Asthma

What is asthma?

Asthma is a long-term lung condition that affects the airways that carry air in and out of the lungs. With asthma, the airways in the lungs can: 

• Swell (become inflamed) 
• Tighten 
• Make extra mucus 

Asthma makes the space inside the airways smaller. When this happens, less air can pass through. This can make breathing harder and may cause symptoms such as coughing, wheezing, and chest tightness. 

In some cases, asthma can cause severe attacks that can be life-threatening if not treated right away.  

If your child has asthma, it is important to work with your care team to develop a plan to control symptoms, limit triggers, and treat asthma attacks if they happen. 

How the respiratory system works

The airways are part of the respiratory system. The respiratory system includes the: 

• Nose and mouth 
• Airways (such as the trachea (windpipe) and bronchial tubes) 
• Lungs 

The respiratory system helps your body take in oxygen and remove carbon dioxide (a waste gas): 

• When you breathe in, air moves through the airways and into the lungs. 
• Oxygen moves into the blood and travels to all parts of the body. 
• When you breathe out, the body gets rid of carbon dioxide. 

Oxygen helps the body: 

• Make energy to fuel the body 
• Keep the brain, heart, and muscles working
• Stay healthy and strong 

Symptoms of asthma

Signs and symptoms of asthma may include: 

• Coughing 
• Wheezing   
• Chest tightness or pain 
• Trouble breathing or shortness of breath 
• Feeling tired during play or exercise 

Symptoms can vary. They may be mild sometimes and worse at other times. Asthma symptoms may be worse during colds, flu, or allergy seasons.  

Asthma attacks 

During an asthma attack, symptoms get worse. Attacks may come on slowly or quickly.  

Sometimes the symptoms can be life-threatening. Asthma attacks (exacerbations) are more common in people who have severe asthma. 

Get medical help right away if your child has trouble speaking, is breathing very fast, or if rescue medicine does not help. 

Causes of asthma

The exact cause of asthma is not known. Certain triggers can cause asthma symptoms. 

Asthma triggers may include: 

• Colds, flu, and other viruses 
• Smoke (including cigarette smoke and secondhand smoke) 
• Dust 
• Mold 
• Pollen 
• Pets 
• Strong smells or sprays 
• Weather changes 
• Physical activity 
• Stress 
• Cold air 

Your care team can help you find your child’s triggers. 

Risk factors for asthma 

Asthma can affect people of all ages, but it often starts in childhood. A child may be more likely to have asthma if they: 

• Were exposed to secondhand smoke before birth or as a young child 
• Breathe in irritating substances, such as chemicals or dust 
• Have a parent with asthma 
• Have other health conditions, such as allergies or obesity 
• Had frequent colds or viral respiratory infections as a young child 

Asthma is more common in Blacks and Puerto Rican children. It is more common in males during childhood. It is more common in females during the teen and adult years.

Diagnosis of asthma

Most children with asthma have symptoms before age 5. 

To diagnose asthma, a care provider will: 

• Ask about symptoms 
• Do a physical exam 
• Do allergy skin or blood tests if your child has a history of allergies. These tests check which things may cause an immune system reaction. 
• Do tests to see how well the lungs work (if your child is old enough) 

Asthma can be hard to diagnose in young children. Young children may not be able to explain their symptoms. They may also be too young to do breathing tests. 

In young children, providers may diagnose asthma based on symptoms and if asthma medicine helps. Asthma-like symptoms in young children may be called reactive airway disease (RAD).

Tests for asthma

Spirometry is a breathing test that shows how well air moves in and out of the lungs. During spirometry, your child takes a deep breath and then blows out as hard and as long as they can into a mouthpiece. The test measures how much air they can blow out and how fast. 

Spirometry may be done before and after your child uses asthma medicine (such as a quick-relief or rescue inhaler). This helps the care team see if the airways open up with medicine. 

A normal spirometry test does not rule out asthma. Symptoms can come and go, and the test may be normal between flare-ups. 

If spirometry results are normal, your child’s health care provider may recommend a trial of asthma medicine. If your child’s symptoms improve, that can support the diagnosis of asthma. 

Challenge tests

If symptoms do not improve, other tests may be used to check how the airways respond to certain triggers. 

• Cold air challenge: Breathing in cold air to see if it triggers symptoms or narrowing of the airways 
• Exercise challenge: Exercising (often on a treadmill or bike) to see how the lungs respond 
• Methacholine challenge: Breathing in a medicine called methacholine to see if it causes the airways to narrow 

Treatment of asthma

Your care team will make a treatment plan to help prevent asthma attacks and manage symptoms. Treatment plans may change over time.  

Medicines for asthma

Asthma treatment usually includes 2 types of inhaled medicine: daily controller and rescue medicine.  

Daily control medicine (taken every day) 

• Help prevent symptoms 
• Reduces airway swelling and mucus 
• Helps keep asthma well controlled 

Rescue medicine (used when symptoms start) 

• Works quickly to relax airway muscles 
• Helps breathing get better fast 

Your child may take other medicines by mouth, such as montelukast (Singulair), if prescribed. 

Preventing asthma attacks 

To prevent asthma attacks, avoid things that can cause your child’s asthma symptoms. For example, do not allow smoking in your home or car, and do not allow others to smoke around your child.  

Your care team may ask you to keep a record of your child’s symptoms, when they happen, possible triggers, and treatments given. This can help you recognize patterns and make sure your child’s asthma is well controlled.  

Asthma and children with serious illnesses

Some children with serious health conditions may have asthma symptoms that need to be watched closely. 

Childhood cancer 

• Chemotherapy, radiation, or frequent infections can irritate or damage the lungs. 
• Because of this, asthma symptoms may be harder to control. 

Sickle cell disease 

• Children with sickle cell disease may have symptoms, such as wheezing, cough, breathing fast, shortness of breath, and chest pain. 
• Their airways may be more sensitive and react more strongly. 
• Breathing symptoms should be watched closely because they may be an early sign of acute chest syndrome. This pneumonia-like lung complication occurs when sickled cells block blood flow to the lungs. 

Other serious or long-term illnesses

• Some children have weaker immune systems. 
• Viral infections, which are common asthma triggers, may cause more severe symptoms. 
• Even mild breathing symptoms may need to be checked to prevent problems. 

If you have questions or concerns, talk to your health care team.  

Asthma can be managed with the right treatment and by avoiding triggers.  Many people can keep their symptoms under control and prevent attacks.  

Living with asthma

If your child has asthma, they should: 

• Take daily medicines as prescribed. 
• Use rescue medicine when symptoms start. 
• Know and avoid asthma triggers. 
• Work with your care team to create an asthma action plan. 
• Know when symptoms require help. 

To help protect your child’s lungs: 

• Avoid smoking, vaping, and secondhand smoke. 
• Be sure your child washes hands often to prevent infections. 
• Stay up to date on recommended vaccines. 
• Encourage your child to do regular physical activity. 

Most children with asthma can: 

• Play sports 
• Go to school 
• Be active 
• Live full, healthy lives 

When to call your care team

Contact your care team if: 

• Asthma symptoms happen more often than usual. 
• Symptoms are getting worse or lasting longer. 
• Your child needs rescue medicine more often than usual. 
• Rescue medicine does not help or does not last as long as expected. 
• Asthma symptoms wake your child at night. 
• Your child is having trouble keeping up with normal activities. 
• You are worried or unsure about your child’s breathing. 

Your care team can help adjust the treatment plan to better control symptoms.  

Seek medical help right away if your child: 

• Is struggling to breathe 
• Has severe wheezing 
• Cannot speak 
• Has a bluish or gray color of the lips or fingernails 
• Has symptoms that do not improve after using the rescue inhaler.  

Questions to ask your care team

• How can we identify asthma triggers? 
• What is the difference between the daily inhaler and the rescue inhaler? 
• What is the correct way to use each inhaler? 
• When should my child use rescue medicine? 
• How can we keep asthma in the “green zone”? 
• When should we get medical help for symptoms? 
• How often should my child’s asthma be re‑evaluated? 

Find more information

Visit the Asthma Resource Library from the American Lung Association for downloadable resources, including: 

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