Information For Patients


What is Asthma?

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs. The airways become over-sensitive, which means that they react to things that would normally not cause a problem, such as cold air or dust.

This reaction means that muscles around the wall of the airway tighten up, making it narrow and difficult for the air to flow in and out. The lining of the airways then gets swollen (just like your nose during a cold) and sticky mucus is produced, clogging up the breathing passages.

With the airways narrowed like this, you can see why it becomes difficult for air to move in and out and why the chest has to work so much. Tightening of muscle around the airways can happen quickly and is the most common cause of mild asthma.

Thankfully, this tightness can be relieved quickly with the right inhaler. However, the swelling and mucus happen more slowly and need a different treatment. They take longer to clear up and are a particular problem in more severe asthmatic cases.

What causes Asthma?

We still don’t know exactly what causes asthma, but what we do know is that:

  • Anyone can develop asthma. It is particularly common in Ireland, where over 470,000 adults and children have the condition.
  • It can start at any time of life, although it most often begins in childhood.
  • Sometimes it affects several family members e.g. if you have parents or brothers and sisters with asthma or allergies such as eczema or hay fever, you are more likely to have it yourself.
  • Conditions like hay-fever, eczema, or hives, which are usually the result of allergy, may occur along with asthma.
  • Adult onset asthma may develop after a respiratory tract infection.
  • Many aspects of modern lifestyles such as changes in housing, diet and a more sterile home environment may have contributed to the rise in asthma over the last few decades.




    Asthma & Your Child


    Asthma affects around one out of every five children in Ireland. Whilst it can’t be cured, asthma can be well controlled. Children whose asthma is well controlled can lead happy, healthy lives. Poorly controlled asthma can have a big impact on a child’s health, as well as their ability to play and learn. Uncontrolled asthma causes children to miss school, can lead to hospitalisation, and, although it is rare, in a small number of cases children can die from asthma. Asthma and Your Child gives parents and guardians the information they need to control their child’s asthma and ensure their asthma won’t stop them leading a happy, healthy and active life.

  • How asthma is diagnosed
  • The symptoms of asthma
  • What triggers asthma
  • Types of asthma treatments
  • How to manage asthma
  • And what to do during and asthma attack.

    About Asthma

    Asthma is a common chronic disease which inflames the airways. The airwaysare the small tubes that carry air in and out of the lungs. Asthma causes theairways to become over-sensitive and react to things they wouldn’t normallyreact to, such as colds and flus or dust mites – even family pets, these arecalled triggers. When asthma symptoms are triggered the muscles around the wall of theairways tighten, making them narrow. The lining of the airways also swells andsticky mucus is produced, clogging up the already narrowed airways. With theairways narrow and clogged with mucus, it becomes difficult to breathe.

    What are the Symptoms of Asthma?

    Asthma symptoms vary in children and can depend on the age of the child. Your child may have one or more of the following common symptoms:


    A wheeze is a whistling sound that happens when you breathe through narrowed airways. Regular wheezing is a symptom of asthma, but not all children with asthma wheeze and not all children who wheeze have asthma. This is why it is important that asthma is diagnosed by a doctor.


    A dry, cough that won’t go away is a symptom of asthma and often occurs at night or during exercise.

    Chest tightness

    Chest tightness is a symptom of asthma. Children may describe it as chest pain or even a tummy ache.

    Shortness of breath

    Shortness of breath is another symptom of asthma and may be triggered by exercise or excitement.

    What Causes Asthma?

    The exact causes of asthma are still unknown but we do know that:

  • Asthma can run in families and children are more likely to have asthma if they have a parent or parents with asthma.
  • Asthma usually starts in early childhood, but can also sometimes develop at later stages in life.
  • Asthma is linked to other allergic diseases, and a child is more likely to develop asthma if they suffer from other allergic conditions such as eczema, hay fever or a food allergy.
  • Asthma is not infectious.
  • Modern lifestyles that have resulted in changes to housing, diet and the levels of air pollution may be contributing to the rise in asthma.
  • Smoking during pregnancy or exposing a child to tobacco smoke will increase their risk of developing asthma.
  • Being overweight increases the risk of developing asthma.
  • Viral respiratory infections can increase the risk of developing asthma.
  • Some children lose their symptoms as they grow older but asthma is a chronic disease so it never goes away and symptoms can come back later in life.

    Diagnosing Asthma

    There isn’t a single test to diagnose asthma. Your child’s doctor will diagnose asthma based on:

  • The family history of asthma
  • The pattern of symptoms
  • Physical examination
  • Peak flow/lung function test (depending on their age)
  • A trial of asthma treatment.

    Your child’s doctor may also ask if they have other conditions, such as eczema or hay fever or ask you to keep a diary of their symptoms.

    Asthma in Children Under 2 Years Old

    Asthma is difficult to diagnose in children under two years old. Wheezing is common in very young children- more than one third of children under two years will wheeze at some point. Most of these children stop wheezing as their airways grow, but for others it could be a sign that they will develop asthma. If your child is under two years old and their symptoms don’t go away, your doctor may decide to give them a trial of asthma medication to help make a diagnosis.

    Asthma Triggers

    There are many things that can trigger asthma symptoms and every child will have different triggers. Knowing your child’s triggers and how to avoid them is very important in controlling their asthma. Keeping an up to date Asthma Management Plan will help you record and monitor triggers. For more information scroll down to the Asthma Management Plan section. Below is a list of the most common triggers and tips on how to avoid them.

    Changes in Weather

    Some children’s asthma is triggered by thunder storms, fog or changes in weather or temperature-especially at the beginning of spring and autumn. If your child’s asthma is triggered by changes in weather it should not limit their activities once they are taking their medication as prescribed.

    Tobacco Smoke

    Tobacco smoke is one of the most common and worst triggers of asthma symptoms. Tobacco smoke increases the risk of pneumonia, bronchitis and ear infections, and can also stop asthma medication working effectively.


    Asthma can be triggered by the chemicals found in household products. Products which may trigger asthma symptoms can be scented or unscented and include: aerosols, cleaning products, paints, adhesives, pesticides, cosmetics and air fresheners.


    Certain trees, grasses, weeds and flowers produce pollen which is a common asthma trigger. Your child’s doctor may review their medication to help reduce the effects of pollen on asthma symptoms.


    Mould spores can trigger asthma. Mould can be found indoors and outdoors in places like bathrooms, kitchens, wooded areas or autumn leaves.

    Exercise and Excitement

    Exercise, laughing and excitement can all trigger asthma in children but this shouldn’t stop them being active. Exercise is very important for people with asthma and can improve asthma symptoms. As long as a child is taking their asthma medication as prescribed they will be able to exercise as normal

    Colds and Viral Infections

    Colds and viruses are common triggers for children, especially when they return to school in autumn and during the winter months. They are difficult to avoid but important to watch out for, as they can trigger an asthma attack.

    House Dust Mite

    House dust mites are tiny insects that are barely visible to the naked eye. They live in warm damp places in every home, such as mattresses, carpets, soft toys and furnishings. It is impossible to completely rid a home of dust mites but there are steps you can take to limit their impact.

    Household Pets

    Asthma can be triggered by fur and dander from household pets, most commonly cats and dogs.


    Food is not a common trigger for asthma, unless someone has a food allergy. If your child has a food allergy that has been confirmed by a healthcare professional, they are at greater risk of having an asthma attack. The most common foods known to cause allergies are cow’s milk, eggs, wheat, fish, shellfish, peanuts and other nuts.

    Trigger Tips

  • Always give your child their medication as prescribed.
  • Keep a written Asthma Management Plan. An Asthma Management Plan will allow you to monitor your child’s symptoms and tell you what to do when they get worse. You can get a free Asthma Management Plan from the Asthma Society of Ireland and it should be filled out with the help of your child’s doctor or nurse.
  • Children should wash their hands and use hand sanitizer regularly to stop the spread of colds and viruses.
  • The annual flu vaccine is recommended for all children diagnosed with asthma. Speak to your health care professional for more information.
  • Children should have a diet that is high in fresh fruit and vegetables to boost their immune system.
  • Use zipped anti-dust mite covers on mattresses, duvets and pillows, and wash them regularly according to the manufacturer’s instructions.
  • Hot wash all bedding at 60°C at least once a week. Dry cleaning is not as effective.
  • Remove carpets where possible, especially in bedrooms. Vacuum at least three times a week, using a vacuum with a HEPA filter. Keep your child out of rooms that have been vacuumed for at least twenty minutes.
  • Clean all surfaces with a damp or electrostatic cloth at least twice a week.
  • Keep soft toys to a minimum and hot wash them at 60°C every two weeks.
  • Think seriously before bringing a pet into your home and consider borrowing a pet for a short time as a trial.
  • If you own a pet it should be kept in one area of the house (e.g. a utility room) and never allowed in your child’s bedroom.
  • Vacuum carpets frequently, using a vacuum cleaner with a HEPA filter.
  • Wash pets frequently.
  • Make sure your child takes their reliever inhaler with them when they are outdoors.
  • Don’t smoke.
  • Children should never be near someone who is smoking and smokers should always go outside to smoke.
  • Keep children away from smoky atmospheres.
  • Both parents should stop smoking during pregnancy.
  • For advice on quitting smoking lo-call the Asthma Adviceline on 1850 44 54 64.
  • Avoid using chemical products where possible.
  • Keep your child away from chemicals and the areas where they are used.
  • Open doors and windows when using chemicals
  • Monitor the pollen count by visiting www.asthma.ie or lo-call the Asthma Adviceline on 1850 44 54 64.
  • If pollen is a trigger, keep children indoors during high pollen count times.
  • Visit www.asthma.ie for more information on allergies, hay fever and how to avoid pollen.
  • Make sure there is good ventilation indoors and air rooms regularly.
  • Check your home for moisture or leaks and repair any broken pipes or structural damage.
  • Remove all indoor plants as they may cause mould growth.
  • Avoid drying clothes indoors or on radiators.
  • Although mould grows in humid environments, dehumidifiers have no proven positive effect on asthma control.
  • If necessary give your child one or two puffs of reliever inhaler before play or exercise.
  • If exercise and activity frequently trigger asthma symptoms it could be a sign a child’s asthma is uncontrolled and you should speak to a healthcare professional.
  • For further tips on exercising with asthma visit www.asthma.ie
  • Speak to a health care professional if you are concerned that your child may have a food allergy.
  • Make sure your child takes their medication as prescribed.
  • Make sure you and your child know what to do in an asthma attack and have an asthma management plan.
  • If your child has an adrenaline pen for emergency use, it is important to know when and how to use it and to make sure your child has it with them at all times.

    Asthma Medications and Treatments

    With the right asthma treatment children with asthma can live and full and active lives. When your child’s symptoms are worse, their doctor may increase their medication and decrease it when their asthma is under control. The following are types of treatment which may be prescribed by your doctor:

    Reliever Inhaler (usually blue)

    Reliever medication relieves symptoms quickly by opening the airways wider and making it easier for your child to breathe. Every child with asthma should have a reliever inhaler and should keep it with them at all times. Reliever medication can be taken before symptoms get worse, for example when a child is getting a cold. If your child needs their reliever inhaler more than twice per week, for two weeks in a row, it means that their asthma is not controlled and they should see their doctor.


    Controller Inhaler (usually brown)

    Controller medication (inhaled corticosteroids) reduces the inflammation of the airways over- time. It does not provide instant relief of symptoms, but builds up protection over a period of time. Not every child with asthma will need controller medication. Your child may be prescribed controller medication if they have regular symptoms and/or use their reliever more than twice a week. Controller medication must be taken every day as prescribed, even when your child is feeling well.

    Possible Side Effects:Controller medication can occasionally cause hoarseness, sore throat or oral thrush. These side effects can be reduced by making sure children use their inhaler correctly, use a spacer device, and rinse their mouths and wipe their faces after taking their medication. It is important to note that the steroids in controller inhalers are similar to those produced naturally in our bodies and should not be confused with anabolic steroids, which are sometimes used illegally to enhance sporting performance.


    Combination Inhalers

    For children with poorly controlled asthma, another treatment option is a combination inhaler. Combination inhalers contain both a slow acting reliever medication and a controller medication, and are an easy way for children to take two medicines at one time. They should be taken every day as prescribed, even when a child is feeling well. Children using combination medication should be monitored by their doctor or nurse to make sure they are on the lowest dose of medication to manage their symptoms.

    Possible Side Effects:Combination medication can occasionally cause hoarseness, sore throat or oral thrush. These side effects can be reduced by making sure children use their inhaler correctly, use a spacer device, and rinse their mouths and wipe their faces after taking their medication.

    Oral Steroid Tablets

    Oral steroid tablets (glucocorticosteroids) may be prescribed, in addition to regular medication, for a period of three to five days to regain control of a child’s asthma following an asthma attack. Steroid tablets are powerful and quickly reduce inflammation in the lungs that causes a child’s symptoms. If a child repeatedly needs steroid tablets to keep their asthma under control then their doctor may refer them to a specialist paediatric respiratory doctor.


    For more information on allergies and immunotherapy visit www.asthma.ie and see our booklet Asthma and Allergic Rhinitis.


    Important Points to Note about Asthma Medication

  • Always give your child their medication as it has been prescribed by their doctor.
  • If your child is using their reliever medication more than twice a week they should see their doctor or nurse.
  • Children should have access to their blue reliever at all times.
  • Children should have their inhaler technique checked at every visit to their doctor and pharmacist.


    How to Take Asthma Medication

    Asthma medication can be given to your child in a variety of ways. It is importantthat children have their inhaler and spacer technique checked by a doctor, nurse orpharmacist regularly. You can view demonstration videos on inhaler and spacer techniqueat www.asthma.ie


    An inhaler is the most effective method of giving asthma medication as it ensures that themedication goes directly to the lungs where it’s needed, and requires smaller dosagesthan tablets


    A spacer device is a plastic container with a mouthpiece or mask at one end, and space to insert an inhaler at the other. Children should always use a spacer with their inhaler. There are several different brands of spacer device (e.g. Aerochamber, Volumatic, Babyhaler), with some available on prescription. You should always use a spacer with children under four years old. Spacers have several advantages:

  • They make inhalers easier to use.
  • They increase the amount of medication that reaches the airways.
  • They reduce the risk of side effects from controller medication, such as oral thrush.


    How to Use a Spacer with a Mask

  • Shake the inhaler
  • Insert the inhaler into the spacer
  • Place the mask over the child’s mouth and nose, ensuring that there is a tight seal
  • Press the inhaler once and allow the child to breath in and out slowly five times
  • Some spacers have a valve which shows the breath going in and out. If so, you can watch this to make sure your child takes five breaths of their medication.
  • Repeat steps 2-5 for each prescribed dose of medication.


    How to Use a Spacer with a Mouthpiece

  • Assemble the spacer if it comes in two halves
  • Shake the inhaler
  • Insert the inhaler into the spacer
  • The child should grip the mouthpiece with their teeth and place their lips around it
  • Press the inhaler once and allow the child to breath in and out slowly five times
  • Some spacers have a valve which shows the breath going in and out. If so, you can watch this to make sure your child takes five breaths of their medication
  • Repeat steps 3-6 for each prescribed dose of medication.

    Remember: Only release one puff of medication into a spacer at a time and always follow the manufacturer’s instructions for care and replacement guidelines.

    Nebuliser Compressor

    The Asthma Society of Ireland doesn’t recommend the use of nebuliser compressors in the home, unless you have been instructed to do so by a health care professional. Using an inhaler and spacer together are equally as affective as using a nebuliser, except in severe asthma attacks. Nebulisers deliver a fine mist of high doses of asthma medication to the lungs. Nebulisers are sometimes used in hospitals to treat asthma attacks or for children with uncontrolled asthma who find it difficult to use a spacer device

    Asthma Management

    Peak Flow

    Children over six years old can use a peak flow meter to help manage their asthma. A peak flow meter is a small plastic tube-like device that a child blows into. It shows how well their lungs are working by measuring how quickly they can blow air out. If readings vary greatly it may be an early warning sign that a child’s asthma is getting worse. Peak flow readings can be recorded in an asthma management plan and over time a pattern of when a child’s asthma control gets worse and better should become clear.

    Asthma Management Plan

    Every child should have an Asthma Management Plan to help monitor and control their asthma. An Asthma Management Plan is tailored to each individual child. A healthcare professional can work with you to complete an Asthma Management Plan which will contain the following information:

  • Contact details for parents, guardians and doctors.
  • A list of medication that has been prescribed for your child.
  • How to recognise when asthma control is getting worse.
  • Steps to take to improve asthma control.
  • The 5 Step Rule- what to do in an asthma attack.
  • You can download our free asthma management app Asthma Coach for iPhone from the App Store.



    Vaccinations are given to immunise children, or in other words to protect them against disease. Immunisation is very safe and effective. All children, including children with asthma, should be immunised according to the Primary Childhood Immunisation Schedule. Speak to a healthcare professional for more information. The annual flu vaccine is recommended for all children diagnosed with asthma. Speak to your health care professional for more information.



    Changing a child’s diet will not reduce their chances of developing asthma, but it is important that children with asthma have a healthy, balanced diet. Obesity makes asthma control worse. Lung function is poorer and asthma is more difficult to control if children are obese. Use the food pyramid below as a guide and give children portions that are appropriate for their age. Children should eat from all of the four major food groups-grains, fruit and vegetables, protein and dairy- and shouldn’t eat sweets, cakes and other food from the top of the Pyramid every day.

    Managing Asthma in Childcare and at School

    One in five children in Ireland has asthma and it is the leading cause of missed school days in the country. Take the following steps to make sure that your child’s asthma is well managed whilst in childcare or at school:

  • Teachers and childcare workers should be alerted if a child in their care has asthma, along with what their triggers are, if they have any allergies, and what to do during an asthma attack.
  • Keep an up to date Asthma Management Plan and make sure your child’s carer or teacher has a copy. This should include contact details for your child’s doctor.
  • Check what policy is in place for medication. Where is medication stored and will children have access to it? Do teachers and childcare workers know when and how to give medication to smaller children? Are they happy to do so?
  • Clearly mark your child’s name on their medication.
  • Give the school or childcare facility a spare reliever inhaler and spacer for emergencies.
  • Make sure your child is cared for in a smoke and pet free environment.


    How to Help Manage Asthma

  • Understand medication: learn about the different types of medication that have been prescribed for your child and how they should be taken.
  • Take medication as prescribed: it is very important that children take their medication as it is prescribed by their doctor.
  • Inhaler technique: children should have their inhaler technique checked regularly.
  • Manage triggers: knowing your child’s triggers and how to avoid them is very important in keeping asthma under control. Triggers should be noted in a child’s Asthma Management Plan.
  • Regular asthma reviews: children should have their asthma reviewed by a doctor every six to twelve months, even when they are well.
  • Vaccinations: making sure vaccinations are up to date is very important in keeping children with asthma well.
  • Diet: eating a balanced diet and maintaining a healthy weight helps keep asthma under control.
  • Asthma in Childcare and at School: teachers and childcare workers should be well informed about your child’s asthma and kept up to date on their asthma management.


    What to do in an Asthma Attack

    How to recognise if your child’s asthma is getting worse

    It is important to recognise when your child’s asthma is getting worse so you can take thenecessary steps to stop them having an asthma attack. To make sure you act fast keep aneye out for the following signs:

  • Wheezing or coughing in the morning
  • Wheezing after exercise or avoiding exercise altogether
  • Waking at night because of asthma symptoms
  • Needing to take reliever medication more often than normal
  • Reliever medication isn’t helping to relieve symptoms

    If you notice any of these signs or are in doubt speak to a healthcare professional immediately.


    There are important steps to take after a child has had an asthma attack:

  • Make an appointment with their doctor to have their asthma and medication reviewed.
  • Have their inhaler technique checked by a healthcare professional.
  • Make sure you know how to recognise if their asthma is getting worse and what to do if they have another attack.




    What to do in an asthma attack


    Asthma attacks can be frightening and dangerous experiences. They can happen when symptoms get worse over a number of days or hours or can happen suddenly, even when someone is taking their medication and avoiding their triggers.

    If a student has an asthma attack or you suspect they are having an attack, you should take immediate action.

    How do I know if it’s an Asthma Attack?

    If someone is having an asthma attack you will have one or a combination of any of the symptoms below:

  • Cough
  • Wheeze
  • Shortness of breath
  • Chest tightness
  • Too breathless to finish a sentence
  • Too breathless to walk, sleep or eat
  • Lips turning blue.


    If it’s an Asthma Attack Follow the 5 step Rule

  • Take two puffs of reliever inhaler (usually blue), one puff at a time
  • Sit up and stay calm
  • Take slow steady breaths
  • If there is no improvement, take one puff of reliever inhaler every minute: Adults and children over six years can take up to ten puffs in ten minutes, Children under six years can take up to six puffs in ten minutes
  • Call 999 or 112 if symptoms do not improve after ten minutes or you are worried. Repeat Step 4 if an ambulance does not arrive within ten minutes.

    (Not designed for people using a Symbicort Inhaler on the “Symbicort Smart Regime” Please speak to your Doctor/Nurse if this is the case.)

    During an asthma attack

  • Use a spacer if possible
  • Don’t lie the person down or put your arm around them
  • Don’t leave the person on their own
  • Don’t worry about giving too much reliever- Extra puffs of reliever are safe


    For informational videos on Asthma Management





    iPhone App

    To help manage symptoms

    Asthma Coach enables you to:

  • Set up a profile
  • Record your regular symptoms and triggers
  • Record your regular medications
  • Record your personal best peak flow reading or predicted reading (if you do not know your personal best)
  • Know what to do in case of an emergency, including easy access to the Five Step Rule (there is also a call function to contact the emergency services directly).
  • Record and access the contact details for your Doctor or next of kin
  • Access the Asthma Society of Ireland’s website and our library of How-To videos including clips showing the correct use of various asthma and devices.
  • Get the latest news on asthma from www.asthma.ie, sent directly to your phone
  • Check the pollen/mould/spores forecast for your province (available March-November)


    ICE – In Case of Emergency

    This section has information on what to do in case of emergency – the five step rule.
    The contact details of your GP and Next of Kin are there and can be called at the push of a button.
    There is also an interactive map which highlights your closest hospital and ED based on GPS.

    App Store


    Source: www.asthma.ie