3 things you might not know about childhood asthma

Claire McCarthy, MD

Senior Faculty Editor, Harvard Health Publishing

Follow me on Twitter @drClaire

Asthma is one of most common chronic diseases of childhood; almost 9% of children in the United States suffer from it. And yet I find it’s a disease that lots of people don’t understand — even parents of children with asthma.

Lungs are made up of lots of little tubes that lead into bigger tubes; they look almost like sponges. In asthma, the tubes get irritated and narrowed, making it hard for air to get in and out. Lots of different things can cause that irritation, such as allergies, cold air, chemicals in the air, exercise, the common cold, or even stress.

As a pediatrician, I see children with asthma almost every day — and have lots of conversations with their families. Over the years, I’ve found that there are lots of misunderstandings about asthma, and those misunderstandings can cause real problems for children with asthma.

Here are three things you might not know about childhood asthma.

1. The symptoms can come and go

Many times, I’ve had parents tell me that their child doesn’t have asthma because they hardly ever wheeze. It’s certainly possible — common, even — to have some wheezing with a bad cold or lung infection and not have asthma. But if that has happened a couple of times or more, then we generally call that asthma.

It’s understandable to want to dodge the diagnosis — who wants their child to have a chronic disease? But it’s actually really helpful to make the diagnosis, because that way we can be watchful and figure out what triggers a child’s symptoms. Once we know the triggers, and know the signs that an asthma attack is beginning, there is so much we can do to help the child. We can avoid triggers, like by staying away from cats, or doing lots of hand washing to avoid illness. We can manage the triggers, like by wearing a scarf over the mouth and nose in cold weather, or by using an inhaler before vigorous exercise. We can be sure they get a flu shot, as influenza can make children with asthma very sick.

The goal is always to help children with asthma lead the healthiest, most normal lives possible. We can’t even begin to do that if we don’t make the diagnosis.

2. You can have asthma without hearing a wheeze

The wheeze is often not at all obvious; you may need a stethoscope and trained ears to hear it. Also, some children with asthma don’t wheeze at all: they just cough. Coughing is the main symptom of asthma in most children. It’s how the body tries to get and keep those airway tubes open.

Now, of course there are plenty of other reasons that children might cough. The common cold and postnasal drip from allergies are the most common. But if your child coughs often at night or after exercise, has a frequent nagging dry cough, or gets a really bad, lingering cough with colds, you should talk to your doctor because it could be asthma.

3. Asthma is really treatable

As I said above, what we most want is for children with asthma to lead healthy, normal lives. And here’s the thing: we can make that happen. Not only can we work to avoid and manage triggers, and not only can we use medications to relieve the symptoms; there are medications we can use that can prevent them. A steroid inhaler or other preventative medication, used every day or during periods when asthma is worse or might get worse, can make all the difference. While some parents get nervous about using steroids, the dose is very low — and while some families find daily medications challenging, there are all sorts of strategies to make it work. It’s worth it. For some children, preventative medication can be the difference between wheezing all the time and not wheezing at all.

Which, you have to admit, is pretty great. So if your child has asthma, or you think they might have asthma, talk to your doctor and get your child started on the healthy, happy life they deserve.


  1. Justine

    My grandson. Gets asthma without the wheeze and has been officially diagnosed with this condition yet still the ambulance officers and emergency dept. question my daughter when she says it is an asthma attack as they can’t hear a wheeze. His is virally induced and always follows if he gets a cold. He is now on a preventative medication but still carries his ventolin everywhere. He is 4 and has had this since 2 years old. He has gone from 12 trips in the ambulance in six months down to 2 in Six months.

  2. Bryan

    My daughter’s asthma is triggered mainly by viruses. It took over a year to figure out why a simple cold would turn into pneumonia or an asthma attack. Very scary. Way too many trips to the emergency room and under dire circumstances. Colds would trigger asthma, which would cause her to breathe short rapid breaths through her mouth, which would dehydrate her, which caused her fever and heart rate to skyrocket. Total downward spiral that took only a day or so. The diagnosis along with an action plan and a medicine regiment including maintenance doses of corticosteroids and at times albuterol have helped us greatly. The corticosteroids do have side effects and we’ve tried several different types and dosages to try and balance the mood swings and effects vs her sustained health.

  3. Tracy

    Glad you mentioned “seasonal” use of inhaled corticosteroids since the general rule that it must be daily and forever “even if you’re feeling well” doesn’t seem to be true and results in overmedicating both children and adults. While it’s true that these are “small” doses with “few” side effects, that’s really a comparison to oral steroids. Even lose dose inhaled steroids have a measurable systemic effect.

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