Childhood asthma

Diagnosis

Diagnosing asthma in children under the age of 6 can be challenging as their symptoms often overlap with those of other illnesses. This is further complicated by the fact that some children may not frequently experience asthma symptoms, leading to confusion with other respiratory conditions. Additionally, young children are unable to undergo pulmonary function tests commonly used for asthma diagnosis. In such cases, healthcare providers rely on a comprehensive approach. They consider the child’s symptoms, their frequency and timing, along with their medical and family history of asthma, allergies, or lung diseases. It is crucial for parents or caregivers to provide detailed descriptions of the child’s symptoms. Additional tests may be required to eliminate other potential conditions and determine the likely cause of the symptoms. In some cases, the child may be referred to a specialist, such as a pediatric pulmonologist or allergist.

Several conditions can mimic asthma symptoms in children, including rhinitis, sinusitis, acid reflux or gastroesophageal reflux disease (GERD), airway problems, dysfunctional breathing, and respiratory tract infections like bronchiolitis and respiratory syncytial virus (RSV). Thorough evaluation and collaboration between the child’s healthcare provider and specialists are essential to accurately diagnose asthma in young children and differentiate it from other respiratory conditions.

To aid in diagnosis, the following tests may be conducted:

• Lung function tests (spirometry): These tests, used for both children and adults, measure the amount of air a child can exhale and how quickly they can do so. Lung function tests may be conducted at rest, after exercise, and after using asthma medication. Another type of lung function test, called bronchoprovocation, assesses how the lungs react to certain stimuli such as exercise or exposure to cold air.
• Exhaled nitric oxide test: If the diagnosis remains uncertain after lung function tests, a healthcare provider might recommend measuring the level of nitric oxide in a breath sample. This test can help determine if steroid medications would be beneficial for managing the child’s asthma.
• Allergy testing: If allergies are suspected as triggers for asthma, allergy testing may be recommended. Skin testing is a common approach, involving pricking the skin with extracts of common allergens and observing for signs of an allergic reaction.
• Chest X-ray: Imaging tests like chest X-rays may be employed to rule out conditions other than asthma.

Treatment

The initial treatment approach for asthma in children focuses on the severity of their condition. The primary goal is to effectively manage symptoms, leading to minimal or no asthma-related issues. This includes the absence of symptoms, rare or no asthma flare-ups, unrestricted participation in physical activities or exercise, limited reliance on quick-relief inhalers (such as albuterol), and minimal side effects from medications. The treatment plan is based on factors like the child’s age, specific symptoms experienced, triggers that provoke asthma, and what proves to be the most effective in maintaining control over the condition.

For children under the age of 3 with mild asthma symptoms, healthcare providers may adopt a wait-and-see approach. This is because the long-term effects of asthma medication on infants and young children are not yet well understood. However, if an infant or toddler experiences frequent or severe episodes of wheezing, a healthcare provider might prescribe medication to observe if it helps improve symptoms. Individualized care and close monitoring are crucial in determining the most suitable treatment options for young children with asthma.

Quick-relief medicines

Quick-relief medicines, also known as rescue medicines, are medications that work rapidly to open swollen airways. They are primarily used during an asthma attack for short-term symptom relief, or as a preventive measure before exercise if recommended by a healthcare provider.

There are different types of quick-relief medications available:

• Short-acting beta agonists: These are bronchodilator medications delivered via inhalation, which quickly alleviate asthma symptoms during an attack. Examples include albuterol and levalbuterol. These medications take effect within minutes and provide relief for several hours.
• Oral and intravenous corticosteroids: These medications reduce airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. Due to potential serious side effects with long-term use, they are reserved for short-term treatment of severe asthma symptoms.

Long-term control medicine

Preventive, long-term control medications are used to reduce airway inflammation in children, which helps prevent asthma symptoms. These medications are typically taken on a daily basis.

Here are different types of long-term control medications:

• Inhaled corticosteroids: Examples include fluticasone, budesonide, mometasone , ciclesonide, beclomethasone, and others. It may take several days to weeks of regular use for these medications to provide full benefits. Although prolonged use of these medications has been linked to a slight decrease in children’s growth rate, the impact is minimal. In the majority of instances, the advantages of maintaining good asthma control outweigh the potential risks of side effects.
• Leukotriene modifiers: These are oral medications such as montelukast, zafirlukast, and zileuton. They help prevent asthma symptoms for up to 24 hours.
• Combination inhalers: These medications combine an inhaled corticosteroid with a long-acting beta agonist (LABA). Examples include fluticasone and salmeterol, budesonide and formoterol, fluticasone and vilanterol, and mometasone and formoterol. LABA medications have been associated with severe asthma attacks in some cases. Hence, it is essential to administer these combination inhalers only when other medications have failed to adequately control asthma symptoms.
• Theophylline (Theo-24): This is a daily oral pill that helps keep the airways open. Theophylline relaxes the muscles around the airways, making breathing easier. It is often used in combination with inhaled steroids. Regular blood tests are necessary for children taking this medication.
• Immunomodulatory agents: Mepolizumab, dupilumab, and benralizumab may be suitable for children aged 12 or older who have severe eosinophilic asthma. Omalizumab can be considered for children aged 6 or older who have moderate to severe allergic asthma.

Treatment for allergy-induced asthma

If your child’s asthma is triggered or worsened by allergies, additional allergy treatments may be beneficial, including the following options:

• Omalizumab: This medication is specifically for individuals with severe asthma and allergies. It works by reducing the immune system’s response to allergens such as pollen, dust mites, and pet dander. Omalizumab is administered through regular injections every 2 to 4 weeks.
• Allergy medications: These include oral and nasal spray antihistamines, decongestants, corticosteroid nasal sprays, as well as cromolyn and ipratropium nasal sprays. These medications help alleviate allergy symptoms and manage asthma triggered by allergies.
• Allergy shots (immunotherapy): Immunotherapy involves regular injections of specific allergens to gradually desensitize the immune system and reduce its reaction over time. Initially, the injections are given once a week for several months, followed by monthly injections for a period of 3 to 5 years.