A child who coughs at night, who gets out of breath while running in the playground, who breathes with a slight wheeze after a fit of laughter: many parents are familiar with these situations. Childhood asthma affects a significant portion of children and requires daily attention, well beyond just the attacks. Managing this respiratory disease day-to-day involves understanding a few simple mechanisms and establishing concrete reflexes.
Inflammation of the Airways: The Mechanism Parents Underestimate
When a child has an asthma attack, what we see is the difficulty in breathing. What we don’t see is the inflammation that is constantly simmering in their bronchi.
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Imagine a garden hose with its inner wall swollen and irritated. Even when water flows normally, the passage is already narrowed. It only takes a trigger (an allergen, exertion, cold air) for the muscles around the bronchi to contract and further close the passage. That’s the attack.
This chronic inflammation of the airways explains why the maintenance treatment is not limited to days with symptoms. Recent recommendations from GINA (updated 2023-2024) support this: even for asthma considered mild, regular low-dose inhaled corticosteroid treatment significantly reduces severe exacerbations. The old reflex of using a bronchodilator alone on demand is gradually being abandoned.
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A well-managed approach to childhood asthma relies on this distinction between rescue treatment and maintenance treatment. The bronchodilator (like salbutamol) opens the bronchi within minutes. Inhaled corticosteroids, on the other hand, reduce inflammation over time. Both have different roles, and one does not replace the other.
Inhalation Technique in Children: The Gesture That Changes Everything
You may have noticed that a child using their inhaler sometimes doesn’t seem to feel better? The problem often lies in the gesture itself, not the medication.
A poorly used inhaler deposits most of the medication in the mouth or throat instead of the bronchi. For a child under six years old, using a spacer with a face mask is the most reliable method. The principle: the medication is sprayed into a small reservoir, and the child breathes in for several cycles. The product has time to reach the deep airways.
Gesture Verification Points
- Shake the inhaler before each use, then attach it to the spacer. Spray one puff at a time, never two at once
- Keep the mask firmly pressed against the child’s face for five to six calm breaths. If the child is crying, the intake is less effective as breathing becomes irregular
- After using an inhaled corticosteroid, rinse the child’s mouth or have them drink water to limit local effects (irritation, oral thrush)
- Check the spacer every month: a worn valve or poorly positioned seal significantly reduces the device’s effectiveness
A correct inhalation gesture can double the amount of medication that reaches the bronchi. This is probably the most underutilized lever in the daily management of asthma. Asking for a demonstration from the doctor or pharmacist, then practicing it regularly, is part of the follow-up.
Allergens and Triggers of Attacks: Identifying What Really Matters
The classic list of asthma triggers is long: dust mites, pollen, mold, pet dander, tobacco, pollution, cold air, physical exertion, viral infections. Not all carry the same weight for every child.
The most useful approach is not to avoid everything (which is impossible), but to identify your child’s two or three main triggers. A simple tracking notebook, either paper or digital, allows you to note the days with symptoms and the associated circumstances. Within a few weeks, recurring patterns often become clear.
Dust Mites: Measures That Have a Measurable Effect
Dust mites remain the most common indoor allergic trigger. A few targeted actions significantly reduce their presence:
- Use certified dust mite covers for the child’s mattress and pillow. There’s no need to treat all the bedding in the house; focusing the effort on the child’s bed is sufficient
- Wash sheets weekly at a temperature of at least 60 degrees. Below that, dust mites survive the wash
- Maintain a moderate indoor humidity level by airing out daily, even in winter. Dust mites thrive in warm and humid environments
Secondhand smoke, on the other hand, directly worsens airway inflammation. Smoking outside is not enough: particles remain on clothing and hair. This is a delicate issue to address within the family, but its impact on the child’s breathing is documented.
Written Action Plan and Individualized Welcome Project at School
A personalized action plan, written with the doctor, precisely describes what to do according to the intensity of the symptoms. It indicates the medications to use, the doses, and the warning signs that justify a call to emergency services.
This document takes on particular importance at school. In France, the individualized welcome project (PAI) allows supervising adults to administer a bronchodilator in case of an attack, without waiting for a healthcare professional’s intervention. Recent recommendations specify that this PAI should contain a clear diagram for using inhalers, the exact doses, and the criteria for calling emergency services.
In practical terms, preparing the PAI at the beginning of the school year with the primary care physician and the school doctor prevents situations where no one knows what to do in the face of a child in respiratory distress. An up-to-date and accessible PAI changes the responsiveness of the school environment.
Childhood asthma is better managed when every adult around the child (parents, teachers, caregivers) understands the basic mechanism and knows the necessary actions to take. Regular maintenance treatment, verified inhalation technique, identification of specific triggers, and a written action plan form a solid foundation. Regular medical follow-up then allows for dose adjustments and, in many cases, gradual reductions.