There are few things as frightening as seeing a baby or a toddler gasping for breath. We talked to the Allergy Foundation of South Africa (AFSA) to find out everything you need to know about asthma.
Most of us have an idea of what an acute asthma attack looks like, but there’s more to asthma than meets the eye – a recurrent wheezing cough can also be a symptom of asthma. And if you have a family history of asthma, there’s a chance your baby or toddler could be asthmatic too.
Being a parent often involves late nights and limited sleep in the early years. However, if your child’s cough is keeping you up at night, or they are having difficulty breathing, it may be more than normal disturbed sleep. By knowing what to look out for, you can recognise asthma symptoms and help your child to breathe easily again.
What is asthma?
Asthma is an incredibly common condition, affecting about 10-20% of South African children. It’s a long-term illness of the lungs that causes the tubes that carry air into and out of the lungs (the airways) to become swollen (inflamed) and produce lots of thick mucus.
In a child with asthma, the inflammation makes the airways ‘twitchy’: this means they are extra sensitive, and so when your baby or child gets a viral infection, when they exercise, or when they’re exposed to cold air, allergens, exercise, and smoke, those airways can close up.
What causes asthma?
The exact cause of asthma isn’t known, but doctors do know that genetic and environmental factors combine to cause asthma, most often early in life. These factors include:
- An inherited tendency to develop allergies, called atopy
- Parents who have asthma
- Parents who smoke during pregnancy and after childbirth
- Certain respiratory infections during childhood
- Contact with allergens or exposure to viral infections early in life when the immune system is developing.
Among children, more boys have asthma than girls. But among adults, more women have the disease than men. It’s not clear whether or how gender and hormones play a role in causing asthma.
What are the warning signs?
Asthma symptoms may include coughing, a whistling noise from the chest (wheezing) and shortness of breath. Symptoms such as wheezing and coughing may be more prominent in the early hours of the morning, especially between 1am and 2am.
Children with asthma do not usually cough up sputum, and other allergies, such as eczema and allergic rhinitis (a runny nose or hay fever caused by allergies), are also linked to asthma, especially in children.
Because babies have very small airways, many things can cause them to wheeze, so it can be difficult to tell whether the wheeze is being caused by asthma, or by a throat or chest infection.
What triggers asthma attacks?
Asthma symptoms are often associated with the common cold (or other upper respiratory tract infections), but may also be triggered by exercise (particularly in cold and dry weather), laughter, crying, and exposure to allergens and irritants such as cigarette smoke, petrol or paint fumes.
The main allergic triggers are pollen, mould spores, animal dander and dust mites. Each person has their own unique set of triggers, which is why testing is so important.
What if I suspect my child has asthma?
You need to consult a medical specialist with a special interest and skill in asthma and allergies, because if asthma is left untreated, your child’s airways could be permanently damaged. There’s a list of health professionals with skills in allergy on the AFSA website: these will usually be paediatric pulmonologists or allergists.
Your medical specialist may request sensitisation (skin or blood) tests be done. These tests determine any allergens that might be causing the asthma to flare up in your little one. If you know what’s causing the asthma, you may be able to limit or even completely stop your baby or toddler’s exposures to those triggers.
Can you outgrow asthma?
Asthma is an interesting disorder in that some children who wheeze a lot when they’re young never go on to develop asthma in later life. In fact, it’s debatable whether some of them truly had asthma at all, or whether they actually had wheezing from bronchiolitis or other chest infections.
In other children with definite asthma, symptoms may go away as the child’s lungs physically grow bigger, only for the asthma to return when they hit their 40s (as their lung function starts to decline).
Treating asthma in babies and toddlers
You can’t cure asthma, but you can take steps to control the disease and prevent its symptoms:
- Learn about your child’s asthma and ways to control it
- Follow the written asthma action plan from your doctor
- Use medicines as your doctor prescribes
- Identify and try to avoid things that make your child’s asthma worse
- Keep track of your child’s asthma symptoms and level of control Get regular check-ups.
Depending on your little one’s specific allergies, some preventive maintenance at home could help control the environment, and reduce your risk of allergic reactions. The most important step is to limit exposure to environmental tobacco smoke, which is a non-allergic trigger of symptoms in people with asthma.
Which medications should I use?
The most common treatments for asthma are pumps, pills and antihistamines. There are two major types of asthma pumps: those that are used every day to control inflammation, and thus prevent symptoms from occurring (controller pumps), and those that are merely emergency medication used to treat symptoms during an exacerbation (reliever pumps). Asthma pumps need to be used with the best possible technique, preferably with a spacer for babies and toddlers.
Pills can be used as preventers in children with mild asthma, but these are not as effective as the preventer asthma pumps. Oral steroid tablets or syrup are used when someone has had a severe attack, but should not be used as regular therapy, as the side effects can be very severe.
Since most asthmatics also have allergic rhinitis, nose sprays and antihistamine tablets are used to treat allergic rhinitis, which helps prevent asthma attacks.
Regular follow-up with your doctor is necessary to ensure regular prevention treatment is used properly. Take your medication with you to every doctor’s visit and ask your healthcare practitioner to demonstrate how they should be used.
If the medication is not working, despite being given regularly and with the best possible technique, your doctor may have to consider other rarer causes of wheezing in childhood.