Each season has its own set of respiratory illnesses that can be problematic for kids — and especially for those with asthma. Typical peaks of asthma exacerbations happen in the fall, around when kids go back to school, and spring, when kids leave for break. Winter, too, can be tough for kids who contract viruses like influenza or rhinovirus (the common cold).
In fact, rhinovirus causes 50-85% of asthma exacerbations in kids. Often these kids will wind up in their pediatrician’s office, urgent care or ER for help managing their symptoms.
While we don’t have a great understanding of why respiratory illnesses are often worse for kids with asthma, research is ongoing to understand these exacerbations further. Here’s what we do know about this challenging combination:
5 Points to Know About Asthma and Seasonal Respiratory Illnesses
1. What happens in the lungs during an exacerbation
When a child with asthma gets a viral respiratory illness, the virus will infiltrate the cells in the lining of the lungs. The immune system will respond by sending an influx of infection-fighting cells (such as lymphocytes, neutrophils and eosinophils) and substances (cytokines, mucus) to attack it. Depending upon the severity, this immune response can look like a mild cough and runny nose to severe wheezing that requires hospitalization.
2. Allergies can play a role
Kids with allergies and asthma have more severe and possibly more frequent viral illnesses. This means that if your kids have both allergies and asthma and they get a cold, they’re more likely to have an asthma exacerbation. Similarly, kids whose allergies are under control are less likely to have breathing problems.
3. The worst offenders
Rhinovirus, or the common cold, causes the most respiratory problems for older kids and teens with asthma. There are two types of rhinovirus that cause issues: A and C. Typically, C has been associated with an increased risk for hospitalization. Researchers are currently trying to understand why Type C rhinovirus is more problematic. Classically, rhinovirus peaks in the fall and spring but can occur at any time of year. For infants, the most common cause of wheezing is RSV, or respiratory syncytial virus. This illness tends to peak in the winter months.
4. The best prevention methods
The best way to prevent a virus-induced asthma attack is to take your allergy and asthma medications properly and as prescribed. Research shows consistently that almost all of us are only 30-70% adherent with our medications. Next, your child should have and follow an asthma action plan that was created by your asthma healthcare provider.
This is a plan that you can create with your healthcare professional to add additional steps to your treatment plan at the first sign of an illness or worsening of asthma symptoms. The recommendations are separated by green, yellow and red zones (like a stoplight!). There is some data to suggest that starting rescue medications, such as albuterol, early can prevent severe exacerbations. This is what we call a yellow zone plan (first signs of illness or worsening of asthma symptoms) and can vary depending on your child.
Other prevention methods include identifying other factors that can trigger or worsen your child’s asthma. This includes allergies, reflux, sinus disease, sleep apnea and obesity. Finally, we can help children understand the importance of preventing viral illnesses in the first place by encouraging proper hand hygiene.
5. When to call your child’s doctor
Having an action plan in place will help you determine which symptoms warrant a call or visit to your child’s doctor. Typically, it’s best to call the doctor when your child is not responding to medicines in the yellow zone after about 24-48 hours (each plan is individualized) but earlier if needed. Symptoms could include wheezing, chest tightness, and coughing that is not improving or worsening, or if they need their rescue medicines more frequently than every 4 hours.
Certainly, if your child is in the red zone get help right away — to go an emergency room or call 911. Red zone symptoms include:
- Trouble speaking or walking
- Blue or grey-looking lips or nails
- Pulling in neck or ribs during breaths
The key is to stay in close communication with your child’s doctor, have them take their medicines as prescribed in the green zone, and follow the plan when sick. Additionally, keep their asthma check-ups as recommended by their asthma provider. At those appointments, parents can have a conversation about their child’s level of asthma control, severity, and make adjustments to the plan as necessary.