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FAQ – Asthma in Children: What Parents Should Know
1. What are the most common asthma symptoms in children?
Children may show signs such as persistent cough (especially at night or after physical activity), wheezing, chest tightness (sometimes described as stomach pain), and shortness of breath.
2. When should I take my child to a doctor for asthma?
If your child coughs frequently, wheezes while breathing, or becomes easily short of breath, consult a pediatric pulmonologist for evaluation and testing.
3. What should I do during a suspected asthma attack?
Keep the child calm and seated.
Use the fast-acting relief inhaler immediately.
If symptoms don’t improve, seek emergency medical attention.
Always have a spacer and inhaler on hand at home, school, and when traveling.
4. How can I help my child manage asthma daily?
Administer preventive medication (maintenance inhaler) daily, even when there are no symptoms.
Ensure correct inhaler technique using a spacer.
Monitor and record symptoms in a diary.
Follow the asthma action plan prescribed by your doctor.
FAQ - Asthma in Children second parts
5. What is an asthma action plan and who should have it?
It’s a document created by your pediatric pulmonologist outlining daily treatment, emergency steps, and medication doses. Provide copies to caregivers, school staff, and save a digital version on your phone.
6. What tests can confirm asthma in children aged 5 and up?
Spirometry: Measures airflow and lung function.
Bronchodilation test: Assesses response to reliever medications.
FeNO test: Detects airway inflammation often linked to allergies.
Exercise challenge test: Evaluates lung function post-exertion.
7. Can a child still have asthma if tests are inconclusive?
Yes. If symptoms persist, the doctor may treat for “suspected asthma” and repeat the tests later. Diagnosis is based on a combination of symptoms, history, test results, and treatment response.
8. Why is it important to confirm the diagnosis even if treatment is working?
To avoid unnecessary medication or overtreatment. Confirming asthma ensures your child receives the most appropriate care long-term.
Asthma Testing and Diagnosis in Children: When to Worry and How to Respond
The signs of asthma appear in children who cough, wheeze while breathing, or experience shortness of breath. If these symptoms are present, it is time to consult a pediatric pulmonologist.
How Asthma Symptoms Present in Children and How to Recognize Them
The presence and combination of one or more of these symptoms in your child should prompt you to consult your doctor.
Asthmatic Cough
Coughing is one of the most common asthma symptoms in children. Watch out for the following situations:
Persistent or recurrent cough.
Nighttime or early morning cough, which is frequent in asthmatic children.
Cough that occurs after physical activity or exercise.
Cough triggered by excitement, such as when laughing.
The Wheezing Symptom
A sharp whistling sound typically occurs when the child breathes. Wheezing is not the same as other chest sounds. Sometimes it can be difficult to detect and assess, so if wheezing is suspected during breathing, it’s advisable to consult a doctor, who can confirm its presence by listening with a stethoscope.
Chest Tightness
Children might describe this asthma symptom as a “stomachache,” or they might repeatedly rub their belly or chest.
Shortness of Breath
Observe the child’s breathing rate and listen to their breath sounds. Watch for signs that the child uses much of their body to breathe—for example, lifting and lowering their shoulders. Check if the child becomes breathless while playing or remains breathless longer than normal. Also note if the child avoids activities due to shortness of breath.
Managing Your Child’s Symptoms
Here’s how you can reduce health risks related to asthma symptoms and help your child feel well while waiting for a diagnosis.
What to Do If Your Child Has an Asthma Attack
It’s important to know in advance what to do in case of an asthma attack, especially when the asthma diagnosis hasn’t yet been confirmed. Talk to your pediatric pulmonologist to learn which symptoms to watch for and when to go to the emergency room.
Always Keep the Child’s Inhaler on Hand
The inhaler with fast-acting relief medication must always be available. Keep it in an easy-to-reach place and remember to take it with you when going out with your child, so it’s ready to use if needed. Don’t forget to bring a spacer as well. A spacer helps the child use the inhaler more effectively and ensures quicker delivery of the medication. If the child attends school or daycare, ask to keep a spare inhaler and spacer there too.
Help Your Child Take Their Preventive Inhaler Daily as Prescribed
If your child has been prescribed a maintenance inhaler, use it daily as directed, even if your child appears to be fine. The maintenance inhaler reduces airway inflammation. With daily use, the child should experience fewer or no symptoms and be less reactive to common triggers. If your child is on a “treatment trial,” they must follow the prescription exactly, and you can monitor symptom improvement, which provides useful information to the pediatric pulmonologist in confirming the asthma diagnosis.
Ensure Proper Inhaler Use
How your child uses the inhaler can significantly impact symptom management. Ask the pediatric pulmonologist to show both you and your child the correct way to use the inhaler and spacer. Additionally, using a spacer is especially important if the inhaler is a pressurized metered-dose inhaler (pMDI).
Attend All Medical Appointments
Make the most of your child’s appointments to:
Discuss any symptoms;
Review the medications your child is taking;
Raise any concerns;
Show your child’s symptom diary or log;
Verify that the asthma action plan is up to date.
If you believe your child’s symptoms are worsening or not improving, schedule a visit as soon as possible. Remember to bring the inhaler and spacer to every appointment to check their correct usage.
Following Your Child’s Asthma Action Plan
Your child’s asthma action plan outlines which medications to take daily and what to do in case of symptom flare-ups or an asthma attack.
You can make paper copies or save a digital version on your phone to share with others involved in your child’s care.
It’s also a good idea to review the plan with your child’s teacher and provide them with a copy.
What to Do After Your Child’s Asthma Diagnosis Is Confirmed
To reduce the risk of asthma symptoms, continue your child’s treatment plan.
If the pediatric pulmonologist determines the treatment is working well, your child will likely stay on the current medication. However, sometimes other treatments are needed to help better control symptoms.
Make sure your child attends all regular asthma check-ups to ensure they continue receiving the most effective therapy.
Keeping Your Child’s Asthma Action Plan Updated
The asthma action plan helps you manage your child’s symptoms. It indicates which medications your child should take, how often, and what to do if symptoms worsen.
Remember: the plan must be updated regularly by your pediatric pulmonologist.
Recognizing When Your Child’s Symptoms Are Worsening
It’s important to know your child’s specific signs and symptoms in order to intervene early before things escalate.
Informing the School About Your Child’s Asthma
Make sure the school is aware of your child’s condition and knows what to do if symptoms occur.
You can share your child’s asthma action plan with them.
If your child is at school, it’s advisable to keep a spare inhaler and spacer there as well.
Asthma Diagnostic Tests for Children Aged 5 to 10
Starting at age 5, children can undergo diagnostic tests for asthma because at that age they are generally more cooperative and able to perform the required tests accurately.
However, some children older than 5 may still struggle to perform the tests well enough to yield useful results.
In such cases, there’s no need to worry. The pediatric pulmonologist can continue treating the child for “suspected asthma” based on symptoms and medical history, and schedule the tests for a later date—perhaps after a few months or a year—when the pulmonologist believes they would be more helpful.
4 Frequently Asked Questions About Asthma Tests
Q: Will my child’s “treatment trial” affect the results?
A: Ideally, to get an accurate picture, your child should take the asthma test before starting a preventive inhaler treatment—but this isn’t always possible.
Your child may need to temporarily stop treatment before testing to obtain useful results, because regular preventive medication can improve lung function and mask the test’s diagnostic value.
Q: What will the tests reveal?
Depending on the pediatric pulmonologist’s evaluation, you may be advised to “wait and observe” or your child may receive asthma medication as part of a “treatment trial.”
The waiting period is helpful in determining the likelihood of asthma.
When tests are eventually performed, their results—combined with recorded symptoms, the child’s response to treatment during the waiting period, and their medical history—will help the doctor confirm or rule out asthma.
Here’s what asthma tests can reveal:
Whether your child’s lung function is improving or worsening, and whether it varies day-to-day, between appointments, or due to treatments. Greater variability increases the likelihood of asthma.
Whether your child’s airways are obstructed and how well they respond to asthma medications.
Whether inflammation in the airways is due to an allergy.
Whether the cause might be a condition other than asthma.
A Single Test Is Not Enough to Diagnose Asthma
There is no single definitive test for diagnosing asthma.
The pediatric pulmonologist may need to perform multiple tests—and even then, tests alone are not sufficient for diagnosis.
Symptoms, their frequency, and family history are all key pieces of the diagnostic puzzle.
If the doctor suspects asthma based on symptoms or a trial treatment’s results, they will use specific tests to confirm the hypothesis.
All elements—symptoms, clinical signs, family history, and test outcomes—must come together to confirm your child has asthma.
What Asthma Tests Are Used for Children?
There are three main diagnostic tests used for children over the age of five:
Spirometry with Bronchodilator Testing
Fractional Exhaled Nitric Oxide Test (FeNO)
Exercise Challenge Spirometry Test
If your child is unable to perform the tests well enough to yield valid results, they may continue with a treatment trial and try the tests again in 6 to 12 months.
Spirometry, FeNO Test, and Exercise Challenge: What They Are and How They Work
During the diagnostic process, spirometry is typically the first test performed. It shows whether the child’s airways are blocked or narrowed.
How Spirometry Is Performed in Children
The child breathes into a mouthpiece as quickly, forcefully, and as long as possible.
Spirometry measures how well the lungs function.
If the airways are blocked or narrowed due to asthma-related inflammation, the doctor will then perform another spirometry test after administering a reliever medication, to assess the improvement.
This second test is called the bronchodilation test. If it shows that the airways are less obstructed, it means the child responded to the relief medication and asthma is likely.
What Is the FeNO Test?
Sometimes spirometry results are difficult to interpret due to poor cooperation from the child.
If spirometry is performed correctly and both the initial and bronchodilation tests are normal (i.e., there’s no difference in the airway condition before and after medication), yet asthma is still suspected, the pediatric pulmonologist may request a FeNO test to clarify the diagnosis.
A FeNO test may also be useful when the child’s airways are blocked but didn’t respond to the reliever medication.
The FeNO Test Machine
This test uses a special device to detect airway inflammation.
The child breathes in and out slowly and steadily into the FeNO machine, which measures the level of inflammation.
A positive FeNO test supports the diagnosis of allergic asthma, while a negative result does not completely rule out asthma.
Exercise Challenge Spirometry Test
The preferred method is the treadmill exercise challenge, which better simulates running—a common and natural activity for children—compared to a stationary bike.
The ideal protocol involves a rapid increase in exercise intensity to achieve a high ventilation rate, encouraging the child to breathe through the mouth while using a nose clip.
The entire test lasts between 6 and 8 minutes.
During the first 2 minutes, the operator gradually increases the treadmill’s speed and incline to raise the child’s heart rate to 80–90% of their theoretical maximum, calculated using a specific formula.
Throughout the test, the child’s oxygen saturation and heart rate are closely monitored.
It’s essential that this test is conducted in a controlled, standardized environment with stable temperature (20–22°C)and relative humidity (around 40%), as exercise-induced asthma can be triggered by heat and/or water loss during exertion.
The child first performs a baseline spirometry test, followed by the exercise challenge, then a series of spirometry tests at predetermined intervals.
A significant worsening of spirometry results after the exercise is usually enough to confirm a diagnosis of asthma.
Often, the pediatric pulmonologist may also perform a bronchodilation test afterward to quickly restore lung function or to further confirm the diagnosis.
After the Tests: When Will I Receive My Child’s Asthma Diagnosis?
The time needed to confirm an asthma diagnosis depends on how well your child performs the tests and how they respond to asthma treatments.
The diagnosis will be confirmed once the pediatric pulmonologist has all the necessary elements:
Your child shows intermittent asthma symptoms;
Tests have indicated airway obstruction, but reliever medications have helped;
Tests for allergic asthma return positive (though not all children test positive);
The exercise challenge test, even when the initial spirometry is normal before and after bronchodilator use, reveals a significant drop in lung function.
If the tests still don’t clearly confirm asthma but symptoms persist, the doctor may reassess and repeat testing within six weeks.
Depending on the outcome, if asthma is not confirmed, the pediatric pulmonologist may consider alternative diagnosesand conduct further examinations.
It’s crucial to confirm a diagnosis through testing, rather than relying solely on clinical history.
Even if your child responds well to asthma treatments, testing should still be performed when they’re able to do so—this ensures that your child is not taking asthma medications unnecessarily, or is not receiving more medication than required.
