Breathe easy

Childhood asthma usually carries a genetic element, although not always. If a child’s mother has asthma, eczema or hay fever, the child has a 50 per cent chance of having some allergic disease, although not necessarily the same one.

If it’s the father who has the condition, the risk drops to 30-40 per cent for the child, but if it’s both parents, the risk increases to 70 per cent. It is significantly more prevalent in boys, but after adolescence it becomes about twice as common in women as in men..

Environmental factors are thought to affect the frequency and severity of attacks, including pollen and dust which trigger hyperactivity in a child’s airways.

Passive smoking is also a factor. Even if just one parent smokes, it’s the equivalent of a child smoking 100 cigarettes a day. Smoking outside doesn’t solve the issue, because nicotine and chemicals stay with the smoker, which means the child is still exposed.

SPOTTING SYMPTOMS

Identifying asthma in small children isn’t easy. Some children have lots of colds that cause viral wheeziness, but it’s not the same as asthma. And it’s not always the wheeziness that is the giveaway sign anyway – generally, the signs are more subtle. They include losing their breathe more quickly than their peers, or getting so breathless that it stops them doing activities. Children with undiagnosed asthma are often seen as the ones who can’t keep up.

An ongoing night-time cough is another sign. If your child disturbs you with their night-time cough two or more times per week, you should get a medical opinion. Chest tightness is another symptom, although some children describe it as tummy ache.

There’s no magic test for asthma. Instead, your health professional may ask about your child’s personal and family history of any allergic disease, as well as how often the symptoms are happening and how long they last.

The history of your pregnancy and the birth may be significant, as well as your child’s personal risks – for example any eczema or rhinitis (nasal irritation and sneezing). You might be asked if your child had any chest infections or bronchiolitis in the early years.

Most of the diagnosis will be based on your answers to these questions, whilst the remainder is done through further investigations and/or skin-prick testing.

GETTING CARE

GPs provide the overall care for most children. But sometimes they may be reluctant to give an asthma diagnosis in children under six and prefer to see if the symptoms resolve themselves naturally. Parents may be asked to keep a symptom diary and/or use a peak flow meter, a little device that a child blows into really hard morning and evening for two to three weeks, recording the results.

Children who are believed to have asthma are given a management plan that’s dependent on the severity of their symptoms. A child who only has exercise problems may not require day-to-day treatment, for example. But every child will get a clear plan outlining treatment and review dates.

Children with more regular symptoms will be given a treatment plan focused around the use of a low dose of inhaled corticosteroids, which will be reviewed on a regular basis. Small children are unable to co-ordinate their breathing to use a spray, so under-threes are given a spacer and facemask, whilst over-threes are given the spacer only.

There are four further stages of treatment levels in childhood asthma and children may need additional medication depending on how they respond to treatment.

Whatever the treatment plan, the outcome should mean

* No night-time or daytime symptoms.

* Ability to do normal activities without problems.

* No need for rescue treatment.

* No time off school.

Because the inhaled corticosteroids can cause candida (thrush), children should brush their teeth, and swill and spit out the water, straight after inhaling. Reliever treatments can cause increased heart rate and tremor in the short-term, although this is nothing to worry about.

HELP AT HOME

Parents can help at home by avoiding triggers, such as dust mite, for example. Vacuum more regularly when your child is not around, change bed sheets regularly and wash them at 60 degrees. Vacuum your child’s mattress, restrict cuddly toys insofar as you can and damp dust rather than polish dusting.

Some parents swear by humidification systems and keep a consistent atmospheric temperature in the house, so that children aren’t moving around from hot to cold. Other parents try yoga and other complementary therapies, but the evidence to support these measures is anecdotal, rather than scientific.

It’s very important to make sure children take the treatment, even when they start feeling well again. Discuss it with your healthcare professional at your child’s next review: they may reduce the treatment. On the other hand, you should ask to have your child’s review brought forward if you think it’s necessary, particularly as reviews only tend to be every six months. ‘Some kids will only ever experience mild problems – a bit of breathlessness and the occasional wheeze. But it’s not possible to predict who is going to have a life-threatening attack: many sudden and severe asthma attacks occur in mild to moderate sufferers. Unfortunately, children don’t ‘grow out of’ asthma. But it can certainly become much less frequent, even disappearing for years. So if it does strike out of the blue, it’s crucial to know exactly what to do.