Dr Phil Kieran: Will my three-year-old grow out of his asthma?

About 75% of kids with asthma will grow out of it between six and puberty

Asthma is the most common chronic condition in childhood

My three-year-old son was recently diagnosed with asthma. He’s on inhalers, which have helped to ease the wheezing, and he now sleeps through most nights. What are the chances he will grow out of it? I’m concerned about him being on long-term medication.

Asthma is the most common chronic condition in childhood, affecting 21% of Irish children. Symptoms include a persistent cough and wheeze or recurrent chest infections.

Asthma is caused by the medium-sized airways in the lungs narrowing more than they should and more frequently. This results in the characteristic high-pitched wheeze as air is forced through narrow passageways. Irritants such as cigarette smoke or vape vapour (even if it’s residue on your clothes) can worsen asthma, so I strongly recommend family members to quit. Carpets, feather duvets and pillows can also cause problems for some with asthma. Most children with asthma use inhalers to manage their condition, allowing them to enjoy the same activities as their peers.

The inhalers we prescribe usually come in two types: relievers and preventers. Typically, your GP will start your child on both inhalers if they believe they have asthma.

The ‘blue’ inhaler is the most common reliever inhaler and contains a medication called salbutamol. The ‘brown’ inhaler has a medication called beclomethasone, a preventer. Salbutamol works very quickly, and it’s the one most people will be familiar with. It goes in the school bag just in case and is often taken before exercise. It gives instant results and is used only when needed. 

The reliever inhaler is also the one most people are comfortable with their child taking and often, unfortunately, the only one used. It only treats the symptoms and does nothing for the underlying condition. In fact, relying on the reliever solely and not utilising the preventer tends to make asthma symptoms worse and attacks more frequent.

You need to use the ‘brown’ preventer inhaler daily, whether you have symptoms or not, to reduce the need for the reliever inhaler. This reduces the inflammation asthma causes and often allows GPs to cut back overall medication.

The goal of asthma treatment is not to need the blue inhaler more than twice per week, ideally not needing to use it at all. Talking to your GP and getting a printed action plan can make it a lot easier to control your child’s asthma.

Your concern about your son being on long-term medication is reasonable. However, about 75% of kids with asthma will grow out of it between the ages of six and puberty. The likelihood of this happening is improved with good control, so it is vital to keep up using the preventer inhaler. Doctors will sometimes change the blue/brown inhaler for a combined inhaler, which can be used as a preventer and reliever, but it is essential to control the asthma first.

If you have a question for Dr Phil Kieran, please send it to [e-mail]