Asthma, a chronic lung disease that affects more than seven million children under the age of 18, occurs when lung inflammation causes the airways to narrow, triggering symptoms including wheezing, breathlessness, tightening in the chest and coughing. A variety of environmental irritants and allergens — cigarette smoke, pets, dust mites, mold, air pollution and respiratory infections — may cause symptoms.

Asthma symptoms often affect a child’s quality of life, disrupting sleep, resulting in missed school days and affecting ability to participate in sports and other activities. Occasionally, asthma results in hospitalizations and may even be fatal.

Appropriate asthma diagnosis and treatment hinges on a clinician’s ability to recognize the disorder’s signs and symptoms. Clinicians should keep in mind pediatric symptoms may differ from those observed in adults, Norman Edelman, MD, chief medical officer for the American Lung Association told Clinical Advisor.

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“Children may not experience the standard wheezing typically seen in adults, but instead may experience coughing or disrupted sleep,” Edelman said. “Sometimes kids experience tightening in the chest, but won’t be able to describe the sensation. They might just appear anxious.”

Another sign is inability to keep up with peers in games that involve exercise. But confirming a pediatric asthma diagnosis can be challenging, as some young children develop wheezy bronchitis in response to infection, which typically resolves as the child’s lungs increase in size. Symptom and family history are important during diagnosis, as well as spirometry to assess pulmonary function.

Diagnosis & treatment

Asthma is typically under-diagnosed, as many clinicians may hesitate to commit to a diagnosis, Derek Johnson, MD, a pediatric allergist in Fairfax, Va., said. But accurately recognizing asthma is critical to providing proper treatment, which should be comprehensive and involve many facets, including environmental management, treatment and planning.

The first step after a patient is diagnosed is identifying asthma triggers. “Asthma is often triggered by environmental causes, so clinicians should determine what a child is reacting to in order to prevent attacks. Consider referring patients to an allergist at least once for testing and evaluation,” Johnson recommended.

Clinicians should also encourage parents to advocate for necessary changes at school, such as removing potential asthma triggers like pet hamsters from classrooms, Edelman said. The American Lung Association offers many tools and resources on it’s website to help parents facilitate asthma-friendly environments in school settings.

In addition to focusing on environmental triggers, clinicians should treat other conditions that may worsen asthma, such as chronic sinusitis or acid reflux.

Overcoming medication hesitation

Although National Heart Lung and Blood Institute guidelines recommend inhaled corticosteroids and combination treatment for patients with asthma, pediatricians sometimes hesitate to prescribe these medications even when a patient’s asthma is poorly controlled, due to concerns about adverse effects.

“While clinicians should always weigh risks of medication against the benefits, avoiding medication may deny patients the opportunity to get their asthma under control,” Johnson said.

Additionally, clinicians should take time to explain to patients and parents how the medications work to alleviate potential concerns. “When parents hear the word steroid, many conjure up images of bulked-up athletes,” according to Johnson. “In fact, an inhaled steroid is more akin to steroid cream that they might buy in a drugstore to treat a rash.”