My Child’s Asthma is not Getting Controlled

What do you understand by a “Good Asthma Control”?

A good asthma control means that you child should not be having symptoms because of the asthma.There should be no cough during the day and night, no cough/breathlessness with exercise and no night time symptoms.

Why is a Good Control required?

Good control is the aim of all asthma control programs. When the asthma is well controlled the allergic swelling inside the airways would be very low or absent. This would lead to three very important things:

  • A good symptom control (as described above).
  • A “normal” lung function test.
  • Would reduce the risk of having future asthma attacks.

Is there any simple way to know whether my child’s asthma is well controlled?

The simple way to understand this concept if by answering a few questions:

  • Does your child have asthma symptoms during the day more than twice per week?
  • Does your child have asthma symptoms during the night more than twice per month?
  • Is your child using their rescue inhaler more than twice per week?
  • Is your child having difficulty with exercise because of their asthma i.e cough or breathing difficulty?
  • Is your child having attacks of asthma more than once a year especially requiring oral steroids?
  • Is you child’s Lung Function testing normal?

It should be remembered that ALL of the above should be met to label a child as “Well controlled” . If the answer to any of above is “YES” then the asthma is uncontrolled or partially controlled.

My child’s asthma is not getting controlled despite all medicines my doctor has advised?

This is the commonest Pediatric Respiratory referral!! The reasons for a poor control of asthma will have to be identified step-wise.

  • The common reasons are: wrong diagnosis (may be having some other diagnosis, NOT ASTHMA), problems with the dose and delivery of the medicine, incorrect technique of inhalers,  associated problems like a sinusitis, allergic nose, etc.
  • The evaluation would start with a detailed case history and examining the child. The child might also need a few basic investigations like a Lung Function Test, X-rays of the chest, sinuses, neck, etc.
  • In “My Experience” most children would settle down with appropriate management of the things mentioned above.
  • Very rarely a child may not respond to the usual medicines . These child might need further investigations and offered other treatment like anti-allergic medicines like Omalizumab etc.

Once controlled will the asthma always remain under control?

This is a very important question which parents would ask me and a difficult question to answer too.

The inflammation tends to be controlled well with the asthma medicines. Usually it would settle down over time which is variable but might take a year or longer depending on the severity in a particular child. Some children hence might need inhalers for a longer time (might be a few years in severe cases) for keeping inflammation under control. Thereafter it might remain well controlled and the child may not need any inhalers again. Although it is very difficult to say that it would not reappear again.

Can the inflammation and symptoms reappear again?

Allergic disorders may not go completely. The inflammation in the airways is variable and sometimes can appear again and can lead to a loss of control. 10-20 % children might need their preventive inhalers again.

Related Link: What are the benefits of Asthma Control? Children Hospital of Philadelphia.