We've had lots of requests coming through lately for more info on asthma, so we've written this blog in the hopes it will help. 

what is asthma?

Asthma is a condition that affects the lower airways in the lungs that causes difficulty breathing in and, in particular, breathing out. Inside the lungs, there are small airways called bronchioles, which contain muscle. Asthma occurs when these bronchioles, which are normally open and relaxed, become contracted, start spasming or become filled with mucous after being exposed to a trigger. As a result, the air flowing in and out of the airways is restricted, making it harder to breathe. 

what triggers asthma?

Asthma can be triggered by one or multiple things. What may trigger asthma in one little one may differ from what triggers asthma in another little one. Asthma could be triggered by: 

-  Exercise [exercise induced asthma] 

- Stress + extreme emotional responses 

- Smoke [such as cigarette smoke, bushfire smoke + bonfire smoke] 

- Weather [such as cold air, changes in air temperature + thunderstorms] 

- Being unwell with a respiratory infection or virus 

- Allergies [such as food, dust mites + pets] 

- Medications [which is why some asthmatics can't take Non-Steroidal Anti-Inflammatory Drugs, like ibuprofen]

symptoms of asthma

Asthma may come slowly and last hours, days or even weeks, or it may also be quick. Symptoms that present may depend on the severity of asthma occurring, ranging from mild to life-threatening.  

 Mild- moderate asthma symptoms: 

-  Coughing 

- Wheezing [a high pitched sound heard when breathing out] 

- Some difficulty breathing 

 Severe asthma symptoms: 

-  Coughing [but not always] 

- Wheezing [but not always] 

- Obvious difficulty breathing and respiratory distress 

- Unable to say a sentence without taking more than one breath 

- Needing to use a Salbutamol [Ventolin] puffer again within 3 hours of previously using it 

 Life-threatening asthma symptoms: 

- Severe respiratory distress 

- Gasping for air 

- Colour changes 

- Drowsiness 

- Unable to speak 

- No longer coughing or wheezing due to fatigue from trying so hard to breathe [not always] 

- Confusion 

- Collapse

what is an asthma attack?

 An asthma attack is a sudden onset of severe or life-threatening asthma symptoms. You can have an asthma episode of mild-moderate symptoms without it progressing to an asthma attack, and this is usually known as an asthma flare-up. This is when you experience an increase or worsening of asthma symptoms compared to what you usually do every day.

identifying respiratory distress  

 Respiratory distress is when your little one is working harder to breathe than normal. You may see: 

-  Changes to skin colour [pale, cool, clammy, bluish tinge] 

- Changes to breathing [faster, slower or noisy] 

- Changes to conscious state [dazed, confused, altered or unconscious] 

- Changes to breathing effort [sucking in around ribs, base of the throat + bottom of the chest] 

- Little ones putting themselves in a sniffing position or doing a head bob

treatment of asthma

When a little one [or anyone at all] is diagnosed with asthma, they will be given an asthma action plan, which outlines the steps they need to take to treat and manage their/ their bub's asthma. When bub goes to daycare or school, it's important you give them a copy of this action plan in case asthma begins while they're there.  

Asthma is treated and managed using short term and long term medications that are breathed in. A short term medication is Salbutamol [sold as Ventolin or Asthmol], which works to relax the smooth muscles in the lower airways, and help everything open back up again, therefore reversing asthma symptoms within minutes. During an asthma episode, your bub may need to take their puffer every 2-4 hours until the initial episode has settled. They may need to then take their puffer 3-4 times a day until any coughing or wheezing has stopped completely. No matter what you do or where you go, always take your little one's Ventolin and spacer.  

Long term medications involve using a preventer each day, which is made up of a type of corticosteroid, to help minimise asthma symptoms occurring in the first place. This may be in tablet form or breathed in. 

As each action plan is personalised, you should always follow the steps outlined by the asthma action plan. In general, they will advise treatment involves: 

-  DRSABCD assessment 

- 1 puff of Salbutamol [Ventolin or Asthmol]; 4 breaths + repeat this 4 times 

- Wait 4 minutes and repeat if there is no improvement  

- Always use a spacer [+ face masks for little ones] 

- Call 000 if asthma symptoms are life-threatening, asthma symptoms are severe in kids, Salbutamol isn't improving asthma symptoms after the second lot of 4 Ventolin puffs, or you're unsure + concerned

using a spacer + face mask

If your little one has ever had to use a puffer, you've probably used the mask and spacer. Using a spacer and mask means your little one inhales more of the medication into their lungs where it's most needed. If you're spraying it into their mouth without using a spacer, most of that medication is probably going to end up on their tongue or at the back of their throat. Spacers should always be used by anyone having an asthma attack. Younger bubs will need a mask that covers their mouth and nose, whilst kiddies over five years may be able to use the spacer alone with their mouth on the end piece. If your little one is required to use one, you shouldn't be sent home without an asthma action plan and a Nurse teaching you how to use it and care for it, but in case you've forgotten, to use your face mask, spacer + inhaler medication: 

1.  Remove the cap from the puffer, check the expiry date and shake it well.  

2. Pop the puffer onto the hole in the spacer and the mask onto the other end. 

3. Prime your spacer by pressing down onto the inhaler medication until one puff of medication comes out. 

4. Place the mask over your little one's mouth and nose, aiming for a good seal so that no air can get in. If your little one is using a spacer without a mask, pop the mouthpiece of the spacer in their mouth, and ask them to close their lips around the mouthpiece to create a seal. 

5. If compliant, get your little one to sit upright and breathe out gently while you hold the spacer and puffer level. In younger bubs, it may be best to lie them down ideally with another adult to hold them. 

6. Press the puffer once to release a dose of the medication into the spacer, and get bub to breathe in as quickly as possible after the medication is released.  

7. Allow bub to breathe in and out four times, leaving the mask in place. 

8. Shake the puffer before spraying again, remembering it can be shaken while still attached to the spacer.  

9. For every puff required, repeat the process of one puff; four breaths. You can shake bub's puffer while it is still attached to the spacer if required. 

10. Clean your spacer and mask at least once a month in warm water and a little dish soap. Avoid rinsing, and allow to air dry. 

 If you dry the spacer with a paper towel or cloth, it can cause static to accumulate inside the spacer, causing the medication to stick to the sides. 

why use a spacer instead of a nebuliser?

A nebuliser is a machine that transforms liquid medication into vapour to breathe in. Research tells us that correctly using a puffer + spacer together works equally as good as using a nebuliser for treating asthma, including during asthma attacks. Spacers can be easily transported, cost less and are more easily accessible when out and about, making it easier to seek treatment for asthma symptoms.

why may asthma be worse in winter?

There are a few reasons.  

-  Cold air can cause the body to produce more mucous 

- Breathing in cold air irritates the lungs 

- Cold air is dryer in winter, which can cause further irritation 

- We typically spent more time inside and in enclosed spaces with others in winter 

- There is usually an increase in the amount of colds + viruses people catch in winter 

- Exercising outdoors in cold weather delivers cold air rapidly to the lungs, leading to further irritation

reactive airway disease

Wheezing while unwell with a virus is very common in little ones, particularly before their 2nd birthday, partly because their airways are so small in comparison to adult airways. In fact, as many as 30% of little ones will have a wheezing episode before 3, and over 50% will have more than 1 episode. Over 60% of kiddies will grow out of wheezing by the time they've turned 6. When little ones experience a wheeze, it's often called Reactive Airway Disease, a Preschool Wheeze or a Viral Induced Wheeze. Only 1 in 5 kiddies will go on to be diagnosed with asthma during childhood, but it is something you can grow out of.  

 Wheezing in little ones is referred to as these names because there's limited evidence that wheezing while unwell in little ones occurs in the same way as asthma in older kids + grown-ups. It's also because wheezing in kids is so common, is often associated with viruses alone [there are no other asthma symptoms outside of being unwell] and is usually outgrown by the age of 6. Because of these reasons, getting an asthma diagnosis before the age of 6 can be tricky.  

 If a bub has a history of allergies or eczema, their mama has asthma, or their wheezing only begins after they're 18mo, they are more likely to receive an asthma diagnosis. So if you suspect asthma, chat to your GP or Paediatrician. 

 I hope this helps our Tiny Hearts tribe better understand asthma. In the original post on Instagram and Facebook, tag your parent tribe, leave any questions you've got and let me know; did your little one experiencing wheezing under age 6? 

 Helping you feel prepared for parenthood is what Tiny Hearts is all about. Book into our baby + child first aid class, and let us empower you to face parenthood without fear. 💗