A Unique Child - Health: A guide to ... asthma

Q: What is asthma?

Asthma is a condition that affects the airways - the small tubes that carry air in and out of the lungs. Children with asthma are sensitive to some substances (called asthma triggers) which irritate their airways, causing the muscle around the walls of the airways to tighten so that they become narrower. The lining of the airway swells and produces sticky mucus. As the airways narrow, it becomes difficult for the air to move in and out. When this happens a child will have asthma symptoms.

Q: How does it affect young children?

Asthma is one of the most common long-term childhood conditions in the UK. The latest figures suggest that it affects over a million children in the UK, so it's likely that a child in your care will have asthma.

The typical symptoms of asthma in young children are:

- cough or wheeze, particularly during the night or after exercise

- a cough that will not go away and keeps coming back

- difficulty in breathing and feeling breathless

- feeling tight in the chest - bear in mind that sometimes younger children will express this sensation as a tummy ache

- feeling tired, not running around as much as usual.

Every child's asthma is different. Some children will experience an occasional cough or wheeze, while for others the symptoms are more severe. Children with asthma will also have different triggers (the things that set their asthma off), and most will have several. Common triggers in children include:

- viral infections (colds or flu)

- exercise

- sudden changes in temperature and weather

- emotions

- allergies (eg to pollen, animals, house-dust mites, moulds)

- irritants (eg cold air, tobacco smoke, chemical fumes).

Q: What causes asthma?

It's difficult to say for sure what causes asthma, but we do know that a child is more likely to develop asthma if there is a family history of asthma, eczema or allergies. There is also strong evidence that children whose parents smoke are more likely to develop asthma, and smoking during pregnancy significantly increases the risk of a child developing asthma.

Other theories on the cause of asthma say it may be related to environmental factors and aspects of modern lifestyle such as housing, diet and a more hygienic environment.

Q: How is asthma treated?

There are two main kinds of asthma treatment that may be prescribed. They are called relievers and preventers.

Reliever Inhalers Everyone with asthma should have a reliever inhaler (usually blue). Relievers are medicines that children can take immediately when asthma symptoms appear. They quickly relax the muscles surrounding the narrowed airways (within five to ten minutes), making it easier to breathe again.

Preventer Inhalers Preventers protect the lining of the airways. They help to calm down the swelling in the airways and stop them from being so sensitive. This means that the child is less likely to react badly when they come into contact with an asthma trigger. The protective effect of preventer treatments builds up over a period of time, so it is important that they are taken every day, usually morning and evening, even if the child is feeling well. Preventer treatments will not relieve sudden attacks of wheezing or breathlessness.

Most children under five need to use a spacer to help them take their inhaler more effectively. Spacers make inhalers easier to use and ensure that the child gets the correct amount of medicine into the lungs.

Spacers are large plastic devices, shaped a bit like a plastic bottle. At one end there is a mouthpiece and at the other a hole for the inhaler to fit in. If the child is under three they will probably use a face mask.

Q: How should practitioners care for a child with asthma?

Many problems encountered at school or nursery regarding asthma can be avoided if the establishment has an asthma policy that sets out the school's or nursery's commitment to meeting the needs of children with asthma. A good asthma policy will ensure that staff receive training about asthma and are confident in recognising asthma symptoms and giving reliever medication. It will also provide advice on making the environment as safe as possible for children with asthma.

Additionally, having a pre-school asthma card will help to record all the information that a pre-school setting will need about a particular child's asthma. It is sent to the child's parents or carers to be filled out with their child's doctor or asthma nurse, and will include written information on the child's symptoms, triggers, medicines and emergency contact details. It also gives further information on what to do in the event of an attack.

If a child has an asthma attack or needs their inhaler while in your care, it is good practice to always inform the person collecting the child.

FURTHER INFORMATION

If you would like to know more about caring for children with asthma in a nursery or school setting, contact Asthma UK for a copy of our pre-school guidelines or school resource pack on 0800 121 62 55. For more information visit asthma.org.uk