Breathing easy with Ashtma

Asthma is one of the most common chronic conditions in children and for parents, managing it can sometimes feel like tiptoeing through a minefield. One minute your child is running around with their friends, the next they’re gasping for breath. It’s frightening, but the good news is that with the right tools, support, and information, parents can help their children live full, active lives.

Diagnosing asthma

Getting a diagnosis of asthma can be tricky, especially in younger children.

“Diagnosing asthma in children can be very challenging, especially in the very young,” explains Dr Refiloe Moreke, a paediatrician at Netcare Garden City Hospital. “This is because of symptom overlap with other respiratory illnesses and the fact that they might not be able to perform certain diagnostic tests.”

In children under five, tools like spirometry (which measures airflow) often aren’t possible. So what can parents do? According to Dr Moreke, it’s all about observation and communication.

“History and clinical examination are the most important,” she says. “A history of intermittent or chronic symptoms of asthma plus the finding of wheezing on physical examination strongly point to a diagnosis.”

Parents should be prepared to share details such as a family history of asthma or allergies, patterns of coughing (especially at night or after exercise), and possible triggers such as pets, pollen, or dust. This gives doctors vital clues and helps ensure an accurate diagnosis.

Know the triggers, reduce the risk

Once asthma is diagnosed, the next big question is: what sets it off? “Common triggers include respiratory infections, allergens like house dust mites, mould, grass, pets, tobacco smoke, changes in weather, especially winter or spring, physical activity, emotions and stress,” says Dr Moreke.

Some of these can be identified through allergy testing, while others become clearer with time and observation. “The best way to manage asthma is to avoid exposure to known allergens or triggers,” she adds.

Of course, avoiding triggers like weather changes or catching colds isn’t always realistic. That’s where knowing how to adjust medication, with your doctor’s guidance, becomes essential.

“Parents should be taught how to adjust their child’s asthma medication to mitigate potential exacerbations,” Dr Moreke advises.

Inhalers: making sure they work

If your child has asthma, chances are they’ll need an inhaler, and using it correctly is key. “Every child who has been diagnosed with asthma needs to have an action plan in writing,” says Dr Moreke. “This provides information and instruction on the medication the child is on and how to use it correctly.”

There are four main types of inhalers:

1. Metered Dose Inhalers (MDIs): These use apropellant to spray medicationin a burst.

2. Dry Powder Inhalers (DPIs): These don’t spray.The medicine is inhaled whenthe child breathes in.

3. Breath-Actuated Inhalers: Also dependent on inhalation,but can contain either powderor aerosol medicine.

4. Soft Mist Inhalers: These create a gentle spray without a propellant.

Dr Moreke recommends using a spacer, a tube that attaches to an inhaler, especially for younger children. But, she cautions, “Parents and caregivers should be taught how to use it correctly,” she says.

Inhalers vs nebulizers: which is better?

Each device comes with its pros and cons.

MDIs are cost-effective, easy to carry, and deliver quick relief. However, they need good technique and regular cleaning, and they can lead to side effects if medicine deposits in the mouth.

DPIs are convenient and don’t need spacers, but they’re pricier and might not work as well in very young kids who struggle with the deep breathing required.

Nebulisers are often used in very young or very ill children who can’t manage handheld devices. But beware: home nebulisers aren’t always effective. 

“They are not able to deliver the required flow rates to break down medication particles to small enough to reach the smaller airways,” explains Dr Moreke. “Hospital nebulisers driven with oxygen at flow rates of about 8L/min work more effectively.”

Recognising an asthma emergency

Perhaps the most frightening part of asthma is the sudden onset of an attack. Knowing the signs and what to do can make all the difference.

“Acute asthma attacks in children typically present with an expiratory wheeze and varying degrees of respiratory distress,” says Dr Moreke. Look out for fast breathing, chest tightness, fatigue, trouble feeding (in babies), and shortness of breath.

“Parents should administer the child’s quick-relief (bronchodilator) medication immediately – they may give two doses 20 minutes apart,” she advises. If symptoms are severe, don’t wait. “Call for an ambulance to transport the child to the nearest Emergency Department.”

Asthma management beyond the home

Children don’t live in a bubble – they go to school, visit family, and attend playdates. That means others need to be part of the asthma plan.

“Parents should alert their child’s school or other caregivers about their child’s asthma and possible triggers, to aid with avoidance,” Dr Moreke advises.

That includes providing the school with a copy of the action plan, having medication available on site, and making sure someone knows what to do in case of an emergency.

Managing asthma may seem daunting, but with the right diagnosis, a personalised action plan, and open communication between parents, healthcare providers, and caregivers, your child can thrive.

“Asthma doesn’t have to limit your child,” reassures Dr Moreke. “With good management and support, they can do everything their peers do – and more.” 

Asthma action plan checklist

• Personalised, written asthma plan from your doctor

• Inhaler with spacer (and back-up kept at school)

• List of known triggers

• Emergency contacts and instructions

• Ongoing follow-ups with your healthcare provider