Keep in mind that 75 percent of all individuals with asthma usually show symptoms before the age of seven. And sometimes children lose their asthma symptoms around age six. (See Chapter 8.) But asthma remains a widespread condition for children ages six through twelve.

Diagnosis

To find out if your child has asthma, your health care provider will ask you a series of questions about her symptoms: about when she coughs, how she sleeps at night, or signs of labored breathing. (See more in Chapter 3.) The provider also might ask about possible triggers — maybe dust mites or cockroaches in a new home or animals in a school classroom. A family history of asthma will be reviewed, and other conditions such as bronchitis, allergies, or even vocal cord dysfunction will be examined as well.

A pulmonary function test can be performed on older children (usually age six or older) to determine how fast they can force air from their lungs. This common and frequently used test, called spirometry, measures how much her airways may be blocked. This test usually can be done at your health care provider's office or in a health care facility. A child breathes into a closed tube attached to a machine that measures how much and how fast she could expel a breath.

Newer methods are available, but they are found more at larger health centers. They include the impulse oscillometry system (IOS), which measures airway resistance while a child breathes normally, and another method, called exhaled nitric oxide or eNO, which monitors the amount of nitric oxide exhaled by a child. With either test, a health care provider can get a better idea how your child is breathing and what course of treatment is needed.

Guidelines for School-Aged Children

The asthma guidelines released by the National Asthma Education and Prevention Program in 2007 include an asthma severity scale created for children ages five though eleven with asthma who are not currently taking long-term control medications. The different levels can give a health care provider a base by which to begin or adjust treatment. These levels are:

• Intermittent — Symptoms occur less than two days a week, two nighttime awakenings related to asthma are reported, quick-relief medications are used less than two days a week, and no interference is reported with normal, daily activities.

• Mild Persistent — Symptoms occur two or more days a week (but not daily), three to four nighttime awakenings related to asthma occur monthly, quick-relief medications are used more than two days a week (but not daily), and minor limitations are reported with normal, daily activities.

• Moderate Persistent — Symptoms occur daily, more than one nighttime awakening related to asthma occurs weekly, quick-relief medications are used daily, and some limitations are reported with normal, daily activities.

• Severe Persistent — Symptoms occur throughout the day, nighttime awakenings related to asthma occur seven days a week, quick-relief medications are used several times per day, and normal, daily activities are reported extremely limited.

At the current time, data is inadequate to link flare-ups with levels of severity. However, for treatment purposes, the guidelines recommend that patients ages five through eleven who have had two asthma episodes in the year requiring treatment with oral corticosteroids may be considered the same as patients with persistent asthma (even if they fail to show signs of impairment associated with the other levels). Once treatment has started, your health care provider can determine if your child's symptoms are well controlled, not well controlled, or poorly controlled using the current guidelines. (See Appendix C.)

Asthma into Adulthood?

One question parents usually ask is whether their child will outgrow his asthma or will he still have asthma when he reaches adulthood? The answer is: It depends. Long-term studies have suggested that most children will improve during their teen years, and up to half will be wheeze-free by the time they turn into adults.

However, up to 80 percent of those symptom-free adults could demonstrate some bronchial problems and could end up redeveloping asthma.

Various risk factors, though, may point to persistent adult asthma such as a family history of asthma, exposure to secondhand tobacco smoke, direct exposure to smoke if the teen starts smoking, obesity, atopic dermatitis or eczema, exposure to the respiratory syncytial virus (RSV), wheezing at ages ten or eleven, a lower socioeconomic status, or earlier exposure to mites, cockroaches, and molds.

But one point that many studies have focused on is that the earlier asthma is diagnosed and actively treated in children, the less likely those children will face lung deterioration in later years.