Asthma attacks often get scary very fast. Every year, one in six children with asthma goes to the emergency room or urgent care, and one in 20 gets admitted to the hospital. But severity doesn’t always mean high drama. It can also refer to sickness frequent enough to interfere with your child’s quality of life. Think back and count the number of times you’ve taken your child to his pediatrician this year—not just for coughs but for any illness.
“It may be that each of your child’s coughs seems like just a cold,” says Andrew Weinstein, M.D., who specializes in allergies and immunology at Sidney Kimmel Medical College of Thomas Jefferson University, in Philadelphia. “But if you pay close attention, you can eventually make connections. After about three or four episodes of severe upper respiratory distress in a single year, you can usually suspect asthma.”
When you’re observing your child, take note of specifics—like whether her cough changes with
exercise or active play or when she’s outside in cold air. Does laughing or crying start a coughing fit? Each of these can be a sign that you’re dealing with more than a run-of-the-mill virus.
4. You child has at least one risk factor.
Doctors use a standard set of questions to determine which patients are most likely to develop asthma. The major ones: Does your child have eczema? Does your child have allergies to airborne irritants, like pollen? Does one of your child’s parents have asthma?
Boys are more likely to have asthma. African-American kids are also at higher risk and six times more likely to die from asthma. It’s more common in Hispanic children, too, especially those of Puerto Rican descent. And children exposed to secondhand smoke are more vulnerable and have more frequent and severe attacks. Babies who are born prematurely (before the 37th week of
pregnancy) are more likely to develop asthma as children but also more apt to outgrow it than other kids who have the condition.
5. She fails the medical tests.
To diagnose older children, doctors use lung-function tests. At the doctor’s office, your child will take a deep breath and then exhale forcefully into a mouthpiece that’s connected to a computer. This measures how much air she can inhale and exhale, as well as how much force she uses. Your doctor may also use a smaller low-tech device called a peak-flow meter that assesses exhalations. These tests don’t hurt, but children have to be able to follow instructions in order for the tests to be accurate. Most 6-year-olds are up to it, and some children as young as 4 can be too.
Health-care providers will typically repeat these tests several times, often before and after medication, and compare a child’s scores with those of other children who are a similar weight and height. Low scores mean that airways are blocked and help confirm the asthma diagnosis.
Another clue may come from a trial of medication. Doctors prescribe bronchodilators such as albuterol for many breathing problems, even colds. These “rescue” medications quickly cause your child’s airway to expand and let in more air. But they also play a diagnostic role. When a doctor suspects your child has asthma, he may send her home with a rescue medication to see if using it for a few weeks reduces her symptoms. (Many young children also use a nebulizer—a mask that allows the child to breathe in vaporized air that contains the medication.) Ultimately, if your child is found to have asthma, you can take comfort in knowing that treatment is very effective and she will be coughing a lot less.
