Dr Andy Whittamore, GP and clinical lead at Asthma UK, provides some essential tips on managing children’s asthma more effectively
Asthma is so common in children, with over 1m affected in the UK. Yet when I ask people to explain what asthma is, very few can. Quite simply, we need to do better for children living with asthma.
Understanding asthma (or any medical problem) is an important part of being able to keep it under control. The following facts may seem obvious, but when I discuss them with carers of children with asthma they often set off a lightbulb moment that helps them to understand and manage these children’s asthma more effectively.
1. Asthma symptoms are caused by inflammation
It’s inflammation within the tubes of the lungs that causes the coughing, wheezing, breathlessness and tight chest. The inflammation is made worse by triggers that are individual to every person. It is best controlled by taking medication that reduces the inflammation in the lungs and avoiding those triggers where possible.
Too many children are living with asthma symptoms. These symptoms not only prevent them living normal lives and achieving their potential at school or on the sports field, they also mean an increased risk of having a life-threatening asthma attack.
2. The blue inhaler does not treat asthma inflammation
Reliever inhalers (usually blue) contain a brilliant, amazing medicine that opens up the lung tubes for a few hours. It makes breathing, coughing and wheezing feel better. What it does not do is treat the inflammation which is still there, waiting to be triggered. It is really important to have a blue inhaler available at all times – it can be life-saving.
If a child needs their blue inhaler three or more times per week then that suggests that there is untreated inflammation in their lungs – make an appointment with their GP or practice nurse to improve this.
3. Asthma comes and goes and is unpredictable
Asthma is a condition that comes and goes. Some people are lucky enough for their asthma symptoms to go quiet for weeks, months or even years. However, it’s still there in the background, waiting for things to trigger it. These triggers are unpredictable – viruses, pollution, allergies, exercise, stress. It may even need a combination of triggers to cause a problem. People caring for children with asthma need to be given the information and tools to help them manage this variability.
4. There is a ‘must have’ treatment for asthma
To treat inflammation in the lungs, an anti-inflammatory is needed within the lungs. A low dose steroid in a preventer inhaler (often brown but some other versions do exist) is the most effective, safe way of doing this. If taken correctly, regularly and as prescribed, an inhaled cortico-steroid will keep the asthma inflammation under control without any problems. I often hear from parents who are worried about their child taking a steroid inhaler every day. It can be reassuring to know that these low doses stay in the lungs where they are needed rather than travelling around the body.
Preventer inhalers need to be taken as prescribed – usually every day. They prevent the silent build-up of inflammation in the background that can tip over into an asthma attack if triggered.
We call it a preventer because by treating the inflammation it is helping to prevent the symptoms that disrupt a child’s life. They also help prevent life-threatening asthma attacks.
Steroid tablets (sometimes also liquid) are much higher doses of the anti-inflammatory steroid. These only get prescribed when there is so much inflammation within the lungs that an inhaled steroid isn’t strong enough or needs treating very quickly (like during an asthma attack).
The low dose steroid in a preventer inhaler are a small fraction of the dose of steroid tablets. That is why it makes so much sense to look after a child’s asthma all the time, not just when it flares up.
5. Asthma attacks – a crucial point for intervention
A flare up of asthma can be scary and can quickly become life-threatening. They are also inconvenient, disruptive, and require extra medication.
The advice is clear: If a child in your care is needing to use their blue inhaler 3 or more times per week get them checked over to help prevent an attack. If they are needing that blue inhaler at night, get an appointment the next day. If the blue inhaler is not completely taking away the child’s symptoms for a four-hour period, or if the symptoms come back within 4 hours they really need emergency treatment – call an ambulance or arrange to be seen by your GP as an emergency or go to A+E as soon as possible
Asthma attacks offer a ‘window of opportunity’ for to work with families to establish the causes of an attack, reinforce the messages that will prevent another, and make sure the child keeps taking any medication as prescribed until they are fully recovered.
Tips to share with families and carers for children with asthma
- Get Written Asthma Action Plan and share it with other people who look after the child.
- Follow Asthma UK on Facebook or Twitter for the latest news, hints and tips
- Get a review of the child’s asthma plan if they need their reliever inhaler 3 or more times per week, after a flare-up or at least once every year.
- Visit Asthma UK’s inhaler page for a refresher on correct use of inhalers.
- Call the Asthma UK Helpline on 0300 222 5800 (Mon – Fri; 9am – 5pm) to speak to one of our friendly asthma nurses for advice.
About the author
Dr Andy Whittamore is a GP and Clinical Lead at Asthma UK.