approach helps to ensure the child's safety and prompt management of asthma symptoms, even while undergoing the diagnostic process.
In children, asthma frequently resolves, especially with the onset of puberty. This resolution is often attributed to the interplay between hormones and allergic asthma. Similarly, during pregnancy, asthma symptoms may improve or worsen. While some children may experience a temporary relief from asthma symptoms during puberty, there is a possibility of symptoms returning in adulthood.
Nevertheless, it is crucial to effectively manage asthma through proper assessment and treatment, rather than relying on the hope for spontaneous resolution. It is essential to recognise that asthma can be a potentially life-threatening condition. Therefore, proactive management and appropriate measures are imperative to ensure the well-being and safety of your child’s health.
Want to know more about symptoms and diagnosing asthma in children? Read the full article on Asthma in children: Symptoms and diagnosis by consultant paediatric allergist Dr Helen Brough. More information can be found on our Asthma Treatment London page.