Coughing and wheezing — Symptoms of asthma in children include coughing and wheezing. The cough is usually dry and hacking and is most noticeable while the child sleeps and during early morning hours. It may also be triggered by exercise. Wheezing is a high-pitched noise that is usually heard when the child breathes out.

Coughing and wheezing tends to come and go during the day or night, depending upon the degree of airway narrowing in the lungs. Breathlessness, chest tightness or pressure, and chest pain may also occur. In addition to coughing or wheezing, a child may report that their chest or stomach hurts.

Asthma symptoms often develop in children before five years of age, although it is sometimes difficult to diagnose asthma in infants and toddlers.

Asthma triggers — Wheezing and coughing may occur at any time, but certain triggers are known to worsen asthma in many children.

Environmental conditions — In children with seasonal allergies, asthma symptoms may worsen during certain pollen seasons; trees pollinate in early spring, grasses in the late spring and summer, and weeds in the summer and fall. Symptoms can also flare as a result of mold growth (eg, during rainy seasons or in damp areas). Cold air, changes in barometric pressure, rain, or wind may cause increased asthma symptoms in certain people.

Upper respiratory infections — Viral upper respiratory infections (head and chest colds) are a common trigger of asthma in infants and young children. The most common viral infections include rhinovirus (the virus that causes most colds), respiratory syncytial virus, and influenza virus. (See “Patient information: The common cold in children” and “Patient information: Bronchiolitis in infants and children”.)

Children with asthma should use their asthma treatments for cough and chest congestion rather than over-the-counter cold remedies.

Exercise — Narrowing of the airways can be triggered by exercise. This is called exercise-induced asthma (also called exercise-induced bronchoconstriction or EIB). Breathlessness, wheeze, and/or cough usually occur within five to ten minutes of the cool-down period after vigorous exercise. These symptoms tend to disappear after 20 to 45 minutes. Certain types of exercise (eg, swimming) are less likely to cause exercise-induced asthma than others (eg, running, skating), probably because they produce less airway cooling and drying. Short bursts of activity tend to be better tolerated than prolonged exercise. (See “Patient information: Exercise-induced asthma”.)

Allergens — Indoor and outdoor allergens are an important trigger of childhood asthma, particularly for children older than three years of age. These include:

House dust (ie, dust mites, cockroaches, mice droppings), particularly during vacuuming
Animal exposures; cats and dogs are especially provocative but other furry animals (gerbils, rabbits, hamsters, etc) may be suspect, particularly if symptoms only occur in settings where these animals reside
Pollens
Molds
Indoor pollutants (eg, paint, perfume, space heaters, gas stoves, room deodorizers)
If allergies are a possible cause of symptoms, skin or blood testing may be recommended. This can help to both identify triggers and determine the necessity of avoiding these triggers at home.

Symptom patterns — Children with chronic asthma may have one of several distinct patterns of symptoms:

Intermittent asthma attacks with no symptoms between attacks
Chronic symptoms with intermittent worsening
Attacks that become more severe or frequent over time
Morning “dipping”, when symptoms worsen in the morning and improve as the day progresses
Symptoms that begin during upper respiratory tract infections (eg, colds) and linger for several weeks after, with resolution during warmer weather.
Most asthma attacks develop slowly over a period of several days. Uncommonly, a severe attack can occur suddenly and with minimal warning.

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