Anyone caring for a child with asthma must recognise the signs of an asthma emergency and know how to respond appropriately.

A paediatrician shares what parents and caregivers need to look for in a child with an asthma emergency and what to do.

A child struggling to breathe is every parent’s worst nightmare. With South Africa facing one of the highest asthma rates in the world, this fear is a daily reality for families across every province.  

“All caregivers of children with asthma must be provided with clear, written instructions by their treating doctor. This must outline exactly what to do during an asthma emergency – an acute exacerbation and potentially life-threatening attack,” says Dr Refiloe Moreke, a paediatrician practising at Netcare Garden City Hospital.

According to the Global Asthma Report, asthma is the most common non-communicable disease among children and adolescents in Africa. However, it remains largely underdiagnosed.

“Acute asthma attacks in children typically present with an expiratory wheeze and varying degrees of respiratory distress. Parents and anyone responsible for caring for asthmatic children must know how to recognise the signs of an asthma emergency early and seek medical help timeously,” she says.

symptoms of respiratory distress

• Fast breathing
• Shortness of breath
• Worsening cough
• Chest tightness
• Use of muscles in the neck, shoulders and chest that are not usually needed for normal breathing
• Feeling tired or weak
• Trouble feeding, especially in very young children.

action plan

“When a parent or caregiver recognises the onset of an asthma attack, the first step is to administer the child’s quick-relief or bronchodilator medication immediately. A second dose can be provided 20 minutes later,” Dr Moreke says.

“For severe attacks, parents or caregivers should immediately call for an ambulance or transport the child to the nearest emergency department. Do this while initiating quick relief medication,” she advises.

Read more about staying on top of your child’s asthma.

awareness alert

“Parents should alert their child’s school or other caregivers if their child has asthma. And, they should share a clear action or treatment plan to be followed in an emergency. A list of possible triggers should also be provided so they can help the child avoid possible exposure,” Dr Moreke advises.

Managing asthma daily requires a comprehensive written action plan. This plan must:

• Detail the medications your child needs and the correct way to use them.
• Ensures caregivers are prepared with enough medication and know how to recognise early warning signs.

“An effective action plan will bridge the gap between emergency response and everyday care, providing essential protection when parents can’t be at their child’s side,” says Dr Moreke.

asthma diagnosis in young children

“Diagnosing asthma in children can be very challenging, especially in very young children, because many of the symptoms overlap with other respiratory illnesses. Another factor is that younger children may not be able to perform certain diagnostic tests yet,” Dr Moreke points out.

A thorough history from parents combined with a clinical examination is important for reaching a diagnosis in childhood asthma.

“Providing the doctor with information, including any family history of asthma or allergies. Also make a list of the child’s symptoms, like breathing patterns, wheezing, coughing, especially at night, after exercise or following exposure to allergens, and how long these have been noted,” she says.

Find out more about understanding and treating allergies.

Confirming an asthma diagnosis is usually based on the demonstration of reversible airflow obstruction with spirometry. “This is a test where the patient needs to exhale their full lung capacity through a tube to measure the volume of air and rate of flow as they breathe out. Unfortunately, spirometry cannot be performed in children under five years old, further complicating the diagnosis of such young patients,” she explains.

identifying and eliminating triggers

“Asthma is easier to manage when parents know what their child is sensitive to and are able to remove these triggers from the child’s environment,” Dr Moreke says.

Common asthma triggers

• Respiratory infections
• Allergens such as house dust, dust mites, mould, grass, pets, and tobacco smoke
• Changes in temperature or weather, especially in winter or spring
• Physical activity
• Emotions and stress.

“Certain triggers can be identified through allergy testing or the appearance of symptoms after exposure to a particular trigger. For triggers that are difficult to avoid, like physical activity, environmental allergens, emotional triggers or upper respiratory tract illnesses, parents should be taught how to adjust their child’s asthma medication to help better manage potential flare-ups that could occur at any time.

“Informed parents, grandparents and caregivers are absolutely vital when it comes to ensuring the safety of asthmatic children. We can never assume someone will know exactly what to do in an asthma emergency. This is why regular communication and clear guidance are essential. Staying prepared can make all the difference when it matters most,” concludes Dr Moreke.