Asthma flare-ups or mild asthma symptoms: treatment

An asthma flare-up is when your child develops mild asthma symptoms like coughing, wheezing or mild breathlessness.

If your child is experiencing these symptoms, here’s what to do:

1. Remain calm and sit your child down.
2. Give your child 2-4 separate puffs from the inhaler (usually the blue one) through the spacer. For each puff of medication, your child should take four normal breaths through the spacer before you give the next puff.
3. Wait four minutes. If there’s little or no improvement in symptoms, repeat steps 1-3. If there’s no or little response to treatment after another four minutes, call 000 for an ambulance. Say that your child is having an asthma attack.
4. If symptoms improve, watch your child throughout the day. If symptoms happen again, repeat steps 1-3.

Follow-up
If your child has flare-ups that need treatment more than once every three hours, make an urgent appointment with the GP for your child.

Asthma attacks or severe asthma symptoms: treatment

An asthma attack is when your child develops severe asthma symptoms like severe difficulty breathing or blue lips.

If your child is experiencing these symptoms or your child’s condition is rapidly worsening, here’s what to do:

1. Remain calm and sit your child down.
2. For children aged 0-5 years, give 2-6 separate puffs from the inhaler (usually the blue one) through the spacer. For each puff of medication, your child should take four normal breaths before you give the next puff.
3. For children aged six years or older, give 4-12 separate puffs from the inhaler through the spacer. For each puff of medication, your child should take four breaths before you give the next puff.
4. Wait four minutes. If there’s little or no improvement in symptoms, repeat step 2 or 3 above.
5. Wait four minutes. If there’s little or no improvement, call 000 for an ambulance. Say that your child is having an asthma attack. Give your child puffs from the inhaler through the spacer every four minutes as described above until the ambulance arrives.
6. If symptoms improve, watch your child throughout the day. If symptoms happen again, repeat steps 1-5.

Follow-up

• If your child has had an asthma attack that improved with treatment, take your child to see the GP as soon as possible. Your child’s symptoms need to be reviewed.
• If symptoms keep happening more than once every three hours, urgently see your GP or take your child to a hospital emergency department.

Severe asthma symptoms can be life threatening. Call 000 immediately for an ambulance if your child’s symptoms don’t improve or continue to get worse even when your child is using an inhaler.

Asthma treatment: categories of asthma

Children with asthma can be grouped into three categories:

• infrequent intermittent asthma
• frequent intermittent asthma
• persistent asthma.

Infrequent intermittent asthma
With this kind of asthma, symptoms happen a few times a year, usually in association with a cold or other viral infection. Children with infrequent intermittent asthma might wheeze or cough for a few days when they’re having flare-ups and respond rapidly to treatment.

Between asthma attacks or flare-ups, children with infrequent intermittent asthma are usually in good health and lead healthy, balanced lives with no asthma symptoms.

Children with infrequent intermittent asthma usually need treatment only for asthma attacks. They might not need to take any asthma medications in between attacks, unless the attacks are severe. Most children with asthma fall into this group.

Frequent intermittent asthma
Children with frequent intermittent asthma have several acute attacks each year, at least every six weeks.

Children with frequent intermittent asthma might have an intermittent cough, or a wheeze or cough triggered by exercise.

Some children with frequent intermittent asthma will probably need to take preventer medication on a daily basis to prevent asthma attacks.

Persistent asthma
Children with persistent asthma have symptoms at least once a week. Their symptoms can happen during the day or night.

Children with persistent asthma need to take several preventer medications each day.

This is the smallest group of children with asthma.

Asthma medication: relievers and preventers/controllers

Asthma medications can be divided into:

• relievers, which treat asthma symptoms
• preventers/controllers, which prevent asthma symptoms.

Some children take one, two or even three of these types of medications. Your doctor will tell you the most appropriate medications for your child.

Relievers
Short-acting beta-2 agonists like salbutamol (Ventolin®, Asmol®) and terbutaline (Bricanyl®) are the drugs most commonly used to treat asthma symptoms. These drugs help to relax the narrowed airway passages and make it easier for air to get through.

If your child is having a severe asthma attack, your child might be given corticosteroids (prednisolone) to reduce inflammation and swelling in the airway passages.

Preventers
Drugs to prevent asthma symptoms are very important. They can reduce inflammation in the airway passages, relax the airway muscles for prolonged periods of time, or target the underlying factors that cause inflammation and allergies.

Asthma preventers include:

• inhaled corticosteroids like beclomethasone (Qvar®), budesonide (Pulmicort®), fluticasone (Flixotide®) and ciclesonide (Alvesco®)
• corticosteroid tablets or mixtures (prednisolone), which children take by mouth
• sodium cromoglycate (Intal®), which children can inhale and is an alternative to corticosteroids
• montelukast (Singulair®), which is a tablet and another alternative to corticosteroids
• combination inhalers, which combine inhaled corticosteroid and long-acting beta-2 agonists like fluticasone and salmeterol (Seretide®), budesonide and formoterol (Symbicort®), and flucticasone and vilanterol (Breo Ellipta®)
• biologics like omalizumab and mepolizumab (Xolair® and Nucala®), which are given by injection every 2-4 weeks, and are used for severe asthma not controlled by other preventers.

Children need to take their preventative medications every day.

Medication safety and side effects
Asthma medicines are generally very safe, especially those that are inhaled. But if you think your child is experiencing side effects from medications, discuss this with your doctor.

Children who use corticosteroids inhalers are more likely to get oral thrush. There’s also a chance that children can damage their tooth enamel if they use an inhaler and don’t look after their teeth properly. Your child can avoid these side effects by rinsing out their mouth after using their corticosteroid inhaler. Also make sure your child’s teeth are cleaned twice a day with toothpaste – but allow 30-60 minutes after using an inhaler before brushing.

If your child uses an inhaler, learning how to use it is very important. You and your child’s health professionals might need to explain and show your child how to do it several times.

Asthma management: avoiding triggers

Asthma management includes avoiding the things that trigger asthma attacks.

For example, your child should avoid things that might irritate their airways, like cigarette smoke and air pollution.

If your child is allergic to certain animals, it’s a good idea for your child to avoid touching these animals. If your family pet is the problem, you could think about keeping the animal outside or not letting the animal sleep on your child’s bed.

If your child is affected by goose down or feathers, they might be better off with non-allergenic bedding.

If your child is allergic to house dust mites, you can reduce dust in your home and your child’s bedroom by:

• regularly wet dusting surfaces and vacuuming floors
• minimising soft toys and clutter in your child’s bedroom
• replacing curtains and carpets with blinds and hard flooring
• using anti-dust covers on your child’s mattress and pillow.

It’s OK to look at how you can balance prevention measures with the need to limit big changes to your family’s living conditions. You might not need to make big changes if your child has only mild symptoms.

Asthma control and management plans

Every child with asthma should have an individualised asthma control and management plan, regardless of how mild or severe their symptoms usually are.

The aim of all asthma plans is to prevent asthma flare-ups and attacks so that your child can lead a healthy, balanced life. An asthma management plan also aims to minimise the severity and length of any attacks that do happen.

To develop the plan, you and your child will need to work with your child’s doctor to make sure you:

• know what triggers your child’s asthma symptoms
• understand how your child takes their asthma medication – how much, how often and how to use the inhaler correctly
• know what to do if your child’s symptoms get worse, and what to do in an emergency if your child doesn’t respond to the drugs they usually take.

You should give a copy of the plan to anyone who is caring for your child. This includes family, carers, babysitters, sports coaches and your child’s school.

It’s a good idea for your child to see their doctor or nurse regularly to monitor their asthma symptoms and treatment, and to review the asthma management plan. If you’re not sure about any aspects of your child’s asthma control and management plan, you should check with your child’s health professional.

Living with asthma

Most children with asthma lead lives that have a healthy balance of physical and other activities.

If your child is diagnosed with asthma, keep encouraging your child to do sport and exercise. Your child might benefit from taking reliever medication just before exercise to prevent a wheeze or a cough from happening.

If your child has frequent attacks, or if symptoms stop your child from playing sport, sleeping at night or feeling healthy, it’s likely that your child is being undertreated or not taking their medication appropriately. Talk to your doctor about this.

Children with asthma aren’t always good at judging the severity of their symptoms – they often say they feel fine even if their asthma is poorly controlled. Keep an eye on your child’s symptoms and visit your doctor if you have any concerns.