With timely diagnosis, personalised treatment, medication adherence and proactive care, children with asthma can breathe easier – and enjoy fuller, more active lives.—Photo from 123rf
ASTHMA, a chronic inflammatory disorder of the airways, remains one of the most common long-term illnesses in children worldwide.
For parents and caregivers, managing childhood asthma can be challenging – not only because of the condition itself but also because of surrounding myths, environmental triggers and treatment complexities.
The nature of childhood asthma
According to Pantai Hospital Kuala Lumpur consultant paediatrician and paediatric respiratory physician Dr Su Siew Choo, one of the fundamental differences between childhood and adult asthma lies in the disease’s phenotype.
“The majority of childhood asthma is allergic in nature,” she explains. “It’s typically linked to personal or family history of conditions like eczema, allergic rhinitis or food allergies.”
Dr Su adds that these cases often respond well to inhaled corticosteroids. By contrast, adult-onset asthma is frequently non-allergic and may be more resistant to standard treatment, requiring higher medication doses for control.
Children with asthma are highly sensitive to a range of environmental triggers. These include: > Viral respiratory infections > Second-hand smoke and air pollution > Allergens like dust mites, pollen, pet dander and mould > Sudden weather changes > Certain foods > Inconsistent medication use
In Malaysia, nearly 500,000 children aged six to 17 live with asthma, according to the National Health and Morbidity Survey 2023.
Children with asthma are particularly sensitive to pollutants and allergens in their environment, and that minimising exposure plays a key role in improving asthma control and preventing flare-ups, says Dr Su. – KAMARUL ARIFFIN/TheStar
The condition appears more common in urban and densely populated areas, likely due to higher pollution levels and environmental exposure.
Globally, asthma affects about 5.2% to 9.4% of children – placing Malaysia within that average range. It often begins early in life, with nearly half of all people with asthma showing symptoms in childhood.
However, diagnosing asthma in infants can be tricky. “Wheezing caused by viral infections is quite common in the first two years of life, especially in babies under one,” notes Dr Su.
“But persistent or recurrent wheezing, especially when not linked to colds and coupled with a family history of asthma or eczema, should raise red flags.”
Parents should be alert to the following warning signs:
> Frequent dry coughing, especially at night or after physical activity
> Wheezing or chest tightness triggered by weather, cold air or allergens
> Shortness of breath
> Unusual fatigue during play
These symptoms tend to fluctuate and may worsen over time if not properly managed, Dr Su points out.
Getting a diagnosis and treatment approaches
Diagnosing asthma in young children, especially those under five, requires clinical skill and pattern recognition, as younger kids often cannot articulate their symptoms or perform objective lung tests like spirometry.
“A combination of clues are relied on. Family history, typical patterns of symptoms, response to medication and sometimes allergy testing,” says Dr Su.
For older children, lung function tests such as spirometry and peak flow measurements are useful tools.
In specialised paediatric respiratory centres, more advanced testing can even be performed on younger children.
Allergy testing – such as skin prick tests and blood tests for common allergens – can help identify specific triggers.
The primary goals in managing childhood asthma are to control symptoms and prevent exacerbations to maintain a normal, active lifestyle.
This, according to Dr Su, usually requires a combination of daily controller medications and quick-relief (rescue) therapies, along with non-drug strategies such as allergen avoidance, vaccination, education and consistent follow-up.
Controller medications: These include inhaled corticosteroids, oral anti-leukotriene medications or combination inhalers containing corticosteroids and long-acting bronchodilators. They reduce inflammation and help prevent symptoms over the long term.
Reliever medications: These fast-acting inhalers help relax airway muscles and provide immediate relief during an asthma flare-up.
“If your child is using a reliever more than twice a week, their asthma might not be well controlled,” warns Dr Su. “It may be time to adjust the controller medication.”
A personalised asthma action plan – developed collaboratively by doctors, parents and children – helps guide when to use which medication, how much to take and what to do during an attack.
For children with severe asthma who don’t respond well to standard medications, biologics and targeted therapies are now available in Malaysia, Dr Su adds.
These specialised treatments require close monitoring and are usually managed by paediatric respiratory physicians.
Additionally, new tech tools like smart peak flow meters – linked to mobile apps – are helping parents and children monitor symptoms and predict potential flare-ups.
Despite technological advances, inhalers remain the cornerstone of treatment.
“Proper technique is crucial,” says Dr Su. “If the medication isn’t reaching the lungs effectively, even the best treatments won’t work.”
Tackling adherence and common barriers
One of the most significant barriers to effective asthma control is poor treatment adherence.
These may include: > Children forgetting doses or feeling discomfort using inhalers > Parents underestimating the severity of the condition or skipping follow-ups > Medication issues, such as complicated regimens or the high cost of newer treatments
“Asthma education is vital,” says Dr Su.
“Even the best medications won’t help if families don’t understand how or when to use them.”
Avoiding triggers isn’t just an added step – it’s central to asthma management.
“Children with asthma are especially vulnerable to environmental pollutants and allergens,” says Dr Su.
“Reducing exposure can significantly improve control and reduce flare-ups.”
For families living in urban or hazy environments, she recommends: > Eliminating indoor smoking and avoiding mosquito coils or incense > Fixing leaks and damp areas to prevent mould > Monitoring the Air Pollutant Index (API) with apps like MY API > Staying indoors when air quality is poor (API >100) > Using HEPA-filter air purifiers > Avoiding outdoor exercise on high pollution days
Can children with asthma be active? Absolutely, with the right management, children with asthma can participate in sports, physical education (PE) classes, swimming and all kinds of physical activities.
“In fact, exercise is encouraged,” says Dr Su.
“It promotes better lung function, improves confidence and supports overall well-being.”
Taking a reliever inhaler 15 to 30 minutes before activity can prevent exercise-induced symptoms.
Asthma shouldn’t be seen as a limitation, but rather a manageable part of life.
What to do during an attack
Recognising an asthma attack early can make a critical difference, Dr Su points out.
Key signs include: > Worsening cough > Increasing breathlessness or chest tightness > Wheezing > Fatigue or bluish lips
“Administer the rescue inhaler immediately and help your child stay calm,” advises Dr Su.
“Sit them upright, encourage slow breathing and if there’s no improvement – or if severe symptoms occur – go to the emergency room right away.”
Being prepared with an asthma action plan and understanding how to act quickly is essential for reducing risks during an emergency.
Remission and long-term outlook
Asthma symptoms may lessen or disappear as children grow older. Studies have shown that up to 59% of pre-schoolers who wheeze stop wheezing by the time they reach six. However, among children with persistent wheezing after age nine, only 15% were symptom-free by age 26.
Predictors of remission include milder and less frequent episodes, improving lung function and reduced airway sensitivity.
Still, remission is not the same as a cure. Many children who “outgrow” asthma may experience a recurrence later in life, and some face faster lung function decline in adulthood.
Regular check-ups and lung function monitoring remain important, even in those who seem to have outgrown their symptoms.
Despite advances in treatment and diagnostics, asthma awareness in Malaysia remains patchy, says Dr Su. “We need to close these gaps to empower families and reduce preventable asthma attacks.”
Effective asthma control is possible - but it requires a team effort involving doctors, parents, schools and community awareness. With timely diagnosis, personalised treatment, adherence to medication and proactive environmental management, children with asthma can breathe easier – and live fuller, active lives.
