Severe Asthma in Children: Symptoms, Common Triggers, and Treatment
What is asthma?
Asthma is a chronic (long lasting) lung condition. It involves increased mucus and swelling that causes inflammation and narrowing in the airways. This results in difficulty breathing and can often interfere with physical activity. The classic symptoms of asthma include wheezing, coughing, chest tightness, and breathlessness.
When does asthma occur and what triggers it?
Asthma symptoms are often caused by some triggers. The reason why only some individuals respond to triggers is not well understood. Common triggers may include:
- physical exertion
- environmental allergens such as pollens (trees, grasses, and ragweed/weeds), dust mites, mold, pets and pet dander, cockroaches and mice
- pollutants or irritants in the air such as cigarette smoke
- respiratory infections such as cold or flu
Are there different types or levels of asthma?
There are different levels of asthma -- mild, moderate, or severe. The level is determined by whether it is controlled or uncontrolled, how often asthma symptoms occur, if symptoms worsen or increase, and the results of breathing function tests.
What are the symptoms of severe asthma and how does it differ from mild to moderate asthma?
Severe asthma in children is different from mild to moderate asthma. Medications commonly used to treat asthma may not work or have reduced effect on alleviating symptoms.
Severe asthma symptoms in children:
- can be more intense than mild to moderate asthma, with persistent cough, shortness of breath, and chest tightness or discomfort
- occur more frequently – multiple times a day to near continuously throughout the day
- are difficult to control, even with high dosages and multiple medications
- cause limitations to physical exertion daily
Is severe asthma life threatening?
Severe asthma can absolutely be life threatening if:
- asthma symptoms are not controlled
- individuals with asthma do not take or adhere to asthma medications properly
- patients or caregivers do not have a clear understanding of the condition and its symptoms
- the patient does not follow up with health care providers
- patients do not seek medical treatment for increased or worsening asthma
Who is at risk?
While anyone can develop asthma, some individuals are at higher risk, especially those who:
- have a family history of allergies, asthma, or eczema
- are exposed to environmental triggers such as allergens or irritants (pollution or smoking)
- experience respiratory infections
How is asthma treated?
Asthma is treated with long-term (chronic) medications that prevent asthma symptoms. Inhaled asthma controllers are considered the cornerstone of asthma treatment. There are also “rescue” or short acting medications that are used as needed to quickly relieve symptoms during an asthma attack. In children with severe asthma, these medications often may not work.
Children may need to take medications for their respiratory allergies if asthma symptoms are triggered by environmental allergens. Also, it is essential to address any triggers in the child’s environment, such as pets or smoking.
Children with severe asthma can be treated with personalized targeted therapy based on their individual needs. This occurs in the form of add-on therapy if their asthma symptoms are not controlled enough by their long-term asthma inhaler. These targeted therapies are helpful in treating daily symptoms and reducing the frequency of exacerbations.
Can asthma be cured?
No, unfortunately asthma is a lifelong condition. The good news is it can be treated and well controlled with treatments. Most children with asthma that is well controlled can live a normal life with little to no symptoms or limitations.
Does asthma worsen or improve with age?
The effects of the natural aging process on symptoms of asthma can be hard to predict. Some children with asthma get better during the teen years. Other children may have asthma symptoms that appear to subside but may come back later in life.
Can children with severe asthma participate in sports and other activities?
Children with severe asthma may participate in physical activities when their asthma symptoms are controlled. Children with asthma may need to take their asthma inhalers to school and have an asthma action plan at school and home to address any asthma attacks that may occur. Parents should work with their child’s health providers and school staff to meet the child's asthma treatment goals.
If you think your child has asthma
If your child is showing signs and symptoms of asthma, discuss it with your child’s medical provider. Early diagnosis is important for controlling symptoms and helping your child to participate in desired activities.
If you think your child has severe asthma, ask your child’s provider for a referral to an asthma specialist. Our team can help provide a personalized targeted therapy for your child, so your child can be happy and healthy. Learn more about our pediatric asthma, allergy, and immunology clinic and our pediatric severe asthma clinic.
About the Author:
Daniella Teape, MD, and Tao Zheng, MD
Dr. Daniella Teape is a board-certified pediatrician and a pediatric pulmonologist at Hasbro Children's Hospital, caring for children with a variety of respiratory issues including asthma, bronchopulmonary dysplasia, and primary ciliary dyskinesia.
Dr. Tao Zheng is a board-certified allergist and clinical immunologist in pediatrics and internal medicine at Hasbro Children’s and Rhode Island hospitals