Asthma is ongoing (chronic) inflammation of airways in the lungs. This inflammation makes the airways vulnerable to episodes of difficult breathing (asthma attacks). Common triggers include allergies, colds and exercise. Asthma is managed by controlling inflammation with drugs, avoiding triggers when possible and using medications to treat asthma attacks.
Diagnosing and managing asthma in children under age 5 can be difficult. In infants and young children, the primary symptoms of asthma -- wheezing and coughing -- may be caused by other conditions. Also, standard diagnostic tests used to measure how well someone is breathing cannot be used easily or accurately with children under age 5. Some treatments available to older children for managing asthma are not recommended for infants and preschool children.
For these reasons, the management of asthma in children under 5 requires careful and relatively frequent monitoring. You can help minimize asthma symptoms by following a written asthma action plan you develop with your child's doctor to monitor symptoms and adjust treatment as necessary.
Common asthma signs and symptoms in children under 5 include:
The severity and patterns of symptoms may vary:
Asthma symptoms may be triggered or worsened by certain events:
Severe asthma attacks can be life-threatening and require emergency room treatment. Signs and symptoms of an asthma emergency in children under age 5 include:
Diagnosis of asthma in children under age 5 can be challenging. The primary symptoms may indicate other conditions. With older children a doctor can use a breathing test that measures how well the lungs work, but these tests are not useful with younger children, who may have trouble following instructions and breathing exactly as directed.
If your child under age 5 has symptoms that might indicate asthma, your doctor or asthma specialist will likely use several pieces of information to make a diagnosis.
Your doctor will likely ask a number of questions, such as the following:
Other tests may include the following:
If your doctor suspects your child has asthma, he or she will likely prescribe a trial treatment. If your child has relatively mild and infrequent symptoms, he or she may take a short-acting drug. If breathing improves in the time and manner expected for that treatment, the improved breathing would support a diagnosis of asthma.
If the symptoms are more regular or severe, your doctor will likely begin a drug for long-term management. Improvement during the next four to six weeks would support a diagnosis and lay the groundwork for an ongoing treatment plan.
It's important for you to keep track of your child's symptoms during a treatment trial and to follow instructions carefully. If you have followed the instructions and there is no improvement within the trial period, your doctor will likely consider another diagnosis.
The treatment goals for young children with asthma are to:
Your doctor will use a stepwise approach for treating your child's asthma. The goal is overall management with a minimum number of asthma attacks that require short-term treatment.
This means that initially the type or dosage of treatment may be increased until the asthma is stable. When it is stable for a period of time, your doctor may then step down the treatment, so that your child takes the minimum drug treatment needed to remain stable. If your doctor determines at some point that your child is using a short-acting drug too often, then the long-term treatment will be stepped up to a higher dose or additional medication.
This stepwise approach may result in changes up or down over time, depending on each child's response to treatment and overall growth and development, as well as on seasonal changes or changes in activity levels.
Long-term control, or maintenance, medications are usually taken daily. Types of long-term control medications include the following:
These medications -- called short-acting bronchodilators -- provide immediate relief of asthma symptoms, and effects last four to six hours. Short-acting bronchodilators for asthma include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA).
For children with mild, intermittent asthma symptoms, the short-acting medication may be the only treatment needed.
For young children who have persistent asthma and use long-term control drugs, the short-acting drug is used as a quick-relief, or rescue, medication to treat asthma attacks. It may also be used to prevent asthma symptoms triggered by exercise.
Overuse of short-acting medications usually indicates that the long-term control treatment plan needs to be revised.
Most asthma medications are given with a device called a metered dose inhaler that requires a correctly timed deep breath to get medications to the lungs. Attachments for metered dose inhalers and other devices can make it easier for children under age 5 to get an appropriate dose. These devices include:
You can best manage your child's asthma by following these tips.
Your doctor can help you create a written action plan that you can use at home and share with other family members, friends, preschool teachers and sitters. A thorough plan includes such things as the following:
Keep a record of your child's symptoms and treatment schedule to share with your child's doctor. These records can help your doctor determine if the long-term control treatment plan is effective and make adjustments to the plan. Keep appointments as recommend by your doctor to review records and adjust your action plan as necessary. Information you record should include:
Depending on the triggers for your child's asthma, make adjustments at home, as well as in child care facilities and other environments, to minimize your child's exposure to triggers. These may include:
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