Your Child's Asthma: Flare-Ups

When your child has asthma, the airways in their lungs are swollen (inflamed). This narrows the airways, making it hard to breathe. During an asthma flare-up (asthma attack), the lining of the airways swells even more and makes extra mucus. This makes the airways even narrower. The muscles around the airways also tighten. This makes it even harder for air to get in and out of the lungs.

What causes flare-ups?

Flare-ups occur when the airways in a child with asthma react to a trigger. Triggers are things that make asthma worse. They can include smoke, odors, chemicals, medicines, pollen from grass and weeds, pet dander, mold, cockroach droppings, and house dust mites. Other things can also trigger a flare-up. These include exercise, times of high stress, having a cold or the flu, and changes in the weather. It's very important to help your child develop strategies to stay away from triggers that cause asthma flare-ups or symptoms.

What are the symptoms of a flare-up?

Your child is having a flare-up if they have any of the following:

• Trouble breathing

• Breathing faster than usual

• Wheezing, a whistling noise when breathing out

• Feeling tightness or pain in the chest

• Coughing, especially at night

• Trouble sleeping

• Getting tired or out of breath easily

• Having trouble talking

What to do during a flare-up

When your child is starting to have symptoms, don’t wait! Follow your child’s Asthma Action Plan. It should tell you exactly what symptoms signal a flare-up in your child. It should also tell you what to do. This may include having your child do the following:

• Use quick-relief (rescue) medicine. Quick-relief medicines ease your child’s breathing right away. Make sure your child uses the inhaler the right way. Refer to the manufacturer's information that came with your child's medicine. Or talk with your child's healthcare provider if you have any questions about how to use the device, such as a metered-dose inhaler or nebulizer.

• Measure your child's peak flow if you use peak flow monitoring. If peak flow is less than 50% of personal best, your child’s flare-up is severe. You need to call your child’s healthcare provider right away. You should also call 911 if your child is having any of the symptoms listed in the box below.

• Learn how to monitor your child's asthma. Some people watch for early changes in symptoms getting worse. Some use a peak flow meter. Write down your child's asthma symptoms and peak flow readings in a diary.

Call 911

Call 911 right away if your child has any of the following symptoms. They could mean your child is having severe problems breathing.

• Very fast or hard breathing

• Sinking in between the ribs and above and below the breastbone (chest retractions)

• Trouble walking or talking

• Feeling faint, lightheaded, or dizzy

• Lips or fingers turning blue, gray, or purple

• Peak flow reading less than 50% of personal best

• Not acting as normal or seems confused

• Not responding to asthma treatments

• Having feelings of doom

• Not conscious or unable to wake up

Preventing symptoms and flare-ups from getting worse

To help manage asthma, you should help your child with the following:

• Work together with your child’s healthcare provider. Managing asthma takes teamwork. Keep all appointments with your child's healthcare provider. Don’t just make an appointment when your child has a flare-up. Follow your child's Asthma Action Plan.

• Talk with your child's healthcare provider if your child doesn't have an Asthma Action Plan or if the plan is not up to date.

• Use controller medicines as instructed. Make sure your child uses their long-term controller medicines. These may include corticosteroids and other anti-inflammatory medicines. A child with asthma can have inflamed airways any time, not just when they have symptoms. Controller medicines must be taken regularly as directed, even when your child feels well.

• Identify and manage flare-ups right away. Learn to recognize your child’s early symptoms and to act quickly. Start quick-relief medicines as instructed if your child begins to have symptoms of a respiratory infection and respiratory infections trigger their symptoms.

• Encourage your child to ask the provider questions about asthma during office visits. This will help give them a sense of control and responsibility for their health.

• Teach your child to recognize and treat their own symptoms if they are old enough. This will help them successfully manage the condition as they get older. Ask your provider what's appropriate for your child's age.

• Control triggers. Helping your child stay away from things that cause asthma symptoms is another important way to control asthma. Once you know the triggers, take steps to control them. For example, if someone in your household smokes, they should quit. Many excellent stop-smoking programs and medicines can help. Also don't allow anyone to smoke near your child, including in your home and car.

• Practice proper handwashing. Wash your hands and your child's hands often with soap and water. Use hand sanitizer when you or your child can’t wash your hands. Have your child stay away from crowds during cold and flu season.

• Help your child stay at a healthy weight. Being overweight can affect how well your child's asthma is controlled. Work with your child's healthcare provider to find out the best weight for your child.

• Don’t be afraid to exercise. Exercise may make your child short of breath. But exercise can strengthen breathing muscles. It can also give your child more energy. Walking is a good way to get oxygen moving through your child's body. Ask your child's healthcare provider about safe exercises.

• Eat a healthy diet. Provide a diet high in fruits and vegetables for your child.

• Do breathing exercises. Ask your child's healthcare provider about breathing exercises for your child. Teaching your child belly breathing and pursed-lip breathing may help your child breathe better. Taking slow, deep breaths at any time can give your child more of the oxygen they need. Ask your child's healthcare provider about the breathing exercise that is the best treatment for your child.