Asthma

Asthma and Wheeze

What is wheeze? Wheeze is one of the main symptoms of asthma, but it also happens in other conditions that are not asthma. It can happen at any age. It is whistling sound caused by narrowing of the airways (breathing tubes). This can sometimes only be heard through a stethoscope. It has many causes including viral infections. If you cannot hear a wheeze, noticing that your child is working hard to breathe can be a useful sign of airway narrowing.

Well-controlled asthma: Having asthma or wheeze doesn’t mean your breathing will always be a problem. If you use your medicines as prescribed you can breathe easily all the time.

Poorly-controlled asthma: When things are not under control, the breathing tubes become inflamed (red, sore, swollen and sensitive). They will also make more mucus and twitch more, meaning you might cough.

Asthma attack: The inside of the airway is so red, sore and swollen that air gets trapped, and can’t get in and out easily. Air will squeeze through, making a wheezing (whistling) sound. There is much more mucus than before which adds to the feeling of chest tightness.

What good asthma looks like - NHS Shropshire, Telford and Wrekin Asthma Nurses

BeatAsthma - How to explain asthma to a young person

Who can help with my child's asthma?

There are lots of health professionals that can help and advise you with your child’s asthma, these include:

• Your child’s GP and Practice Nurse
• School Nurse
• They may be under the care of the Respiratory Team at the hospital
• Managing my child's asthma - Beat Asthma
• Asthma and Lung UK

What are the signs of an asthma attack?

An asthma attack happens when your child's asthma symptoms get much worse. This can happen quite suddenly or can build up gradually over a few days.

If your child’s having an asthma attack, they might:

• find it hard to breathe
• breathe more quickly
• be unable to talk or walk or eat
• wheeze and cough a lot
• complain of a tight chest or a tummy ache
• say their reliever inhaler is not helping, or they need it more than usual

What do I do if my child is having an asthma attack and when do I need to get help?

"An asthma attack can be a life-threatening emergency. Getting the right help when your child needs it is vital to make sure your child is treated quickly and remains safe. Never think you are wasting anyone’s time." - Laura Scott – Children’s Community Asthma Nurse Specialist

Follow your child’s asthma action plan if they are experiencing symptoms, this will have a green, amber and red section and guides you on how much reliever inhaler to use and when you need to seek urgent medical review.

Asthma Management Plan - NHS Shropshire, Telford and Wrekin Asthma Nurses

Asthma & Lung UK: Asthma Action Plans

When should I be concerned?

Call 999 if your child’s reliever inhaler is not helping, or you’re worried at any time.

While you wait for an ambulance, you can help your child use their reliever inhaler again:

• one puff every 30 to 60 seconds, up to 10 puffs if they use a blue reliever inhaler
• one puff every 1 to 3 minutes, up to a total of 6 puffs if they use a MART inhaler.

If their symptoms are not better, and the ambulance has not arrived, contact 999 again.

What do I do after my child’s asthma attack?

See your child’s GP or asthma nurse for an urgent follow up

Everyone who has an asthma attack should have a follow up appointment with their GP or asthma nurse. Even if your child seems better, take them to their follow-up appointment. This is important for their recovery and to lower their risk of another attack.

If you dealt with your child’s asthma attack at home, make an urgent same day appointment with your GP or asthma nurse.

If your child’s asthma attack was treated in hospital, make an appointment to see their GP or asthma nurse within two working days.

You should talk to your child’s GP or asthma nurse about:

• how long they need to take medicines like steroid tablets (prednisolone) for if they were given these
• changing your child’s regular asthma medicines if needed
• making sure your child is using their inhaler and spacer correctly. Click here to see how to use your inhaler and spacer.
• updating your child’s asthma action plan.

How do I know if my child is using their inhaler correctly?

There are different types of inhalers, some inhalers must be used with a spacer device – these are known as metered dose inhalers, and some can be used directly into your child’s mouth – these are known as dry powder inhalers. It is important that you are aware of which inhaler your child has and how they need to use this to ensure they receive their medication.

• Reliever Inhaler and Spacer Devices - NHS Shropshire, Telford and Wrekin Asthma Nurses
• Asthma & Lung UK: How to use your inhaler

How will I know if my child’s inhaler has run out?

Your child's inhaler will have a certain number of doses/puffs per inhaler, this is usually 120 or 200 doses dependant on which type of inhaler your child has. It is really important that you keep track of the puffs your child has had as the inhaler can run out of medication and this may not be obvious - most inhalers can still appear to have medicine in them even when they have run out. Please see this chart below to help guide you.

How can I tell if my inhaler is empty

When should my child's asthma be reviewed?

Your child's asthma should be reviewed on a regular basis by your GP or Practice Nurse, this should be at least once a year and more frequently if your child is experiencing any uncontrolled asthma symptoms - these could include:

• Symptoms on exercise when well - cough/wheeze/chest tightness/shortness of breath
• A dry night time cough 1 night per week or more when they are well
• Your child is using their salbutamol inhaler more than 3 times a week to manage any asthma symptoms.
• Contact your doctor, nurse or other healthcare professional if you are using a MART (Maintenance and Reliever Therapy) inhaler and:

1. You need to use the maximum daily dose of your MART inhaler and your symptoms are not improving or
2. You’re regularly using extra doses of your MART inhaler most days for weeks (as advised by your healthcare professional) or
3. You’re worried about your asthma

If your child experiences an asthma attack, they should be reviewed by their GP or Practice Nurse within 2 days after the attack.

If your child's asthma medication is changed, your GP or Practice Nurse should arrange to review this to check if the change has been effective.

How will my child’s asthma be looked after at school/childcare setting?

Your child’s asthma should be managed at school through a plan involving you, your child, school staff and any relevant healthcare providers. The staff at your child's school should have completed training to enable them to care for your child with asthma. If the school have any questions or concerns you can signpost them to this free nationally recognised training, school staff only need to complete Tier 1 level - https://www.e-lfh.org.uk/programmes/children-and-young-peoples-asthma/

• Your child should always have available to them in school a salbutamol inhaler (EMERGENCY/RELIEVER INHALER) and an appropriate spacer device, if they are an older child and have been prescribed a MART inhaler they should have access to this.
• Your child should have an asthma action plan in school - Asthma Management Plan - NHS Shropshire, Telford and Wrekin Asthma Nurses
• Asthma & Lung UK: Asthma Action Plans
• Asthma & Lung UK: Asthma at School and Nursery
• Some schools are recognised as "Asthma Friendly Schools" - please discuss with your school for further information.

How does the air quality affect my child’s asthma?

Air pollution harms everybody, but it’s especially harmful if you have asthma. Around two-thirds of people with asthma report that poor air quality makes their asthma worse, putting them at risk of an asthma attack.

Air pollution can irritate your airways. It can also make your asthma symptoms like coughing, wheezing, breathlessness and chest tightness worse. This means you may need to use your reliever inhaler more.

Beat Asthma Air Pollution
Top Tips Air Pollution