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Column originally published Jan 8, 2008

Severe Asthma Attack Can Be Caused By Multiple Triggers

Question: Our ten-year-old son was admitted to the hospital several weeks ago. The night before he got sick, he had a sleep-over at a friendʼs house. The next morning he called me, and I could tell that he had trouble speaking. When I arrived to pick him up, he had difficulty breathing and he could hardly walk. We took him to the hospital right away. The doctor told us that he had a severe asthma attack. We never knew that he has asthma. When he has a cold, he would cough for no more than one to two weeks, and he always gets better with some cough medicine. When we asked him what happened at his friendʼs house, he said that his friendʼs parents were smoking. They played in the basement, and he ended up sleeping on their couch. When he woke up in the morning, he was coughing and had difficulty breathing. The paediatrician that saw him told us to keep giving him the steroid puffer for a while even though he is better now. I am really scared of steroid, and I am still not convinced that our son has asthma. Is there a way to find out about this?


From your description, your doctors are correct: your son most likely has had a severe asthma attack. It is sometimes difficult for parents to understand how their children can suddenly develop an asthma attack without ever being diagnosed with asthma before. In my work, I have been asked this question many times. Let me try to explain to you here.

Asthma is an allergic condition of the lungs. There are many forms of allergy: hayfever, food allergy, drug allergy, skin allergy, etc. Allergy is a genetic condition where our body over-reacts to things. Most of the time, asthma is caused by allergy in the bronchial tubes reacting to things we breathe into our lungs.

In spring and summer, the most common triggers of asthma are pollens from trees, shrubs, grass, as well as flowers from the garden. In the fall, molds from fallen leaves and decomposting vegetation can trigger asthma.

However, most Canadians with asthma are affected by things indoors, like dust, molds, animal danders, cigarette smoke, as well as chemicals. It is the dropping of dust mites (a tiny insect in house dust) that cause allergic reaction in the bronchial tubes of those who have asthma. The dust mites are found in pillows, mattresses, bedding, stuffed toys, carpet, curtains, sofas, and force-air heating system.

Molds are often found in damp basements, in bathrooms, around windows, and in the soil of indoor plants. If there is any water leak or flooding indoor, it is almost certain that molds would grow there.

Some children are allergic to household pets. Recent research has caused some confusion about this issue. Several researchers found that having pets at home can prevent some children from developing asthma. However, if a child is clearly allergic to a pet, it would be worthwhile to find a new home for it.

Cigarette smoke is a serious problem for anyone with asthma. It irritates the bronchial tube and can trigger a severe asthma attack. Parents who have children with asthma are recommended not to smoke in the house or in the car. There are some communities that have actually made it illegal for adults to smoke in the car when there are children present.

Most people are not aware of the harmful effects of chemicals that are used indoors. These chemicals include cologne, perfume, deodorant, hair spray, air freshener, and cleaning agents. Scented candles give out chemicals all the time, even when they are not being lit. Chemicals can irritate the bronchial tubes and keep them inflamed and unhealthy.

Another important trigger is viral infections. Viruses are more likely to spread in winter time when we spend more time indoors and being close to each other. Children with asthma react more severely to viruses so that their bronchial tubes are more swollen, with more mucus being produced. As a result, many children with asthma are sick for a longer period of time after a viral infection.

In your sonʼs situation, he may have developed a severe attack of asthma because he was exposed to several triggers all at once. Molds can be present in the basement of his friendʼs house. Lots of dust mites can collect inside a couch, and they were all around him while he was sleeping. His friendʼs parentsʼ smoking definitely is an important factor also. When exposed to multiple triggers, some children can develop a severe attack that can take them weeks to months to recover completely.

You may not be aware that your son has asthma because his symptoms are too mild to be recognized. Many children only have mild cough when they are not sick. They can get out of breath when they run, but unless parents are watching carefully, it can be hard to tell. Many children do not wheeze at all unless when they are very sick.

The most effective medicine for asthma is steroid. It can be given intravenously (IV) in an emergency, or can be given as pills or liquid by mouth. Steroid can get asthma under control very quickly, and it is very safe if used for a short time.

Steroid can also be given as a mist, or as puffer or dry powder that is delivered directly into the lungs to control asthma. As a result, it is extremely safe even if used as prevention for months or years. Just like any medicine, use of inhaled steroid should be supervised and guided by a physician.

It is important to recognize that once your son develop an asthma attack like what you have described, the bronchial tubes are severely inflamed and need weeks to months to completely heal. That is why your doctor recommended him to continue to use the steroid puffer even though he appears to be much better already.

If you question that your son may not have asthma after all, a lung function test can be done to examine how well air can pass through his bronchial tubes. However, this test is far from perfect, and may be completely normal because he is much better already.

Another alternative is to wait and see whether he develops symptoms of asthma, especially when he gets a cold. Although cough medicine may suppress the cough, it is not recommended for young children, or anyone with asthma.  He has to cough up the mucus that is produced in his bronchial tubes. You can also ask your doctor for a small gadget called peak flow meter which can be used at home to monitor his breathing regularly.

The best suggestion that I can give you is this: learn more about what is asthma, and what can make asthma worse. You can ask your doctor for a referral to your local Asthma Education Centre, and go to the Canadian Lung Association website ( for additional information. If there are potential triggers in your home, try to remove them. You may be able to keep your son very healthy and he may never have another attack again.