Warning signs of a severe asthma flare vary for individual children. As you know, flares occur when a trigger increases inflammation in the airways of the lung. Research suggests that common colds and flu viruses trigger the great majority of severe flares, although conditions in the environment (such as smoke and allergens) can also be important triggers. Airway inflammation leads to increased mucus production and contraction of the muscles in the airway wall (bronchospasm). When the airways in the lung narrow, more work is needed to push out waste gases, such as carbon dioxide. The body’s normal response to this airway obstruction is to increase its effort to breathe by using muscles between the ribs and in the neck, which may become more noticeable than usual, as Robert’s parents observed in the middle of the night.
The chest and belly may move in opposite directions like a seesaw as muscles below the diaphragm help to move air up and out of the lungs. A child may stop doing other activities and sit up straight to focus on breathing. His rate of breathing will increase. He may become short of breath and able to speak only a few words at a time. Normal breathing rates vary by age and are displayed on the next page.
Signs like these indicate an important change in the child’s condition and require immediate treatment with a quick-relief medicine such as albuterol. If these signs continue, it’s time to begin the flare part of your management plan and call your doctor or nurse practitioner. If symptoms get worse despite this treatment, go to an emergency department.
Normal Rates of Breathing While Awake by Age
| Age | Normal Rate of Breathing |
| Less than 2 months | Less than 60 breaths per minute |
| 2-12 months | Less than 50 breaths per minute |
| 1-5 years | Less than 40 breaths per minute |
| 6-8 years | Less than 30 breaths per minute |
With most children, particularly infants and toddlers, you can easily observe signs of severe airway obstruction. But other problems can occasionally mimic an asthma flare. In young infants, for example, a nose blocked with mucus can mimic wheezing. Clearing the nose with a suction bulb should resolve the breathing trouble. On the other hand, some children adjust to chronic obstruction of their airways and show few signs even when their condition becomes worse.
This usually happens in children with a long history of poorly controlled asthma. For these children, obtaining an objective measurement of lung function by using a peak flow meter can be very helpful. A reduction in peak flow to less than 80 percent of a child’s usual best measurement indicates moderate obstruction that should be treated with a quick-relief medicine such as albuterol. A reduction in peak flow to 50 percent of the child’s usual best should be considered a severe obstruction that requires immediate evaluation.
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