What Happens During an Asthma Flare-Up?

Asthma (say: AZ-muh) is a condition that affects a person's airways, which are also called breathing tubes or bronchial (say: BRONG-kee-ul) tubes. These tubes lead from the windpipe, or trachea (say: TRAY-kee-uh), into the lungs.

For most kids, breathing is simple: They breathe in through their noses or mouths and the air goes into the windpipe. From there, it travels through the airways and into the lungs. But for kids with asthma, breathing can be a lot more difficult because their airways are very sensitive.

An asthma flare-up, which some people call an asthma attack or episode, happens when a person's airways get swollen and narrower and it becomes a lot harder for air to get in and out of the lungs. Sometimes the swollen airways produce extra mucus, which makes things pretty sticky, so it's easy to see why it's hard to breathe.

In between flare-ups, a kid's breathing can be totally normal or seem that way. But during a flare-up, it can feel like the person is breathing through a straw. A kid with asthma may wheeze (a whistling sound when he or she breathes), cough, and feel tightness in the chest.

An asthma flare-up can get worse and worse if a kid doesn't use asthma medicine. After an asthma flare-up, the airways almost always return to the way they were before, although it can take several days.

Who Gets Asthma?

Asthma is more common than you might think. As many as 7 million kids in the United States have it. Asthma affects about 1 or 2 kids out of 10. That means if you have 20 kids in your class, 2-4 of them might have asthma. Asthma can start at any age — even in a little baby or an adult — but it's most common in school-age kids.

No one really knows why one person's airways are more sensitive than another person's, but we do know that asthma runs in families. That means if a kid has asthma, he or she may also have a parent, sibling, uncle, or other relative who has asthma or had it as a child.

Asthma flare-ups may sound a little like a cold, with coughing and wheezing, but asthma isn't contagious. You can't catch it from someone like you can catch a cold.

What Causes an Asthma Flare-Up?

Different kids have different triggers — things that set off asthma flare-ups. There are a lot of triggers. Some kids are sensitive to allergens (say: AL-ur-jenz), substances that cause allergic reactions in the airways. Common allergens for kids with asthma include:

A lot of kids have asthma flare-ups when they are near furry animals. Cats and dogs both have what's called animal dander in their fur. This is sort of like dandruff, and it's a trigger that can cause a powerful reaction in the airways.

Some substances can trigger flare-ups because they really irritate the airways. These include perfume, chalk dust, and cigarette smoke. Smoking is always a bad idea, especially around someone who has asthma.

Sometimes an infection can be a trigger and set off an asthma flare-up. If a kid comes down with a cold or the flu, his or her airways may become more sensitive than usual. In some kids, cold air itself can cause an asthma flare-up, and so can exercise. In fact, some kids have what's called exercise-induced asthma. This means they have breathing problems mainly when they exercise.

How Is Asthma Treated?

Kids who have asthma should try to avoid things that can cause their airways to tighten. But some triggers — like cats, colds, and chalk dust — can't always be avoided. That's why kids who are sensitive to those things must manage their asthma by taking medication.

Not every kid's asthma is the same, so there are different medicines for treating it. It's not like curing a sore throat or an earache, when everybody gets the same medicine. Instead, the doctor will think about what causes the asthma flare-ups, how fast the flare-ups happen, and how serious they are. Then he or she will decide on the best kind of treatment.

Some kids need to take an asthma medicine only once in a while, when they have a flare-up. This is called quick-relief medicine (also called rescue or fast-acting medicine) because it works fast to open the airways, so the kid can breathe. Other kids may need to take long-term control medicine (also called controller or maintenance medicine) every day. Control medicine works to keep flare-ups from happening.

A kid who knows in advance that he or she will be around allergens or other triggers may need to take medicine ahead of time that will keep the airways open. And kids who have exercise-induced asthma can take medicine before exercising so they'll be able to finish a race or game.

Kids with asthma might use a peak flow meter to get an idea of how well they are breathing that day and whether they need to take any medicine.

Asthma medicine often is taken through an inhaler (say: in-HAY-lur), a plastic tube that holds a container of medicine. You may have seen a friend or someone in school using an inhaler, which is held up to the mouth. A kid holds the inhaler up to his or her mouth and breathes in. The medicine comes out in a mist that goes into the lungs. The medicine in the mist relaxes the airways, so the person can breathe easier.

Space Out With a Spacer

Sometimes a kid uses an inhaler and something called a spacer. A spacer is a piece that attaches to the inhaler and holds the mist in one place, between the inhaler and the kid's mouth. It lets the kid breathe in when he or she is ready, so it's easier to inhale all the medication.

Using a spacer is important because it makes sure the medicine travels to where it needs to be — the lungs. Without a spacer the medication can be wasted by traveling too short to the mouth or too far to the stomach.

Sometimes kids take other asthma medicines by swallowing them. Whatever medications a kid takes, the goal is always the same: to get the asthma flare-ups under total control, so the triggers don't create problems.

A lot of kids find their asthma goes away or becomes less serious as they get older. Some doctors think this happens because the airways grow wider as a kid grows up and gets bigger. With more room in the airways, the air has an easier time getting in and out.

Some people do have asthma as adults, but it doesn't have to slow them down. Plenty of Olympic athletes and other sports stars manage their asthma and keep on playing!

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: November 2011
Originally reviewed by: Nicole Green, MD

Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

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