Could my child have asthma?

Asthma is a common long-term condition in children worldwide, causing wheezing, coughing, trouble breathing, and a tight feeling in the chest. 

Find out all about asthma, including its causes, triggers, and how to tell it apart from less serious respiratory issues.

Understanding childhood asthma

“In children, asthma is mostly allergic in origin and closely linked to other respiratory allergies, like hay fever,” says Dr Pieter de Waal, a paediatric asthma and allergy specialist at Mediclinic Panorama. “A strong family history of a first-degree relative with asthma is the most reliable predictor of possible asthma in the offspring.”

But what exactly happens in the airways of asthma sufferers? “Allergic inflammation in the smaller airways is the most important cause for asthma symptoms,” Dr de Waal explains. “Inflammation causes the airways to become ‘twitchy’ and leads to closing of the airways – also known as bronchospasm – during an acute asthma attack. This closing of the airways leads to a longstanding cough and the wheezing sound from the chest, commonly reported by asthmatic sufferers. Thick mucus production due to allergic inflammation is another hallmark of asthma.”

While childhood asthma cannot be cured, with symptoms possibly continuing into adulthood, proactive treatment improves one’s prognosis. Yet predicting whether a particular child will outgrow asthma is difficult, says Dr de Waal. “Longstanding, uncontrolled and untreated asthma symptoms, and the frequency and severity of asthma attacks, are all predictors of a smaller chance of outgrowing asthma.”

“Yet most children, if their asthma is diagnosed early and treated effectively, will have fewer asthma symptoms – and may even outgrow their asthma – as they get older,” he adds. “It is, however, important to remember that asthma can recur at any stage, even in adulthood and even if you haven’t had asthma symptoms for many years.”

What causes asthma in children?

When it comes to asthma, it’s often all in the family. “Genetic susceptibility – the presence of a first-degree relative with asthma – is the most common risk factor for asthma,” says Dr de Waal. “Other allergic disorders, for example, eczema, hay fever and food allergies, also increase a child’s risk of suffering from allergic asthma.”

Other external factors are also instrumental in increasing one’s asthma risk, he adds. “Air pollution, especially in children growing up next to busy streets and areas with high traffic emissions, have also been shown to increase one’s risk for asthma.”

According to Dr de Waal, asthma triggers, stimuli or factors that exacerbate asthma symptoms by increasing airflow disruption, commonly include:

• Viral airway infections, for example, cold and flu
• Contact with a known inhaled allergen like pollen from grasses, weeds and trees; house dust mite; and moulds
• Exercise
• Cigarette smoking exposure and vaping
• Emotional upsets and stress

Crying and laughing can sometimes even act as triggers in an asthma patient.

Symptoms of childhood asthma

“Symptoms may vary from day to day and asthma symptoms may be absent for long periods before suddenly presenting as an acute asthma attack,” Dr de Waal cautions. “Common symptoms include distinct episodes of a dry, ongoing cough; audible chest wheezing; and waking up at night due to a troublesome cough or difficulty in breathing.”

Those with exercise-induced asthma commonly complain of reduced exercise tolerance and shortness of breath during physical activity or exertion. Other allergic conditions, such as eczema and hay fever, may be accompanying allergic conditions.

Differentiating between asthma and respiratory infection

While certain respiratory infections may cause alarm as symptoms may be similar to what’s experienced by asthma sufferers, there are ways to distinguish between them. “Although a respiratory infection may trigger asthma and may present with the same symptoms, clear distinguishing features of an airway infection may be reported,” Dr de Waal explains. “These include a fever, sore throat, body pains and aches, headaches due to sinus congestion, and a runny nose.”

“On the other hand, asthma symptoms, like coughing, chest wheezing and shortness of breath, usually occur in isolation, in an otherwise healthy patient,” he says. Because respiratory infections are highly contagious, if the patient is exposed to a friend or family member with respiratory infection, and then suddenly falls ill, this points to a respiratory infection rather than asthma.