By Jessica P. Hollenbach, PhD, AE-C, Co-Director, Asthma Center, Melanie Sue Collins, MD, and Caleb D. Wasser, DO, FAAP

According to the Connecticut State Department of Public Health, an astonishing 370,000 people in Connecticut have asthma—71,900 of which are children. That’s 1 in every 8 children in the state. It’s the most common chronic illness in kids and there are many causes.

Many of us have a basic understanding of asthma, but what else should parents know? Connecticut Children’s pediatric experts weigh in. 

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1. Medically speaking, what is asthma?

Asthma is a chronic disease caused by inflammation (swelling) of the airways (breathing tubes).  This inflammation is caused by inheriting genes as well as everyday exposures in our environment like pollen, animal dander, and even viral respiratory infections such as the common cold.

Typically, people who have asthma have three things going in in their body that cause symptoms.  These are:

  • Chronic inflammation of the airways (swelling of the breathing tubes)
  • Obstruction of the breathing tubes (from the swelling OR mucus blocking the breathing tubes) which can typically reverse in most children with medication
  • Hyper-responsiveness of the airways (overreacting breathing tubes) to different exposures like allergies, smoke, pollution and respiratory viruses 

In people with asthma, breathing can become difficult because of the swelling of the airways (breathing tubes) which narrow the path air takes getting in and out of the lungs.  Children with asthma can have symptoms like chest tightness or pain, wheezing, cough or feeling out of breath.

Asthma can cause such a wide variety of symptoms because each person’s disease is unique and not all children with asthma necessarily have all the symptoms.  Some children may only cough and other kids may only wheeze.  It is how often your symptoms are occurring that determine how severe your asthma is, not what kind of symptoms you have.

>Related: Learn More about Connecticut Children’s Asthma Center

2. Who does asthma affect the most?

Asthma can affect anyone. But in childhood, asthma affects significantly more boys than girls, as well as underrepresented populations. Black people and some Hispanic people have higher asthma rates than other groups.  For example, Puerto Rican children have the highest asthma rates of all ethnic and racial groups, but Mexican children have one of the lowest reported rates.

3. Are there certain things that can trigger asthma?

Yes—many factors can trigger asthma and cause symptoms or an “asthma attack.” When a child has symptoms of cough, wheezing and/or shortness breath this is called a loss of asthma control.  This loss of control can be caused by a variety of exposures.  For some people irritants like pollution, strong smells, cigarette smoke, vape, and essential oils being diffused can cause a loss of control.   Others may have increased symptoms only with exercise or exposure to very hot or cold temperatures OR big temperature changes.  Loss of asthma control that lasts longer are referred to as moderate or severe exacerbations.  These exacerbations are usually from exposure to allergens or respiratory viruses like the flu or human rhinovirus or respiratory syncytial virus (RSV).

>Related: RSV and Flu: What’s the Difference and When Should I Seek Care?

4. What’s the best treatment for asthma in kids?

Every kid is different, so that depends. The key to treating asthma is treating the inflammation of the airways (swelling of the breathing tubes) as well as the hyper-responsiveness (overacting breathing tubes).

Inflammation is treated by inhaling low doses of steroid medication, the amount and how often medication is taken depends on how often the symptoms are occurring.  Some kids might only take medication during illnesses where others need medication every day to help their symptoms stay under control. To treat the hyper-responsiveness, medications called bronchodilators are used to help open the airways and improve symptoms.

Depending on the medication and the child, it may be given with an inhaler and spacer (aka pump) or a nebulizer (machine) with a liquid medication(s) inside. There is even newer medications that combine both steroids and bronchodilators into one inhaler so that patients can use a single inhaler for controlling their asthma as well as treating increased symptoms!

Other medications like antihistamines, which help minimize asthma triggers like seasonal allergies, can also help to improve asthma control.

5. How can you prevent or lessen the effects of asthma?

Here are some steps you can take

  1. The first step is awareness. Talk to your doctor about your child’s symptoms and make sure you are keeping your eyes and ears open! 
  2. Trust your instincts as a parent. Don’t hesitate to ask for a written asthma treatment plan. This plan should advise you what to do in times of sickness as well as everyday health. It should also address what you can use to prevent your triggers from making your asthma control worse.   
  3. Keeping a calendar or journal to keep track of:
    • Illnesses-how long, how severe and what symptoms are occurring the most
    • Changes in symptoms during different seasons and different types of weather
    • Changes in environment. For example, did symptoms increase when you moved or did an area of mold appear in your home?  Any new pets? Also note patterns—what time of year does it get better? Worse? How long does it last?

If you start to notice a particular pattern, discuss this with your pediatrician and they may be able to recommend some things to help evaluate the patterns as well as provide symptom relief.

>Related: Building for Health: Peace of Mind for Emily and Family

6. Are kids with asthma considered immunocompromised?

In general no.  The amount of low dose steroid medication given to children with asthma doesn’t impair their immune systems.  However, in children, respiratory viral infections like COVID-19, RSV, the flu and even common colds increase the risk of a moderate to severe asthma exacerbation.  Simply put, a cold is rarely just a cold for kids with asthma.

>Related: Beyond Imagination: The Technology and Team that Saved Kaitlyn

A young girl uses an inhaler

7. When should I ask for a referral to a specialist?

While the vast majority of children don’t need a specialist to manage their asthma, your pediatrician might recommend a referral.  For some children, pediatricians recommend lung function testing with a pediatric pulmonologist to help evaluate their level of disease and response to medications. Other times they may recommend further evaluation by a pediatric allergist/immunologist or otolaryngologist (ear, nose and throat specialist).

8. Does asthma go away?

Every child with asthma has their own unique course. For most kids with asthma, symptoms can be controlled with appropriate medications and by following a written asthma treatment plan.  As our bodies go through different changes throughout the lifespan, asthma symptoms can vary.  For example, someone may not have asthma symptoms for years, but then moves to a new state and has significant symptoms during spring allergy season.  It is very important to remember that people with asthma are more likely to develop symptoms, so maintaining healthy habits like avoiding environmental tobacco smoke and careers where there is a lot of inhalation of dust and debris are smart choices.

Kids with asthma are elite athletes, college graduates, opera singers and ballerinas.  With a little patience, the benefits of new medications, a written asthma treatment plan and open communication with your pediatrician, your child can lead a happy, fulfilling life.