Your Child’s Asthma at Different Ages

The National Heart Lung and Blood Institute's National Asthma and Education Program released an updated Expert Panel Report on the Diagnoses and Management of Asthma in 2007. The Expert Panel's new recommendations prescribe different specific medication plans for children ages 0-4, children 5-11, and children 12 and over who have asthma. The medication plans also differ according to the seriousness of their disease, which is divided into 4 classifications:

• Intermittent
• Mild persistent
• Moderate persistent
• Severe persistent

It will be up to your child's health care team to decide upon a course of asthma medication and management based on both their age, and on the severity of their asthma.

Children Age 0-4 Years Old

Children younger than five years can develop asthma. In fact, up to 80% of older children with asthma develop symptoms before they turn 5. Asthma can be hard to diagnose in this age group. Many children are not correctly diagnosed, and receive the wrong therapy.

The most common cause of asthma-like symptoms in children 5 and under is a viral infection of the lungs. Some children outgrow the pattern of viral-associated wheezing while others go on to develop true asthma.

The current government guidelines state that an infant or young child with frequent wheezing — defined as more than 3 episodes in the past year that lasted more than 1 day or affected sleep — is at greater risk of developing asthma if:

• A parent has asthma
• The child has a history of allergic skin rashes
• The child has had 2 of more of the following:
  
  • Allergy with a runny nose
  • An increase in white blood cells
  • Wheezing not associated with a common cold

Treatment for infants and young children with asthma has not been adequately studied. The doctor may try using a bronchodilator, inhaled corticosteroid, or both, to see if symptoms are controlled. Infants and young children who need treatment for symptoms more than twice a week should be given daily anti-inflammatory therapy, preferably with an inhaled corticosteroid.

Children 5-11 years old

The 2007 Expert Panel report strongly recommends that children over years old, and younger when appropriate, should be directly involved in developing their written asthma plans. Children entering puberty may have more trouble than younger children in sticking to a written asthma plan. They may fail to realize the danger of poorly controlled asthma. They may not accept having a chronic illness or see the plan as an imposition on their growing freedom. In teaching these children some of the same self-management techniques as adults, your doctor will help your child address issues such as:

• Building a positive self-image and confidence
• Increasing personal responsibility
• Gaining problem-solving skills

To help accomplish this, your child's health care team may meet with your older child without parents first, in order to involve your child directly in setting therapy goals, choosing treatment and reviewing a personal written asthma plan at each visit.

School issues must be addressed in relation to children of this age, including access to medication during school to treat acute symptoms. Many children who have asthma may cough, wheeze, or experience fatigue when they exercise. Treatment immediately before activity usually prevents exercise-induced asthma. Activity should only be limited or curtailed as a last resort.

Youths 12 years and older

The key points to managing asthma in this age group include:

• Preventing chronic symptoms
• Maintaining near normal lung functions
• Maintaining normal activity levels including exercise and school attendance
• Minimizing the need for emergency visits or hospitalizations
• Preventing reduced lung growth

A stepwise approach to medication is recommended to gain and maintain control of asthma, according to level of severity. Monitoring and followup are considered essential in order to ensure that asthma control is achieved.

As with children ages 10 and over, adolescents should be directly involved in creating goals for therapy and developing an asthma management plan. Active participation in exercise and sports should be promoted. A written asthma management plan should be prepared for the adolescent's school including plans to ensure reliable, prompt access to medication.

Whatever age your child is, once medication therapy is decided upon by your child's health care team, your child's response should be watched carefully. Once asthma symptoms are controlled, a cautious reduction — called a “step-down” — of medications should be attempted to assess further need.