Asthma is a common condition that makes it difficult to breath — more than 4.6 million children and 22 million adults in the U.S. have the disease, according to the Centers for Disease Control and Prevention. People with asthma have underlying inflammation in their lungs and airways, and when they are exposed to a trigger — for example pollen, mold, a virus, or pollution — the airways tighten. This leads to labored breathing and the body receiving less oxygen.

For parents and caregivers who are managing childhood asthma, the spring season usually raises the risk of asthma symptoms. “Because the most common triggers for asthma are viruses and irritants in the air, we usually see a huge uptick in asthma exacerbations in the spring,” says Dr. Kalliope Tsirilakis, a pediatric pulmonologist at Children’s Hospital of New York at NewYork-Presbyterian Queens.

While millions of children and adults have asthma, each case is unique, and understanding the causes and treatment is complex. The key, according to Dr. Tsirilakis, is to recognize the symptoms, identify the triggers, and partner with a provider or asthma specialist to figure out a management plan.

“The goal is to keep them under the best control possible and to be on as little medicine as possible,” says Dr. Tsirilakis, who is also the director of the NewYork-Presbyterian Queens Pediatric Asthma Center. “I tell all of my patients, there are Olympic athletes who have asthma. Your asthma should not be limiting you in any way, shape or form. Every child with asthma can live a full life.”

To better understand the signs of asthma, the triggers and how to manage it, Health Matters spoke to Dr. Tsirilakis. 

What is asthma?

When a child has asthma, there is at least a low level of inflammation in the lungs on a regular basis. I describe it to my patients as like having a rash. Kids have that same redness and swelling inside their lungs, even when they seem totally healthy. We call it persistent asthma. It is not a matter of having symptoms every day, it’s a matter of that inflammation being there every day.

Then a trigger comes along, and the inflammation gets out of control. That’s when kids have what we call an asthma attack.

It’s not just pollen and dust that can trigger it. At a young age, it can be viral illnesses. Pollution, certain types of fungal infections, and indoor allergens (like cockroaches and mice) can also exacerbate asthma.

Who is at greatest risk of asthma?

Children have a much, much higher incidence of asthma, especially children in New York City. The latest data show that more than one in 10 children under the age of 12 in New York City have asthma, and certain neighborhoods are hotspots, particularly when you’re looking at high congestion traffic areas. Along the Cross Bronx Expressway, the entire strip has the highest rate of asthma in the city.

Is asthma genetic?

There is definitely a familial association. More than 30 genes have already been associated with asthma. But there is not one gene that is going to cause asthma. There is an intersection of the genetic predisposition, plus the environmental triggers that work together to cause asthma.

How do you diagnose asthma?

Very few tests will tell you 100% if you have asthma or you don’t.

We start with a clinical diagnosis, and as children get older, we do spirometry testing. For spirometry testing, we have patients breathe into a tube attached to a computer that measures the flow of the air coming out of their lungs. Spirometry can show us if the lungs or small airways are tight.

For kids over the age of 3 who have asthma or persistent asthma, we also recommend allergy testing because kids who have asthma often have allergic triggers, and it’s very important to also control their triggers as best as possible.

Do kids grow out of asthma?

Asthma absolutely can change with time. Sometimes it gets better, sometimes it gets worse.

It can change with hormones, so when kids go through puberty, there are oftentimes big changes in one direction or the other. It can also change with environmental factors. When a child goes away to college, or a family moves, the change in environment can affect asthma.

What is the best treatment for asthma?

We don’t have a cure for asthma, so our goal with asthma therapy is to control the inflammation and avoid the need for the emergency room and a heavy dose of steroids.

The fundamental, first line therapy is an inhaled steroid. These inhalers have very tiny doses of steroids that go directly to the lungs, so they do not have the same side effects as the big, oral, systemic doses of steroids.

On top of the inhaled steroids, some patients benefit from combination medicines that also include a long-acting beta agonist (also known as LABA), which is a medication that opens up the lungs all day. The LABA medicines are like a long-acting albuterol and for some patients can be used as a rescue medicine.

Rescue medications, like albuterol or combination inhalers, work to relax tightened airways and quickly relieve symptoms. It’s important to talk to a doctor to determine which medications are right for each patient, as there are lots of treatment options.

If a child continues to wheeze after having bronchiolitis or a respiratory virus, does that mean they have asthma?

That happens all the time. A child will get a virus, be diagnosed with bronchiolitis, sometimes they even land in the hospital, and they have asthma symptoms, such as wheezing and difficulty breathing. They may be coughing a ton. The key difference is: Does the wheezing and labored breathing happen once or multiple times?

If a child needs to use that inhaler over and over again after recovering from the virus, I usually tell parents, ‘Come back and see me, and then we’re going to have the asthma talk.’

Can you share some tips to manage asthma at home?

There are many ways to reduce exposure to triggers, for example putting dust mite covers on the mattresses and pillows; using household supplies without toxic chemicals; cleaning mold; and eliminating pests.

It’s also helpful to develop an asthma action plan with your child, so they know exactly how to manage it. Put the action plan with asthma medications in a clear, plastic bag that your child can carry to a friend’s house or school.

What new treatments for asthma are on the horizon?

One of the most exciting advancements is what we call the biologics. Biologic therapy is an injection of monoclonal antibodies that target allergic triggers. Most of the biologics are to treat moderate to severe asthma. The injections, given every two to four weeks, are the closest thing to a cure for asthma because they can actually reverse the allergic inflammation from the very beginning.