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This information was reviewed and approved by Ronina A. Covar, MD (6/1/2017).

Asthma symptoms can range from very mild to severe. Some children with asthma have only occasional or episodic symptoms, and some have seasonal symptoms.

Asthma symptoms can range from very mild to severe.Others have a more chronic form of the disease and experience symptoms such as a chronic cough, shortness of breath or activity limitation weekly or daily. Some children have “asthma attacks,” in which symptoms seem to develop suddenly.

You and your child can learn to recognize signs and symptoms of asthma, and take precautions to decrease the exposure to triggers and the severity of an asthma episode. It is important to recognize and treat even mild symptoms. This can help decrease the amount of inflammation and reduce the risk of a more serious episode.


Early Warning Signs of Asthma

Many times, you receive clues that an asthma episode may be developing — before breathing difficulty begins. These clues are called early warning signs. Listed below are common early warning signs. These early warning signs are often unique for each person. Keep track of these signs for a few weeks. It is also helpful to look back on past episodes and see if your child had any of these early warning signs.

Common early warning signs include:

  • Breathing changes
  • Sneezing
  • Moodiness
  • Headache
  • Runny/stuffy nose
  • Coughing
  • Chin or throat itchiness
  • Feeling tired
  • Dark circles under eyes
  • Trouble sleeping
  • Poor tolerance for exercise
  • Downward trend in peak flow numbers


Asthma Symptoms

Asthma symptoms indicate that an asthma episode or asthma attack is occurring. Changes have taken place in the airways, and airflow is obstructed. Individuals with asthma experience some or all of these during an asthma episode. Action should be taken to treat these symptoms before they become worse.

Asthma symptoms include:

  • Coughing
  • Shortness of breath
  • Tightness in the chest
  • Wheezing


Severe Asthma Symptoms

Severe asthma symptoms or a severe asthma attack can be a life-threatening emergency.

Severe asthma symptoms include:

  • Severe coughing, shortness of breath, tightness in the chest and/or wheezing
  • Difficulty talking or concentrating
  • Shortness of breath when walking
  • Breathing that may be shallow and faster or slower than usual
  • Hunched shoulders (posturing)
  • Neck area and area between or below the ribs moving inward with breathing (retractions)
  • Gray or bluish tint to skin, beginning around the mouth (cyanosis)

If any of these symptoms occur, seek emergency treatment right away. Have an action plan for getting emergency care quickly in the event of severe asthma symptoms.


Peak Flow Monitoring

In addition to watching for asthma symptoms, a peak flow meter can help you monitor your child’s asthma. A peak flow meter can be especially useful if a child has moderate to severe asthma or has difficulty identifying asthma symptoms. A peak flow meter is a small, easy-to-use instrument that measures the peak expiratory flow — how fast you blow out air after a maximum inhalation. It reveals how well your child’s lungs are working. Young children, often by age 5 or 6, can learn to use a peak flow meter and produce reliable, consistent results.

It is important to know that peak flow numbers are effort dependent. This means your child needs to put forth a good effort to have reliable, consistent results. Your doctor may have your child demonstrate peak flow meter technique at each visit to make sure it is done correctly.

It is very important to understand that you should seek medical attention (doctor’s office or emergency room) when your child is not responding to treatment at home.

A daily (or regular) record of peak flow numbers can provide you with a valuable early warning sign. Sometimes peak flow numbers will decrease hours, or even a day or two, before other asthma symptoms become evident. When you monitor peak flow numbers on a daily (or regular) basis, you can identify this drop and take steps to prevent an asthma episode. The peak flow numbers, along with watching for asthma symptoms, can be used to make decisions about asthma treatment.

The highest number your child can blow regularly is the “personal best.” This is determined by recording peak flow numbers daily for two to three weeks when the asthma is under good control. Talk with your child’s doctor about determining your child’s “personal best.”

Once you know your child’s personal best, it may be helpful for you and your doctor to establish zones. Zones will cue you about how well your child is breathing and actions you should take. The zone system can be compared to the colors of a traffic light.

Green Zone Signals All Clear

This indicates good lung function. Follow the routine treatment plan for maintaining asthma control.


Yellow Zone Signals Caution

Your child may need more aggressive medical management for asthma. This may include a temporary increase in quick-relief medication and inhaled steroid medications, an oral steroid burst or other medications, as prescribed by your child’s doctor.


Red Zone Signals a Medical Alert

Your child needs immediate treatment with quick-relief medication. Notify your child’s doctor or go to the emergency room if peak flow numbers don’t return and stay in the yellow or green zone.

Your doctor can help determine what your child’s “personal best” is and what steps you should take when the peak flow numbers are in the green, yellow or red zones.

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