Asthma in children in Singapore: signs, inhalers and what to do in an attack

If your child wheezes, coughs at night or after running around, or gets breathless with colds, ask your doctor about asthma. Asthma in children is common in Singapore: HealthHub says it affects about one in five children here. Most children keep it under control with a reliever inhaler, sometimes a daily preventer, a spacer and a written asthma action plan. If your child is gasping or can't speak, call 995.

What to do when your child's asthma flares, step by step

1. Stay calm and sit your child upright. HealthHub says to loosen clothing around the neck and let fresh air into the room.
2. Get out your child's written asthma action plan and follow it. HealthHub says the plan comes first whenever your child has one.
3. Give the reliever inhaler through the spacer, one puff at a time, the way the plan says. With no plan, HealthHub says a child whose doctor gave an inhaler can use it for quick relief, repeated as the doctor advised.
4. Watch how your child breathes, talks and drinks. KKH says to see a doctor if your child stays breathless despite the reliever, can't speak in full sentences, can't drink well, or is drowsy or hard to calm.
5. Call 995 if your child is gasping, can't speak, or has blue lips or fingertips. HealthHub says a severe attack can become life-threatening and needs a doctor at once or an ambulance.
6. Let your child rest once breathing settles. KKH advises no exercise during an attack or soon after it.
7. Tell your child's doctor about the attack. NUH says needing the reliever very often is a reason for a medical review.
8. Tell grandparents, your helper and the preschool what happened, and where the plan and inhaler are.

Signs of asthma in children, and how doctors check

In asthma, the airways are extra sensitive. When a trigger sets them off, KKH explains, they narrow and make more mucus, so breathing gets hard. Signs to look for:

• A wheeze, the whistling noise in the chest (HealthHub).
• A cough that keeps coming back, especially at night or after exercise (HealthHub, NUH).
• Shortness of breath or a tight chest (NUH).

To tell a wheeze from the rattles of a blocked nose, see our guide to baby blocked nose and noisy breathing. If the cough came with a cold and your child breathes easily, our baby cough remedies guide covers home care.

KKH says children with eczema, allergic rhinitis or food allergies are more prone to asthma, as are children whose family members have it. See our guide to child allergy symptoms.

HealthHub says a paediatrician can usually diagnose asthma from your child's history and an examination. In children under 3, viral infections are the usual trigger. In older children, allergy matters more. The tests depend on age, as NUH and HealthHub set out:

Inhalers and the asthma action plan, in plain words

Your child's doctor picks the medicine and the dose. Your job is to know which inhaler does what. This is how KKH and NUH describe the two:

After a steroid preventer, HealthHub says to gargle and rinse the mouth with water.

Ask the doctor for a written asthma action plan if you don't have one. HealthHub says it sets out the medicines to use at home each day, the warning signs that asthma is getting worse, what extra medicine to give, and when to get help or call an ambulance. During an attack, KKH says, follow the plan and give the reliever as directed.

How to use an inhaler with a spacer

A spacer holds the puff so your child can breathe it in over several normal breaths. NUH says reliever inhalers work best this way. These steps follow HealthHub's guide:

• Take the cap off and shake the inhaler for 3 to 5 seconds.
• If the inhaler is new or hasn't been used for several days, release 2 puffs into the air first. Before a new spacer's first use, press the inhaler into it 10 times.
• Hold the inhaler upright and fit it into the end of the spacer.
• Place the mask over your child's mouth and nose with no gap. An older child using a mouthpiece seals their lips round it.
• Press the canister once to release one puff into the spacer.
• Let your child breathe in and out normally for 5 to 10 breaths. Watch the valve open and close to check it's working.
• If the doctor prescribed more than one puff, wait a minute and repeat, one puff at a time.
• If your child uses a reliever and a preventer one after the other, give the reliever first.
• Wipe the mask or mouthpiece, take the inhaler out and put the cap back on.

KKH says to clean the spacer once a week. Soak it in water with two to three drops of dishwashing liquid, don't rinse it, and let it drip dry. Don't dry it with a cloth or tissue. This keeps static down, so more medicine reaches the lungs. If your spacer's leaflet gives different cleaning steps, HealthHub says to follow the leaflet.

Common triggers in Singapore, and what helps

KKH lists colds and flu, house dust mites, animal dander, pollen, mould, changes in temperature or humidity, cigarette smoke and haze. HealthHub suggests these steps:

• Dust mites: take carpets, curtains and soft toys out of the bedroom. Use anti-dust-mite covers on pillows and mattresses, and wash bedding in 60 degrees C water every 1 to 2 weeks.
• Damp and mould: a dehumidifier can keep indoor humidity between 30% and 50%.
• Haze: keep windows closed and limit time outdoors. A mask may help if your child has to go out. Our guide to haze and kids covers asthma on haze days.
• Colds and flu: keep up with recommended vaccinations, including the yearly flu vaccine, and wash hands often. Let your child rest and recover fully when ill.
• Smoke: keep your child away from cigarette smoke. If someone at home smokes, HealthHub asks them to smoke outside and change clothes afterwards.
• Pets: if your child is allergic, keep pets out of the bedroom.

Preschool, school, sport and swimming

Everyone who looks after your child needs the plan. HealthHub says to give teachers and school staff a copy of the asthma action plan and tell them where the inhaler is kept. Grandparents and your helper need to know the symptoms and how to use the inhaler with the spacer. As your child gets older, teach them to spot breathlessness, a wheeze or a tight chest, and to tell an adult.

Exercise is good for children with asthma. HealthHub says children with exercise-induced asthma can and should join all physical activities, with good control and the right medicine. If the doctor prescribed medicine for before exercise, use it as the plan says.

Swimming is often the sport of choice, HealthHub says, because it's least likely to set off symptoms. Sports with natural breaks, like badminton, basketball and football, also tend to suit. For classes, see our guide to swimming lessons for kids.

Start with a short warm-up and end with a cool-down of 5 to 10 minutes, as HealthHub suggests. Pack the inhaler and water. If symptoms start, your child stops and rests. HealthHub says symptoms usually peak 5 to 10 minutes after the activity ends, so keep watching after the game.

When to see a doctor

See your GP, a polyclinic or your paediatrician if your child has a wheeze, a cough that keeps coming back or trouble breathing and hasn't been checked for asthma, as HealthHub advises. KKH says a cough that won't go away, with no fever or breathing trouble, can wait for your family doctor or polyclinic.

Go to KKH Children's Emergency or NUH Children's Emergency straight away if your child:

• Has very difficult or very fast breathing (NUH).
• Is too breathless to talk, drink or play (KKH).
• Can't speak in full sentences (NUH).
• Isn't helped by the reliever, or needs it very often (NUH).
• Seems very tired, drowsy or distressed, or irritable and hard to calm (NUH, KKH).
• Can't feed or drink well (KKH).
• Seems seriously unwell to you. NUH says your worry is reason enough.

Call 995 for an ambulance if your child is gasping for air, can't speak, or has blue lips or fingertips. HealthHub lists these, with chest pain, as signs of a severe attack. KKH says to call 995 in any emergency.

For regular follow-up, our guide to choosing a paediatrician and the paediatrician map help you find one nearby. Our guide to common childhood illnesses covers the other coughs and fevers.

Frequently asked questions

How common is asthma in children in Singapore?

About one in five children in Singapore has asthma, HealthHub and KKH say. In 2023, KKH's children's emergency department saw about 2,800 asthma cases, and about 1,000 of those children were admitted to hospital.

Will my child outgrow asthma?

Many children get better as they grow. HealthHub says up to half of children with asthma are likely to be attack-free in their teens, and only five percent still have asthma as adults. KKH's respiratory team adds that asthma can come back in adulthood, even after years without symptoms. Keep the preventer going until your child's doctor says to stop.

Can cold drinks or air-con trigger asthma?

Usually not. HealthHub says cold drinks, ice cream and chocolate are usually not asthma triggers, and most children can sleep in air-conditioned rooms without problems. KKH notes that some children's cough is set off by cold drinks or cold air, and suggests skipping cold drinks and citrus fruits while your child is unwell.

Do asthma inhalers affect a child's growth?

Not at normal doses. KKH says inhaled steroids used this way don't make a real difference to a child's final height, and preventer inhalers aren't addictive. Poorly controlled asthma is the bigger risk to growth.

Can my child have asthma without a wheeze?

Yes. KKH says a wheeze is common, but its absence doesn't rule asthma out. Symptoms vary, and can include a cough that's worse at night or set off by exercise or cold food and drinks. Tell your doctor about the pattern you see.