Breastfeeding.com - What's an Asthma Flare-Up?

If your child has asthma, he or she might have days with no breathing problems at all. That's probably a relief for both you and your child, because it means that your child's asthma is under control and isn't getting in the way of what your child wants to do. But when symptoms of asthma, such as wheezing, coughing, or shortness of breath, become more severe, more frequent, or both, it's known as an asthma flare-up (also called an asthma flare, attack, episode, or exacerbation).

If the flare-up is severe:

• your child may struggle to breathe even when sitting still
• your child may not be able to speak more than a few words at a time without pausing
• you may notice retractions in your child's neck and chest

How Does a Flare-Up Affect My Child's Lungs?

Here's what's happening inside your child's body when an asthma flare-up occurs. In the lungs, there are airways that let air in and out. When someone has asthma, these airways, also called bronchial tubes and bronchioles, may always be somewhat inflamed or swollen.

But during an asthma flare-up, the inflammation gets worse. Sticky mucus clogs these important tubes, and their walls get more swollen. The muscles around the airways get tight, further narrowing the airway. This leaves very little room inside for the air to flow through - think of a straw that's being pinched.

What Causes an Asthma Flare-Up?

But why do asthma flare-ups happen? People with asthma have airways that are overly sensitive to certain things that normally don't bother people without asthma. These things are called triggers because they bring on asthma symptoms. Common triggers include:

• tobacco smoke
• cold air
• exercise
• infections, such as colds
• animal dander
• dust mites
• mold
• cockroaches

A lot of people who have asthma also have allergies. In these people, the allergens - the things that cause the allergic symptoms - can also cause asthma flare-ups. Left untreated, a flare-up can last for several hours or even several days. Rescue medications often take care of the symptoms pretty quickly. Your child should feel better once the flare-up is over, although it can take several days to completely resolve.

How Can I Predict a Flare-Up?

The severity and duration of asthma flare-ups vary from person to person and even from attack to attack. Flare-ups may happen without warning, with sudden coughing, shortness of breath, and wheezing. But because people with asthma have inflamed airways that worsen with gradual exposure to triggers, flare-ups can also build up over time, especially in people whose asthma isn't well controlled.

Flare-ups can and should be treated at their earliest stages, so it's a good idea to recognize early warning signs that a child might experience just before a flare-up occurs. These clues are unique to each child and may be the same or different with each asthma flare-up. Some early warning signs include:

• coughing, even if your child has no cold
• throat clearing
• rapid or irregular breathing
• unusual fatigue
• trouble sitting or standing still
• restless sleep

A peak flow meter can also be a useful tool in predicting when a flare-up may be on its way. But not all flare-ups can be prevented. Because they can be life threatening, asthma flare-ups demand attention. Your child might need to take rescue medication, visit the doctor, or even go to the hospital. Having a set of instructions called an asthma action plan can help you know which course of action is needed.

Preventing Flare-Ups

By taking the following steps, you and your child can also help prevent flare-ups:

• Always make sure you or your child has an inhaler and spacer.
• Encourage and help your child avoid substances that you know trigger flare-ups.
• Make sure your child takes his or her controller medicine as the doctor has directed - even if your child is feeling better, it's important not to skip it.
• Work with your child's doctor to follow an asthma action plan.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: March 2007