Both children and adults have airway inflammation and obstruction, as described on the previous page. However, asthma in children differs from asthma in adults for several other reasons. Children are not diagnosed with asthma until they have had several attacks, as described on the next page. For many children who have asthma before age 3, there is a good chance it will go away in the next few years. This is particularly true for children who have no family history of allergy or asthma and who started wheezing because of an infection.

Diagnosing asthma is also more difficult in children, particularly those under the age of 5. In adults, it is fairly easy to perform a lung function test. This is not the case with young children, who can't easily be coaxed to blow into a spirometer, a device that measures lung capacity. Therefore, the physician often has to assume the diagnosis is asthma and treat it without really being sure. Also, an adult patient can tell the doctor if he is wheezing, waking up at night, and having difficulty breathing. Nighttime wheezing is a common symptom of asthma in both adults and children, and often precedes daytime symptoms. With a young child, someone else has to observe the symptoms. If the child's symptoms aren't disturbing enough to wake a parent during the night, the parent is often unaware. This frequently leads to a delay in recognizing the symptoms and seeking care. Thus, children often aren't seen by a physician until later in the course of the problem--and their first visit may be to the emergency room.

A key part of managing chronic asthma is following patients to determine how they are doing and to adjust medications accordingly. Part of that monitoring is making objective measurements of the airflow in the lungs. This can be done using a spirometer in a doctor's office or at home with a peak flow meter. But most young children (again, under 5) can't effectively use these devices, which require patients to follow instructions and blow into a tube. This means it is impossible to keep measurements on lungs over time, which makes it harder to make decisions about medication use for a young child.

Young children do not have as many medication options as adults because many asthma medications have not been studied in young children. Also, young children can't always take medicines the same way adults can. Adults can use inhalers and nebulizers to take aerosol medications, while young children must use face masks. Face masks reduce the dose that actually reaches the lung. The exact dose has been calculated for children of different ages using various medication delivery systems, but all of these choices and issues make children's asthma more difficult to manage. Older children can handle inhalers; a good time to teach kids to use inhalers is when they start school.

A key difference between young children and adults is that side effects of medications in children are not well understood. While adults can describe when they are feeling different as a result of medication, this is not usually the case in children. Therefore, the side effects described for medications in young children are what adults report about the same medications (such as a headache or feeling jittery) or symptoms that adults can observe in children (such as shaking of the hands or tremor). Children may not eat, sleep, or play as usual with certain medications, but these symptoms are difficult to report or observe until they represent a marked divergence from normal behaviors.

All of these differences make treating young children with asthma a little more difficult than treating adults.