Asthma in Children

​What Is Asthma?

Asthma is a chronic inflammatory disease affecting the lower air passages in the lungs. It is very common worldwide and in Singapore, about one in five children have asthma.

Children with asthma have air passages that are hyper-responsive (sensitive) to triggers compared to other children. Asthma may present as recurrent episodes of wheezing, breathlessness, chest tightness or coughing.

The severity of asthma differs in each child and can change with the course of time. Most children have mild asthma, and are generally well and have a few mild asthma attacks or less a year. Some children with more severe asthma may have frequent or life threatening attacks, or persistent symptoms of asthma that affect their daily activities.

What happens during an asthma attack?

Asthma attacks are usually caused by exposure to triggers, which lead to increased inflammation of the air passages. The air passages narrow and produce more mucus, leading to obstruction of the air passages and difficulty in breathing for the child. Although inflammation is worse during an asthma attack, it may also be present and ongoing even when a child with asthma appears to be well without much asthma symptoms.

Causes of Asthma

The triggers that result in asthma attacks may differ in each child. It is important to avoid triggers where possible.

Some common triggers include

• Viral infections, including the common cold and flu.
• Environmental allergens, including house dust mites, animal dander, pollen and indoor mould.
• Changes in temperature or humidity due to indoor and outdoor climate variation.
• Environmental irritants, including cigarette smoke and smoke haze.

What medicines are used to treat asthma?

There are two main groups of asthma medicine, relievers and controllers/preventers.

Relievers: Medicines that work rapidly to open up the narrowed air passages during an asthma attack. They provide quick relief of asthma symptoms and enable your child to breathe better. They are used when needed.

Controllers/preventers: Medicines that work gradually to control the chronic inflammation in the air passages, making them less hyper-responsive (sensitive) to triggers. These medicines need to be used daily if prescribed by the doctor and should only be stopped when advised by the doctor. The period of treatment for each child prescribed with controllers/preventer medicines can range from many months to years, depending on the response and control of your child's asthma.

All children with asthma will be prescribed with a reliever medicine for use during asthma attacks. Some children whose asthma is not well controlled may need to use a controller/preventer medicine daily.

The doctor will be able to assess and advise if your child needs to use a controller/preventer medicine daily.

What else should I take note of?

• Do not expose your child to second hand cigarette smoke and keep your child away from cigarette smoke-filled environments at all times.
• Avoid giving your child cold drinks and citrus fruits when unwell.
• Get your child to rest and avoid exercise during and soon after an asthma attack.
• Consult your doctor if during an asthma attack, your child
  - Remains breathless despite reliever medicines following the asthma action plan by the doctor
  - Is unable to feed or take in fluids well
  - Is unable to speak in complete sentences
  - Is drowsy, unresponsive and lethargic, or irritable and difficult to calm

How to care for the spacer and inhaler

1. Clean your spacer once a week.
2. Soak the spacer completely in mild soapy water made by adding two to three drops of dishwashing liquid into a container of water. Do not use a scrub to clean the spacer. Do not rinse the spacer again after removing it from the soapy water.
3. Allow the spacer to drip dry. Do not use tissue paper or cloth to dry the spacer after washing it.
4. Following the steps above help to reduce the static charge in the spacer and allow for better delivery of the medicine from the inhaler to the lungs.
5. If you need to use the spacer urgently before it is dry after washing, prime the spacer by actuating ten puffs of reliever medication into the spacer after drying it.
6. Wash the plastic holder of the inhaler once a week under warm running water and air dry the plastic holder thoroughly before putting the inhaler back into it for use.

How to use the inhaler with a spacer with mouthpiece/facemask