Is your child coughing a lot – could it be asthma?

Is your child coughing a lot – could it be asthma?

By pediatrician Anette Broen Sandmo

Does your child cough a lot at night, during play or when they have a cold? Do you sometimes hear wheezing or whistling from the chest? Symptoms like these can be caused by asthma – and good treatment is available.

Small children often have colds, and coughing is a natural part of many respiratory infections. But some children cough more than others. Perhaps the cough lasts a long time after every cold, keeps coming back or wakes the child at night. Some parents also notice that the child coughs or becomes short of breath when running and playing.

In that case, there may be reason to examine whether the child has asthma, and if so, to start treatment. The specific goals of asthma treatment are: good control of symptoms, maintaining a normal level of activity and normal sleep, and minimal risk of both asthma attacks and side effects.

How do you notice asthma in children?

Asthma is the most common chronic disease in children and adolescents, and it can present differently from child to child. Typical symptoms may include:

• coughing at night or early in the morning
• prolonged coughing after colds
• the child / adolescent may describe a feeling of not getting enough air
• wheezing or whistling from the chest
• coughing or heavy breathing when running, crying / laughing or during physical activity
• the child tiring more easily or having to stop during play, e.g. on the trampoline. The kindergarten may describe the child as getting more tired than the other children.
• repeated episodes of heavy or laboured breathing

In small children, asthma can be harder to recognise than in older children. They cannot always tell you themselves that breathing feels heavy or that their chest feels tight. Sometimes a prolonged or recurring cough is the first thing parents notice.

The suspicion of asthma becomes stronger if the child also has atopic eczema or allergies.

Does this sound familiar?

How is a child examined for asthma?

As a pediatrician, I start first and foremost with a thorough medical history. The child / adolescent and the parents describe the symptoms. It is helpful to know, among other things, when the cough occurs, what triggers it, how long it lasts, whether the child has had wheezing or heavy breathing, and whether the child has eczema or allergies.

I would then like to know whether anyone in the family has asthma, allergies or eczema – so-called atopic diseases. We know there is a strong genetic component in the development of asthma. In children with asthma, there is usually a cousin, grandparent or sibling who has had or has one of these conditions, but not always.

I examine the child carefully from head to toe and listen to the lungs with a stethoscope. Sometimes you can then hear the classic "asthma wheeze" in the lungs. It is important to know that the lungs may well sound completely normal on the day the child sees the doctor – children with asthma can be symptom-free between episodes.

In older children, from around 5–6 years of age, we can examine lung function with a breathing test, called spirometry. In small children this is more difficult.

The final piece of the puzzle in getting closer to a diagnosis can be to try asthma medication for a period, e.g. 4 weeks. During this period it is helpful to keep a "symptom diary", which we then go through together afterwards to assess whether the child's symptoms have clearly improved.

Asthma can be treated

The most important message to parents is that good treatment is available. I like to say that we don't give up until things are good!

As a pediatrician, I often meet patients and parents who have almost become "too tough"; it has nearly become normal to cough through the night, have a "cold" for 3–4 weeks at a time, sleep half sitting up in a chair, or even cough until you vomit. That is why the joy is great for me, the child and the parents when they come back for a follow-up after starting asthma medication and describe a completely different quality of life.

The goal of treatment is not only to treat acute episodes. A child with well-treated asthma should be able to sleep well at night without being woken by coughing, run and play like other children, take part in activities and have as normal an everyday life as possible, without unnecessary coughing and heavy breathing holding them back.

Asthma medicines are usually given by inhalation. This gives a high concentration of the medicine exactly where we want it – in the lungs – and minimal systemic side effects. In small children, the inhaler is used together with a spacer, often with a mask, so the child can breathe the medicine in calmly.

Some medicines, e.g. Ventoline, work quickly and open the airways when the child has symptoms. Others, e.g. Flutide, are used preventively to reduce inflammation and sensitivity in the airways. In the event of an asthma attack, it is important to have medicine at home and feel confident handling it, and also to know when the child is so unwell that you need to seek emergency care.

In addition to medication, there are other things we can do to achieve the best possible asthma control: investigate pet or pollen allergies where necessary, assess air quality, make sure the child is in a smoke-free environment, and make an individual assessment of the child's surroundings.

When should the child be seen by a doctor?

It may be a good idea to get an assessment if the child:

• coughs a lot or repeatedly, especially at night
• has a cough that keeps coming back or lasts a long time
• gets wheezing or whistling in the chest
• coughs or becomes short of breath during physical activity or play
• repeatedly becomes very congested in connection with colds
• has eczema or allergies in addition to respiratory symptoms
• has parents or siblings with asthma or pronounced allergies
• already uses asthma medication but still has a lot of symptoms. We can then go one step up the treatment ladder and try a different medicine.

It is not certain that the child has asthma. But if coughing or heavy breathing keeps affecting sleep, play or the family's everyday life, I think there is good reason to look into it more closely.

Many children have a recurring cough for a long time before the cause is found. If asthma is suspected, an assessment by a pediatrician can help clarify the symptoms and find out whether the child needs treatment.

Have questions about your child's cough, or want an assessment?

Anette Broen Sandmo
Specialist in Pediatrics