What are the features of asthma?
The reactions we've described lead to the features of asthma. Children with asthma may have these features in any combination — most of the time, or only during an asthma attack.
- wheezing is a high-pitched noise that comes from the chest, usually as the child breathes out
- Chest Tightness, or Shortness of Breath, or Trouble Breathing
What are the symptoms of asthma?
People with "classic" asthma develop cough, wheezing, and/or shortness of breath or chest tightness following exposure to things the individual is allergic to — such as pollens or horses. The majority of people with typical asthma also have these types of symptoms during or after exercise — especially in cold, dry air. However, in many children, the symptoms of asthma are much more subtle.
Asthma with "Colds"
About 90% of asthma attacks in children are triggered by "colds" — upper respiratory tract infections caused by viruses. Colds are even a more common trigger of asthma attacks in children who are under 4 years of age. Recent research has shown that viruses can trigger the same kinds of inflammatory reactions in the lungs of children with asthma that are seen in the lungs of people who are exposed to the things they are allergic to.
Children who have asthma triggered by colds may develop wheezing or trouble breathing, typically 2-3 days after they start having a runny nose. Most affected children will cough more with their colds than children who don't have asthma, and the cough often continues for weeks after the cold has gone away. Like most things in Pediatrics, the cough tends to be worse at night.
The excess mucous production that is part of asthma leads to chest congestion, rather than the nasal congestion that is seen in any child with a cold. Asthma should be considered as a possible diagnosis in any child whose colds always seem to "settle in the chest," who wheezes with colds, or who nearly always coughs for a long time after colds.
Excess mucous production in the bronchial tubes is an important part of asthma. When a doctor listens to the chest with a stethoscope, mucous "rattling around" in the bronchial tubes can produce the same sounds one hears with pneumonia. mucous, clogging up a bronchial tube, can even mimic the appearance of a pneumonia on a chest X-ray. Research studies have shown that many children who are believed to have "recurrent bronchitis" or "recurrent pneumonia" actually have asthma.
Many people believe that all asthmatics wheeze. In fact, quite a few people with asthma never wheeze or have "trouble breathing". In these people, excessive cough is their only symptom of asthma. Doctors call this type of asthma "Cough-Variant Asthma." Children with Cough-Variant Asthma may have a persisting cough at night, cough with exercise, and/or prolonged (or excessive) coughing during and after colds.
Can babies have asthma?
Note that many doctors are uncomfortable diagnosing asthma before the age of 6-12 months. In very young infants, other (sometimes more serious) conditions can cause asthma-like symptoms. If you have a small infant with asthma-like symptoms, your doctor will evaluate him/her for these other conditions.