How to spot signs that a child's asthma is not under control

Asthma | 10/26/2020
How to spot signs that a child's asthma is not under control
Parents may feel overwhelmed to learn their child has a chronic illness such as asthma. According to Dr Will Carroll, a consultant respiratory paediatrician in the UK, parents have a vital role in helping children manage their asthma correctly.

Children's asthma is often poorly controlled because symptoms are wrongly tolerated as a 'fact of life', says Dr Will Carroll, a consultant respiratory paediatrician and a clinical and academic lead in paediatric respiratory medicine at University Hospitals of the North Midlands in the UK. But not managing asthma correctly can have serious consequences, including life-threatening asthma attacks. Dr Carroll says it's vital parents are alert for any signs asthma may be causing problems – by talking, listening and watching their child.

“Alertness is awareness of what symptoms suggest that asthma is controlled or not,” explains Dr Carroll. “Do they need to use their blue inhaler (their reliever)? If the answer's more than twice a week, then the asthma is not well-controlled.”

Other signs Dr Carroll highlights include the child waking in the night, their sports or play being affected, or child needing a course of oral steroids to treat their asthma. To help keep an eye on this, Dr Carroll suggests asking questions and listening carefully to the answers.

“The first thing you have to do is ask the child,” he explains. “Parents assume if they've not been told by school, or they've not seen it, that it's not happening. But when you do ask them, lots of children are having symptoms. So make sure you're asking about things that are really important to the child, such as 'is your asthma stopping you from doing anything you want to do?”

Using an inhaler is about technique and memory

Taking medication properly is fundamental, says Dr Carroll. Some parents may become lax about this over time, thinking that their child may be 'outgrowing' their asthma – a common myth. Instead, it is the medication that is actually keeping everything under control.

Dr Carroll recommends parents watch their child use the inhaler, to ensure it's done at the right times and done properly. “Once a child is five or six and can put their mouth around a mouthpiece, it's about technique and memory,” he explains. “It's a complicated task to take most inhaler medications, and to assume that six-, seven-, eight-year-olds can do this unsupervised is a big mistake.”

It is also a good idea for children to use a spacer. Of course, they may not want to because it's uncool or inconvenient, but Dr Carroll points out that children may lack the coordination and inspiratory flow to use a dry powder device directly. Apps and online videos can help with inhaler technique.

Helping teenagers manage their asthma

According to Dr Carroll, most children tend to take over responsibility for their own medication at about age 13. While supervising your teen may not be as easy as it once was, parents can still play an important role to support their children with their condition.

“Teenagers are hard enough to deal with, so the parents' approach needs to change,” says Dr Carroll. 'We go back to talk, listen and watch – ensuring that they have enough medicines available, being vigilant, and then talking to them about it in a supportive way.”

As Dr Carroll concludes: “Giving time and space to allow the child to talk about their asthma is the critical message.”

5 tips for parents to take better care of child’s asthma

  1. Don’t underestimate asthma. It’s a serious condition that might put your child at risk.
  2. Be vigilant. Don’t assume that everything is okay.
  3. Practise using inhaler together. It’s easy to learn wrong habits.
  4. Be patient. Stick to the same message.
  5. Aim higher. There’s no need to settle for any asthma symptoms if your child’s asthma is treated correctly.

By Esther Beadle

Photos and video by Dan Douglas


Wildhaber, Johannes & Carroll, William & Brand, Petrus. (2012). Global impact of asthma on children and adolescents' daily lives: the Room to Breathe Survey. Pediatric pulmonology. 47. 346-57. 10.1002/ppul.21557'_daily_lives_the_Room_to_Breathe_Survey

Asthmatic children: Parents knowledge is enough? (2015). Roseane Caldeira, Iuri Oliveira
European Respiratory Journal 2015 46: PA1278; DOI: 10.1183/13993003.congress-2015.PA1278.


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Orion Corporation is a globally operating Finnish pharmaceutical company. We develop, manufacture and market human and veterinary pharmaceuticals and active pharmaceutical ingredients. The dry powder inhaler developed at Orion is in the core of our respiratory therapy area.