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Updated asthma guidelines and how they affect kids

A young girl holds her hands to her chest and breathes in during an asthma doctor's appointment.

In terms of updating asthma guidelines, not much has changed in over 13 years – until recently. With the recent 2020 National Institutes of Health (NIH) report, there’s a new way to help children who have asthma, and it may impact how your child is treating their asthma now.

Asthma guidelines updated

For years, The Global Initiative for Asthma (GINA) has published an annual update focusing on the asthma population worldwide. These annual updates did not have much impact or announce drastic changes in treatment plans for kids with asthma. Now, after the NIH report was released, we are seeing a major shift in treatment plan recommendations. You may have already heard about the new guidelines at your pediatrician’s office, but if not here is the latest information.

 

Old guidelines

New guidelines

Asthma types

  • Symptoms less than 2x a week are considered mild or intermittent.
  • Symptoms more than 3x a week or more are moderate to severe.
  • Both the frequency of symptoms and lung function are now considered together when categorizing asthma types.

Inhalers

  • Use 2 different types of inhalers regularly – maintenance and rescue.
  • One inhaler is a maintenance inhaler to take every day (1x or 2x a day depending on asthma type.) The second is a rescue inhaler to use as needed if you are short of breath which acts fast but doesn’t help long-term.
  • In some patients, one inhaler can be used for maintenance & rescue.
  • Children should use their maintenance inhaler daily (1x or 2x a day depending on asthma type), but also use the same maintenance inhaler as a rescue inhaler.  

Impacts of the updated asthma guidelines for kids and parents

  • Easier to manage inhalers. In patients who can use one inhaler for maintenance & rescue, there is less confusion about which inhaler to use daily and in case of emergency.
  • May come with insurance issues. These new guidelines are not yet FDA-approved. So, insurance may not cover more than one of the maintenance inhalers. If it’s now recommended to use only 1 type of inhaler, you may end up using more of it up for rescue situations and then needing more of the maintenance inhaler than you previously needed.

It’s so important to communicate with your child’s pediatrician to find the best solution for your needs. The whole goal here is to help your child prevent asthma attacks. Speak to your provider about which strategy will work best for your family.

What is asthma?

Asthma is when the air in the lungs doesn’t move the way it should. People with asthma have a harder time getting air through their lungs when breathing in and out. An asthma attack is when triggers like exercise, cigarette smoke, and allergies irritate the airways, leading the airways to fill with mucus and the muscles around the airways tighten up. 

Based on the new guidelines, the names of the types of asthma remain the same – mild, moderate and severe. Which type your child has will now be determined by how often they are experiencing asthma symptoms, but also how their lungs work.

Asthma is a chronic disease in childhood that affects the way you breathe. Meaning if diagnosed, most likely the person will have asthma for their entire life. There is no cure, but by managing asthma with steroid inhalers and avoiding triggers an asthmatic person can live a life just like anyone else.

What causes asthma?

Asthma is somewhat a mystery when it comes to what causes it, but we do know it can be a mix of genetics and environmental factors. So, if someone in your family has asthma, you are more likely to have asthma yourself. Environmental factors could mean poor air quality, tobacco or vaping smoke exposure, chemicals, fumes or pollution.

Who can get asthma?

We know 1 in 2 kids will wheeze at least once in their lifetime. So, 50% of all kids will wheeze once in their lifetime. Wheezing is caused by a viral infection, but not all kids who wheeze will go on to develop asthma. You can develop asthma at any time. Typically, when we see asthma in kids, we see it in 2 groups.  The first is preschool asthma - kids who have asthma symptoms before the age of 6.  The other is persistent asthma - kids who have asthma symptoms beyond the age of 6.

Symptoms of asthma in kids

The most common symptoms of asthma are:

  • Cough.
  • Wheeze – a whistling sound when breathing.
  • Chest tightness.
  • Trouble breathing or shortness of breath.
  • A fast heartbeat.

What are common asthma triggers to watch out for?

  • Cigarette or vaping smoke.
  • Air pollution like car exhaust fumes and smog.
  • Dust, pollen and mold.
  • Pet dander from things like cat hair and dog saliva.
  • Exercise.
  • Weather changes.
  • Dust mites in carpets and drapes.
  • Cold, flu and other respiratory illnesses.

How do asthma inhalers work?

Inhalers are small devices that deliver medication through the mouth. It helps take liquid medicine and turn it into a mist to breathe in. The medicine will help to open the lungs and remove mucus making it hard to breathe. They're used to both treat asthma and help prevent asthma attacks.

Some parents often have questions about growth with inhalers. Inhalers with steroids do not stunt a child’s growth. In studies, we have seen a 1-centimeter growth delay, but then the growth is caught up over time.

How is asthma diagnosed in children?

Asthma is diagnosed by a doctor. The doctor will ask about your child’s symptoms, medical history, family history and do a physical examination. Tests like blowing into a spirometer to measure airflow or and chest X-ray may be needed.

Helping kids manage their asthma symptoms

Parents play a huge role in helping to prevent and treat asthma in kids. Here are a few things you can do as a family.

  • Have regular check-ups with your child’s doctor to make sure your child is on the right medication. Adjustments may be needed and are common.
  • Have an asthma action plan. This plan is typically written by your pediatrician or asthma specialist.
  • Understand your child’s asthma triggers and try to avoid them as much as possible.
  • Keep track of how your child is using the inhaler in rescue situations so you can notice any increases and talk to your doctor about getting asthma under control.

The biggest misconception about asthma

Your child should be able to breathe. Normally. Without restriction.

The goal of asthma management is for your child to live a normal life. Meaning asthma is not a limitation for your child in any way. They should be able to participate in any sport they want to without having to sit out, sit down or struggle to breathe. They should be able to play and be able to do any activity they want to do without any limitation. If asthma is standing in the way of anything they want to do, the asthma is not under control and a doctor’s help may be needed.

They should be able to be a kid in all aspects, even with asthma, and live life like anyone else.

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Telemedicine, Pediatric Pulmonology

Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine

Pulmonology

Clinical Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Education Assistant Professor of Pediatrics, University of Kansas School of Medicine