Asthma in children and youth

What is asthma? 

Asthma is a chronic (long-term) illness that can make breathing difficult and cause wheezing, coughing, chest tightness and shortness of breath. 

About 1 in 10 children in Canada have asthma, and almost half these children have mild asthma. That means their symptoms, such as wheezing or coughing, may be caused by a common cold, allergy or vigorous activity, but rarely need medication from an inhaler or ‘puffer’ to relieve them. Children with mild asthma use their ‘reliever’ medication only occasionally, but they may also take a regular (‘controller’) medication at home to keep asthma well controlled.

Asthma symptoms can also be moderate, when children need to use their reliever medication more frequently when they are very active or have a cold or other respiratory infection. These children usually have a controller medication that they use regularly at home, plus their reliever. 

Even children with mild or moderate asthma, who do not have a lot of symptoms and do not need a lot of medication, can still have serious asthma “exacerbations”, sometimes called asthma “attacks”.

Asthma is severe when children need to use a few controller medications regularly at home plus their reliever medication more frequently, including at school, to treat symptoms. Their asthma may have more triggering causes than children with mild asthma, and they may miss school more often due to exacerbations, or need to be accommodated during strenuous activities, or be indoors when air quality is poor.

What is an exacerbation and who is at risk?

When air passages to the lungs swell, become inflamed or go into spasm, and mucus in the lungs thickens, it is called an “exacerbation”. Exacerbations can happen quickly or slowly, be mild, moderate or serious, and colds are a common cause in children. Children can feel healthy between exacerbations, and they can play and participate in sports and other physical activities as much as other kids.

Symptoms of a serious exacerbation are coughing that will not stop, being out of breath, wheezing and working hard to breathe. 

A serious exacerbation can happen to anyone with asthma and for many reasons, such as illness, stress, allergies or odors, weather or environmental factors (e.g., wildfire smoke), exposure to tobacco or cannabis smoke or vaping, strenuous activity, or vigorous laughter or crying. 

Risk factors include: 

• a previous serious attack, 
• uncontrolled asthma symptoms, 
• not following a treatment plan,
• relying too much on reliever medications (specifically, using more than 2 reliever inhalers over 1 year), or
• exposure to smoke, including smoked cannabis or vaping as well as tobacco.

How is asthma treated?

Two medication types, relievers and controllers, are used to treat asthma. Reliever medications work quickly to relax airways muscles, treating symptoms as they happen. They wear off within a few hours and do not treat airway swelling or mucus. Controller medications, usually inhaled corticosteroids (ICS) taken every day, work slowly over weeks and months to prevent symptoms. For children 12 years of age and older who have mild asthma but find taking medication every day difficult, there is also an alternative medication, called budesonide/formoterol, which can act as both a controller and reliever. Many asthma medications are sprays or powders that are inhaled, but one kind of controller medication can be taken by mouth every day.

Children who take controller medications still need to carry and use their reliever medication to improve symptoms quickly in case of exacerbations. 

Severe asthma exacerbations can be life-threatening, and every exacerbation must be taken seriously. Exacerbations that are not treated can become more serious over time. 

Your child’s asthma doctor will create a treatment plan to prevent exacerbations by using the least possible medication needed to control your child’s symptoms. When treatment plans are working, children should have well-controlled asthma symptoms and no attacks.

What is well-controlled asthma?

When doctors describe asthma as “well controlled”, they mean that a child or youth:

• does not have symptoms often: no more than twice a week during the day, and less than once a week at night,
• does not need to take medication for symptoms more than twice a week, and 
• can participate fully in school or work, play, sports, and other activities. 

Every child with asthma should be able to have it well-controlled with the right treatment plan. If exacerbations are making your child’s life difficult, ask your doctor to revisit their treatment plan.

Are there side effects from asthma medication?

Preventing and controlling asthma symptoms with ICS, used daily, is the best therapy for children and youth with asthma. ICS also treat exacerbations safely and effectively and improves lung function over time. Parents may have concerns about side effects from steroid use, but the evidence is strong that the benefits of ICS therapy far outweigh the risks of possible effects on growth or behaviour. 

When to go to the hospital

Seek urgent medical attention if a child or youth repeats their reliever medication but then shows any of these signs: 

• Bluish or grayish lips and fingernails; OR
• Trouble speaking and breathing; OR
• Areas below the ribs or between the neck and ribs pull in as they inhale