Dr. Lucy Ansell is a Medical Director at The Linbury Doctors, and she’s on hand to share her expert advice on children and asthma. Wondering when your child’s cough is something to worry about? Read on to find out.
What is Asthma?
Asthma is a chronic disease of the airways. These airways become swollen, narrow and inflamed. The degree and severity of airway inflammation varies over time and exposure to triggers. Children with asthma may also be sensitive to colds and other viral infections, cold air, allergens in the environment, pollution and even sometimes certain foods and drink. Ongoing exposures to these substances will not only worsen asthma symptoms but also continue to aggravate airway inflammation. Inflammation of the airways causes them to be oversensitive and often called “hyperreactive.” When the airways are hyperreactive, they can go into spasms, causing blockage and symptoms of wheezing, chest tightness, and shortness of breath. Around one million children in the UK are receiving asthma treatment
As a GP, one of the most common child consultations I do is for a chronic cough in an otherwise well child. Even as a health professional it has been difficult to see the wood from the trees lately with COVID-19 thrown into the mix. There are some key questions I always ask that may help identify the asthmatic child.
Symptoms of childhood asthma
- Does the child have days or weeks where they don’t cough?
- Is the cough throughout the day or worse in the morning and at night?
- Is the cough worse during or after exercise?
- Do they wheeze?
- When you compare your child to others do they seem to be out of breath sooner and longer than their friends of similar ages?
- Do they ever look like they are shrugging their shoulders or using their tummy when breathing?
- Is the cough dry or productive of phlegm?
- Does the child have any other allergies, eczema or hay fever?
- Do the parents have asthma, eczema or hay fever?
This is not an extensive list but builds the basics of the decision-making process. Often Asthma will run in families and occur in children with other allergic tendencies. It normally presents as a mostly dry cough which is worse in the morning and throughout the night and particularly worse during and after exercise, where the child will take longer to recover and have to stop sooner than peers.
What should I do if I suspect my child has asthma?
Asthma can be a difficult diagnosis, especially in children under five. I always ask my patients to keep a symptom diary documenting coughing and wheezing episodes with a date, time, and activity at the time or not, if they were inside or outside and how long it lasted. This can often help identify triggers like activity, pet hair and exhaust fumes. Some parents have shown me voice recordings of their child coughing in the night or videos of them after activity wheezy. This can be invaluable as more often than not when I see them they examine entirely normally
What happens if my doctor suspects my child has asthma?
In an ideal world, all children would be ‘tested’ for asthma, but this is not always possible and wouldn’t be offered for a child under five. The first step is normally to offer a trial of treatment if asthma is suspected. If your child has quite sporadic attacks, then this is likely in the form of a reliever inhaler that is to be used as and when coughing or wheezing is an issue. If your child has a continuous chronic dry cough, this may be the form of a preventer inhaler. This is used every day regularly. Both types of inhalers are often given via a spacer to make it easier for the child to use the inhaler and to get the maximal benefit. Normally a review would take place after around six weeks and if the symptoms have improved then a diagnosis may be made. In older children sometimes more formal lung function testing or peak flow monitoring is done during the diagnosis phase.
A lot of children with mild asthma will have a reliever inhaler to use as and when they need it. If the asthma is not controlled by this, then the child will have two inhalers; a daily preventer with a reliever to use as and when its needed. In asthma induced by allergies commonly a chewable tablet called montelukast (singular) is added to the inhaler regime.
Article by Dr. Lucy Ansell.
Dr Lucy Ansell is a Medical Director at The Linbury Doctors. The Linbury Doctors is a members-only private GP service that provides 7 days a week bespoke family medicine to members in the Cotswolds, Gloucestershire, Oxfordshire, Warwickshire, Worcestershire and Wiltshire. More information can be found at www.linburydoctors.co.uk or by calling 0330507338.