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Your need-to-know on childhood asthma


11 Dec 2017

The UK has one of the highest rates of asthma symptoms in children. So how can pharmacists support these families? Dr Andy Whittamore shares the key advice.

Asthma is a long-term condition that affects the airways. A person with asthma has sensitive airways that are inflamed and will react when they meet a trigger, such as cold and flu viruses, pollen, pollution – including cigarette smoke – and house dust mites. Such a trigger will set off a chain of events: the muscles around the walls of the airways tighten, the lining also becomes inflamed and starts to narrow, and sometimes mucus builds up, narrowing the airways even more.

The UK has among the highest prevalence rates of asthma symptoms in children worldwide.[1] Around 1.1 million children under the age of 12 have the condition, which equates to one in every 11 children,[2] and a child is admitted to hospital every 20 minutes because of an asthma attack.[3] It’s difficult to say what causes asthma, and the causes vary from child to child. But evidence suggests that children are more likely to get asthma if:

  • They were born early (premature), especially if they needed help with their breathing.
  • They had a low birth weight.
  • Their mother smoked during pregnancy.
  • They also have eczema or allergies.
  • There is a family history of asthma, eczema, hayfever or other allergies (known as ‘atopy’).
  • They are exposed to secondhand cigarette smoke or pollution.
  • They have had repeated bouts of bronchiolitis or croup as a baby or toddler.[4]

Getting a diagnosis can take time

Although most children develop asthma symptoms under the age of five,[5] it’s quite hard to diagnose because many of the tests we use aren’t suitable for young children.

Also the typical symptoms – wheezing, coughing, difficulty breathing and a tight and sore feeling in the chest – are like other conditions, such as croup and colds.

As a pharmacist, you may find parents that ask for your help are upset or frustrated by not getting a firm diagnosis. Often the term ‘suspected asthma’ is used, meaning that the child will be given asthma medicines to see if they help reduce the symptoms although the diagnosis hasn’t been confirmed.[6] They will be regularly assessed to see whether the medication is being used often and correctly, whether it is having an effect and to address any concerns about the treatment or the diagnostic process in general.[7]

You may be asked by parents how their child will be diagnosed with asthma. You can explain that the GP will need to consider many factors, such as the history of the child’s symptoms (for example, pattern, triggers and response to medication), risk factors (family history of asthma or allergies), and examine them for alternative diagnoses. GPs also use tests – spirometry, FeNO and peak flow readings – to confirm the hypothesis.[8]

Child symptoms may not be typical

One difficulty is that children’s symptoms don’t always fit into neat categories. Not every child with asthma will wheeze and they may use different words to describe their symptoms because they find them challenging to articulate.

Asthma UK has done a lot of work with parents of children with asthma and has identified signs that asthma symptoms have flared up. Their child might:

  • Go quiet.
  • Complain of a tummy ache.
  • Go off their food.
  • Say that their ribs ache.
  • Seem more tired than usual.
  • Become very active.
  • Seem distracted.
  • Not want to do their usual activities.
  • Cry more than usual.
  • Become clingy.
  • Seek attention.
  • Have a very slight wheezing (so you can only hear a sound when you press your ear to their chest).

Good self-care is vital

Asthma is a condition that differs from person to person, but there are some important steps a sufferer can take to manage their asthma and stay well.

  • Taking medicines as prescribed to reduce that inflammation and sensitivity to reduce the chance of getting symptoms.[9]
  • Attending regular asthma reviews with a GP or asthma nurse. Children should have their asthma reviewed every six months.[10]
  • Using a written asthma action plan and sharing it with their friends, family and school — evidence shows people are four times less likely to be admitted to hospital if they follow one.[11]

Parents and children should also get into a daily routine to manage their asthma: for example, making sure they always have their reliever inhaler (usually blue) with them.

It’s not possible to avoid all triggers but people can take steps to manage some of them better, such as taking antihistamines during pollen season and avoiding busy roads on high pollution days. Also, making sure the school, grandparents or childminders are aware of the asthma and know what to in the event of worsening symptoms is a good tip.

Despite all the preventative steps, they are still many challenges. For example, a study by the Asthma UK Centre for Applied

Research found that many teenagers with asthma are embarrassed to use their inhalers even though they could prevent life-threatening asthma attacks.[12] 

Asthma attacks rarely come out of the blue

There are often warning signs days or even weeks before an asthma attack occurs.[13] This is why encouraging people to pay attention to ongoing symptoms is so crucial.

You should encourage a child with asthma to get an urgent appointment with their GP or asthma nurse if they need to use their reliever inhaler three or more times a week, they are feeling out of breath,[14] are waking at night due to their asthma or struggling with daily activities. Getting help could reduce the risk of them having a potentially fatal attack.

Signs to look out for:

  • Their reliever inhaler isn’t helping (it should last for at least four hours), and/or;
  • They can’t talk or walk easily and/or;
  • They are waking at night due to their asthma and/or;
  • They are breathing hard and fast and/or;
  • They are coughing or wheezing a lot and/or;
  • They complain of a tummy ache or a chest ache.[15]

If a child is having an asthma attack, the advice is to:

  • Help them sit up and keep calm.
  • Help them take one inhaler puff every 30 to 60 seconds – they can take up to 10 puffs.
  • Call 999 for an ambulance if either their symptoms are getting worse, they don’t feel better after 10 puffs or you’re worried at any time.
  • Repeat step two if the ambulance is taking longer than 15 minutes.

Always call 999 immediately if the child doesn’t have a reliever inhaler with them.

Even if the child’s symptoms improve after using their reliever inhaler, they will still need an urgent same-day GP appointment.

How a pharmacist can help a child’s asthma care

Every contact with a healthcare professional is a chance to monitor a child’s asthma.

Increase asthma understanding

Asthma UK’s study on teenagers found that some didn’t feel supported by their parents, as they didn’t understand the impact of an asthma diagnosis.[16] You can help parents and children increase their understanding of asthma, including emphasising that it is a chronic condition that needs daily treatment and stressing the importance of them following their written asthma action plan.

Explain asthma medicines

It is often hard for parents and carers to understand an asthma diagnosis and they will have lots of questions and worries about the medicines their child needs to take and the side effects they might cause.

You can help them understand what each medicine does, how to use it and when. This will reinforce all the good selfmanagement

messages they receive from their GP or asthma nurse. If you have been trained in inhaler technique, you can check the child’s inhaler technique to help them get the most of their medicines.

Dr Andy Whittamore is Asthma UK’s in-house GP and clinical lead. He is a practising GP in Hampshire and specialises in respiratory care and sits on the Executive Committee of the Primary Care Respiratory Society UK

For more information on asthma in children, check out Asthma UK’s online advice www.asthma.org.uk/advice/child You can also call the Asthma UK Helpline to speak to expert asthma nurse specialist on 0300 222 5800 (Monday to Friday, 9am to 5pm)

References:

 

  1. The Global Asthma Report 2014. Auckland, New Zealand: Global Asthma Network, 2014.
  2. Health survey for England, 2001; Scottish Health survey, 2003; Welsh Health survey, 2005/06; Northern Ireland Health and Wellbeing survey, 2005/06. Data accessed via UK Data Service.
  3. Asthma emergency admissions. Data via requests to NHS Digital (England), ISD Scotland, NHS Wales, Department of Health (Northern Ireland)
  4. NHS Choices, Asthma Causes, 2016, http://www.nhs.uk/Conditions/Asthma/Pages/Causes.aspx
  5. BTS SIGN Guidelines, 2016, p14, https://www.brit-thoracic.org.uk/standards-of-care/guidelines/btssign-british-guideline-on-the-management-of-asthma/
  6. BTS SIGN Guidelines, 2016, p79, https://www.brit-thoracic.org.uk/standards-of-care/guidelines/btssign-british-guideline-on-the-management-of-asthma/
  7. BTS SIGN Guidelines, 2016, pg29, https://www.brit-thoracic.org.uk/standards-of-care/guidelines/btssign-british-guideline-on-the-management-of-asthma/
  8. BTS SIGN Guidelines, 2016, pg29 & 30, https://www.brit-thoracic.org.uk/standards-of-care/guidelines/btssign-british-guideline-on-the-management-of-asthma/
  9. NHS Choices, Asthma treatment, page 2 http://www.nhs.uk/Conditions/asthma/Pages/treatment.aspx
  10. BTS SIGN Guidelines 2014, page 31 https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2014/
  11. Thorax, 2000, Robert J Adams, Brian J Smith, Richard E Ruffin http://thorax.bmj.com/content/55/7/566.full
  12. De SimoniA, Horne R, Fleming L, et al What do adolescents with asthma really think about adherence to inhalers? Insights from a qualitative analysis of a UK online forum. BMJ Open 2017;7: doi: 10.1136/bmjopen-2016-015245 http://bmjopen.bmj.com/content/7/6/e015245
  13. J Allergy Clin Immunol 2008;122:741-7, http://www.jacionline.org/article/S0091-6749(08)01552-2/pdf
  14. NHS Choices Asthma – treatment, page 1 http://www.nhs.uk/Conditions/asthma/Pages/treatment.aspx
  15. NHS Choices, Live Well, Astham Attack – What to do nhs.uk/Livewell/asthma/Pages/Asthmaattacks.aspx
  16. De SimoniA, Horne R, Fleming L, et al What do adolescents with asthma really think about adherence to inhalers? Insights from a qualitative analysis of a UK online forum. BMJ Open 2017;7: doi: 10.1136/bmjopen-2016-015245

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