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Dr David Cremonesini
Consultant Paediatrician with an interest in allergy and respiratory paediatrics, Hinchingbrooke Hospital
Runs private clinics in Huntingdon, Milton Keynes, and Oxford for ages 0-18
Email: kidsallergy@gmail.com
Website: www.kidsallergy.co.uk
https://www.dubaiallergy.com/
The UK has the highest prevalence of asthma in the world, which means that in every classroom across the UK, there are two children with asthma. Asthma kills 10-15 children every year, and many are admitted to hospital. We know that in the vast majority of these cases, if children were treated differently, these outcomes might have been avoided. With winter approaching, it’s vital that your child’s asthma is well controlled. Here are some tips from Dr. David Cremonesini for the correct management of this common condition.
First, assess if your child’s asthma control is poor. I see children in my asthma clinic whose parents have become accustomed to their child’s asthma, limiting their sports activities, frequent coughing, and constant use of inhalers. Children should only experience these issues if they’ve been advised by a specialist and are on maximum treatment. Good control means:
If your child’s asthma doesn’t meet these criteria, see your doctor for an assessment. Frequent requests for a Ventolin inhaler are a clue; a good control means one inhaler should last 3-4 months. Unfortunately, asthma management in the UK is often suboptimal, leading to poor outcomes compared to Europe.
Poor asthma control can often be due to the failure to take prescribed treatments. If your child is on a steroid inhaler, they must use it daily, usually twice a day. If control isn’t good, treatment strength may need adjustment or additional non-steroid medications might be needed. It’s important to follow strict guidelines for escalating and reducing treatment. Parents often worry about steroids, but they are the most effective treatment if used daily. Supervision is crucial, as children may not understand why they need to take their medication. Working as a family to ensure proper usage, especially in the busy mornings, is essential.
Here’s something not all GPs know: ALL CHILDREN TAKING A PREVENTER INHALER MUST USE A SPACER. A spacer helps the medication reach the lungs more effectively. Older children might resist using spacers, finding them “babyish,” but alternative breath-activated inhalers (e.g., Accuhalers, Turbohalers) might be considered. Discuss these options with your GP or asthma nurse. For a useful summary, visit NHS Video on Inhalers.
Asthma often worsens in the summer due to hay fever. Manage allergic rhinitis with antihistamines and/or nasal steroids, ensuring proper application. If your child has symptoms all year round, consider house dust mites or pet allergies. Allergy tests can help determine if a pet contributes to asthma, though results only suggest a possibility. If removing a pet, remember it can take 6 months for all hair to leave the home. For house dust mite allergies, allergen-proof bedding like Allerguard might help. More information can be found here. Immunotherapy for house dust mites is available but not widely offered on the NHS.
NICE guidelines recommend all children have a personalized asthma plan (NICE Asthma Guidance). This plan empowers families to manage asthma effectively and know what to do during an asthma episode. If symptoms are managed well at home with Ventolin, but not improving, seek further medical advice.
Asthma is a serious condition, and in 90% of cases, deaths are preventable. Support your child, work with their school, ensure they have enough medication and an asthma plan, and visit your primary care team regularly. Consider allergies, a significant cause of asthma in children. Ensure they can lead a normal life by taking asthma seriously.
For more information, visit www.asthma.org.uk. Dr David Cremonesini offers skin prick testing and management for food allergies, hay fever (offering immunotherapy), asthma, and eczema.
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