Asthma in children | Mate huango tamariki

 Key points to remember about asthma in children

  • Asthma is a condition that leads to narrowing of the airways of the lungs.
  • Symptoms include wheeze, cough and difficulty breathing.
  • Common asthma triggers are colds (viruses), exercise, dust, pollens and cigarette smoke.
  • This page focuses on asthma in children. See also asthma in adults for more information.



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Video: What is asthma?

This video is about your lungs and how asthma affects them. It may take a few moments to load.

(Asthma Foundation NZ, 2017)

Asthma is a common breathing condition. It affects the small and medium-sized airways (bronchi) in the lungs. 

In asthma, your child's airways are inflamed and there is:

  • swelling of the airway wall
  • an increase in mucus or phlegm
  • tightening of the muscle in the airway wall (see the image below).

These changes cause narrowing of your child's airways. This leads to wheezing, cough and difficulty with breathing.

Wheezing is a musical, whistling sound that children make, usually when breathing out. It can also happen when they breathe in. The sound comes from the chest, not from the nose or throat. 

Image credit: Wikimedia Commons

One in 4 tamariki in New Zealand will have asthma at some time during childhood. It is not clear why some children have asthma when others do not.

Asthma in children is more likely if:

  • the mother smoked during pregnancy
  • they have eczema, hay fever or allergies
  • there is asthma in the family – parent, brother or sister
  • one or both parents have an allergic condition such as asthma, hay fever or eczema.

Modern Western lifestyle may play a part in the rise in asthma that has happened over the last few decades. Changes in housing, diet and a more hygienic environment may contribute. Outdoor environmental pollution may make asthma symptoms worse but it does not actually cause asthma. Experts continue to study the reasons for the increase in asthma.

Children with asthma have airways that are sensitive and react to certain triggers. Some children have asthma all year round. Others may only have it in certain seasons or situations.

Triggers that cause an asthma attack include:

  • viruses – eg, a cold with a runny nose
  • things you are allergic to such as pollens, moulds, pet hair and dust-mites
  • cold or humid weather, or a change in the weather
  • exercise
  • emotions such as anxiety and excitement
  • air pollutants, such as cigarette smoke.

Keep a symptom diary and a record of possible triggers

Asthma symptoms and triggers may differ from child to child and from time to time. It is useful to know your child's triggers. Keep a symptom diary and keep a record of possible triggers.

Make sure your child's environment is smoke-free

Ensure your child's environment is smoke-free, wherever they happen to be. Asthma increases in children whose parents smoke. Tobacco smoke also triggers asthma attacks and makes a child's asthma more severe than it would otherwise be. Many environmental factors contribute to asthma; cigarette smoke is one that you can avoid.

If you want to give up smoking:

Keep your house warm and dry

Aim to keep your house warm, dry and well-insulated.  

Read about keeping your home warm and dry(external link)

You should see your doctor and ask about asthma if your child:

  • wheezes and coughs with a cold (virus)
  • wheezes and coughs after exercise
  • wheezes and coughs during the night
  • cannot keep up when they are running around with children of the same age
  • says they are out of breath or breathless
  • complains they feel tired or asks you to carry them (depending on their age) when you go for a walk
  • does not run around as much as other children of the same age.

These are some of the symptoms of asthma in children, but they may also be due to other less common conditions. Talk to your doctor about them.

Video: Spotting asthma symptoms in your child

This video may take a few moments to load.

(Asthma UK, 2018) 

Every child with asthma needs an action plan. If your child has asthma, ask your family doctor for an asthma action plan. The plan will tell you how to prevent asthma attacks and how to manage them when they happen.

Action plans

See a child asthma action plan in te reo Māori (PDF, 574 KB)(external link)
See a child asthma action plan in English (PDF, 593 KB)(external link)
See a child asthma action plan in Samoan (PDF, 561 KB)(external link)
See a child asthma action plan in Tongan (PDF, 547 KB)(external link)

Online learning tool

You can use the Asthma + Respiratory Foundation NZ's online learning tool(external link) to learn more about how you can help children with asthma stay fit, healthy and happy.

Screenshot of Asthma + Respiratory Foundation interactive resource(external link)

Booklets to download

You can read the following translated booklets alongside the online learning tool above. 

Read a booklet about managing your child's asthma in te reo Māori (PDF, 3.06 MB)(external link)
Read a booklet about managing your child's asthma in English (PDF, 3.59 MB)(external link)
Read a booklet about managing your child's asthma in Samoan (PDF, 3.05 MB)(external link)

Preventers help prevent asthma.

Not all children need preventer medicine. If your child is getting wheezy more than once a week, your family doctor may suggest a preventer medicine. Your child needs to take their asthma preventer every day, sometimes twice a day, even when they are well. Most asthma preventers are inhalers that you need to use a spacer with. Sometimes, your doctor may give you a preventer that is a tablet.  

You will need to use the blue inhaler with a plastic tube called a spacer. 

  • give 2 puffs of the blue inhaler, one puff at a time, using the spacer, every 4 hours
  • for each puff of the blue inhaler, your child will need to take 6 breaths through the spacer

If your child is still not improving:

  • you can give up to 6 puffs of the blue inhaler every 4 hours

You need to take your child to your family doctor, or an after-hours clinic, or the hospital:

  • if you need to give the blue inhaler more often than every 2 hours
  • if there is no improvement 30 minutes after giving 6 puffs of the blue inhaler

Video: MDI and Spacer

Watch Lachlan show how to use your inhaler with a spacer (Asthma Waikato video). This video may take a few moments to load.

Asthma Waikato, NZ 2018

There are many different types of asthma medications. The choice of medication will depend on how bad your child's asthma symptoms are and how often they experience them. Sometimes more than one medicine is needed to control symptoms. A spacer with or without a mask can help deliver doses of medicines from inhalers.

The main forms of medications used are:

  • Inhalers (puffers)
  • Oral medicines such as prednisone and montelukast
  • Nebulisers (often used in hospital)

Video: Getting the best out of your asthma medicine

This video may take a few moments to load.

(Asthma + Respiratory Foundation, NZ, 2017) 


Most asthma medication is available as an inhaler (puffer). An inhaler is a device used to deliver medicine to the lungs and airways. By getting medicine directly to the lungs, smaller doses of medicine are needed and it can start working more quickly. The main types of inhaled medicines are relievers and preventers.  

The inhaled medicines can be delivered by different types of inhaler devices. The different types of inhaler devices are:

  • metered dose inhalers (MDIs) such as Respigen
  • dry powder inhalers such as Turbohalers and Accuhalers.

The type of inhaler should be chosen to suit your child's age and ability to use them properly. You should discuss the best choice for your child with your healthcare provider. Younger children can use MDIs with a mask attached to a spacer. As children get older, they can use their MDIs with a spacer (without a mask) or a dry powder inhaler. 


Examples of relievers

Image: Asthma Foundation NZ

What do relievers do?

Relievers are used for quick relief when your child has difficulty breathing. They are fast-acting and improve breathing immediately.

  • Relievers should only be when needed. Using them too often means that your child's asthma is not well controlled.
  • Relievers don’t have a lasting effect like preventers – their effect wears off in a few hours and they don’t change the swelling in the breathing tube.


Preventers are used long term to prevent asthma symptoms from coming on.

  • Preventers must be taken every day, even when your child is not having symptoms.
  • Preventers take days or weeks to work. They do NOT provide quick relief of asthma symptoms.
  • The main types of preventers commonly used are:
    • steroid preventers
    • long-acting bronchodilator preventers
    • combination steroid + long-acting bronchodilator preventers.

Steroid preventers

Examples of steroid preventers

Image: Asthma Foundation NZ

What do steroid preventers do?

They work by reducing swelling of your airway and preventing mucus build up, which narrows the airways.

Side effects: 

  • Research has found steroid preventers to be safe when used for long periods. 
  • There are some side effects that can be reduced by using a spacer and rinsing your child's mouth after using their preventer.

Combination steroid + long-acting bronchodilator preventers

Examples of combination steroid + long-acting bronchodilator preventers

Image: Asthma Foundation NZ

What do combination steroid + long-acting bronchodilator preventers do?

If your child's asthma symptoms are not fully controlled with the steroid preventer alone, your doctor may add a long-acting bronchodilator preventer in a combination inhaler.

  • The long-acting bronchodilator widens (dilates) the airways (bronchi) by relaxing the muscle that surrounds the airways for a longer period of time.
  • The long-acting reliever is combined with the steroid inhaler to help prevent and control symptoms.

Prednisone (liquid or tablets)

Prednisone is a steroid medicine that works quickly to reduce inflammation in the airways.

  • Prednisone is used if your child's asthma symptoms become severe or they have an asthma attack
  • It works slowly over several hours to reverse the swelling of the airways. 
  • Prednisone is a tablet form of corticosteroid.
  • In younger children who cannot swallow tablets, a liquid form is available called prednisolone (Redipred®).
  • Read more about prednisolone and prednisone here. 


Montelukast is a type of anti-inflammatory medicine that comes in tablet form. Montelukast is NOT used to treat an acute attack of asthma. Read more about montelukast.


A spacer is a long plastic tube that the inhaler fits onto. It makes it much easier to use an MDI and delivers more medicine to the lungs. In younger children, the spacer is attached to a mask that holds the spacer in place over the nose and mouth. As your child gets older, they can use a spacer without a mask. Your doctor or nurse can show you how to use a spacer properly. Read more about Spacers. 

TIP: You can get a spacer free from your doctor or nurse – just ask them for one.

Many children have only mild asthma. But be careful - it's possible for any child with asthma to have a severe, life-threatening attack.

When to see a doctor urgently

Keep your child sitting up and give them 6 puffs of the blue inhaler through the spacer and see a doctor urgently if your child has any of the following symptoms:

  • Is breathing fast, wheezing and having to use extra effort to breathe.
  • Is breathless at rest.
  • Looks unwell.
  • Looks pale and is beginning to get tired.
  • Gets worse after beginning to get better.
  • Has trouble completing a sentence because of difficulty breathing.
  • You are worried.

Check out the signs that your child is struggling to breathe.(external link)

When to seek emergency medical help

With severe asthma it is usually better to dial 111 rather than drive your child in your own car to the hospital.

Keep your child sitting up and give them 6 puffs of the blue inhaler through the spacer. Immediately dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for emergency medical help if your child:

  • Has severe difficulty breathing.
  • Is too breathless to talk.
  • Is floppy and very tired.
  • Is becoming less responsive.
  • Has blue lips and tongue.
  • Has periods of stopping breathing.

With severe asthma, it is usually better to dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for emergency medical help, rather than drive your child in your own car to the hospital.

While you are waiting for the ambulance, keep giving your child 6 puffs of the blue inhaler through the spacer every 5 minutes.

Asthma is a long-term condition. The majority of children with asthma have less troublesome asthma as teenagers. Symptoms can appear again in adulthood. If your child has severe asthma, it is more likely to continue or return in later life.

Your child should learn about asthma and gradually take over responsibility for its management, as they become a teenager, with support from you.

This page is about asthma action plans for children. 

What is an asthma action plan?

It can be hard to remember directions or instructions from your healthcare provider. That's why you also need an asthma action plan for your child. This is a written document to help you remember what you need to do to help them manage their asthma well.

It includes information on how to:

  • manage their asthma daily, including making sure they take their medications correctly
  • identify and avoid allergens and irritants that can bring about asthma symptoms
  • know what worsening asthma symptoms are and what to do when your child has them
  • know when, how and who to contact in an emergency.

You can develop your child's asthma action plan with your healthcare provider. It will be based on how severe their asthma is and your preferences. At each visit with your healthcare provider, you can review their plan and make changes as needed.

What are the benefits of an asthma action plan?

Using an asthma action plan that meets your child's needs has been found to:

  • reduce absences from school
  • reduce hospital admissions
  • reduce emergency visits to your general practice
  • reduce reliever medication use
  • improve lung function.

Sample asthma action plans

Note: Some of these resources are from other countries, so make sure you know the emergency numbers for New Zealand. In an emergency, phone 111 and if you want advice at other times, phone Healthline on 0800 611 116.

Asthma action plan


Child asthma symptom diary
Asthma & Respiratory Foundation, NZ

Child asthma action plan
Asthma & Respiratory Foundation, NZ

image of an interactive asthma action plan in Samoan, Tongan and Maori

Pictorial Asthma Medication Plan
Waitematā DHB

This website is for health professionals to create a PAMP (pictorial asthma medication plan) for children and their families to remind them to use their regular inhalers for asthma. Fill in plan online to create a pictorial resource of an asthma medication plan.

Start here(external link) by entering patient and medication details.

See an example of the completed plan in the following languages:

Malachi's story – asthma plan reaps positive results

Malachi Douds Nanapoy is a six-year-old from New Plymouth who has asthma. Malachi was born 31 weeks gestation (average is 40 weeks) and lives with respiratory conditions that impact on his health and his learning.

Malachi now has an asthma plan which he and his family follow. Through the guidance of their asthma nurse Sharani at Taranaki Hospital, they have become educated in managing Malachi’s asthma much more effectively. He only had one hospital visit in 2015, which is a big improvement from recent years.

Malachi's grandmother Vicki says, "as a family we are becoming more educated and able to manage without escalating crisis. Bouts of breathlessness and coughing are recognised earlier and the plan is actioned".

Malachi can now understand some of the triggers and helps his family to recognise the signs that he is not coping effectively. He understands that the cold wind affects his breathing and will come inside. Malachi also takes his inhalers, counts his puffs and lets his family know if it has not been done properly.

The improvement in Malachi's health has allowed him to attend school more frequently, and the teachers have started to see progress in his learning.

Malachi doesn't let his condition hold him back, and lives a very active life. He enjoys swimming lessons, is a great cricket player, and has done very well in cross country. Malachi came second in his first school cross country, when he only had to stop to get his breath once.

Swimming is important to Malachi and unfortunately it was an activity he could not participate in often as he had no breath. He is now becoming a confident regular swimmer at a private swimming school where the water is warmer and he can enjoy being part of a class and shooting off in the water.

Malachi also enjoys mega bounce and is quite skilled at riding his bike, remembering to come inside when it is windy.

“Malachi’s extremely confident in sports, and the joy it brings to him when he has completed a game of cricket is just awesome. We are all looking to enjoy more involvement in the community rather then being extremely ill and missing out on being an active 6 year old child," says Vicki.

Tomairangi's story – 89 hospital admissions yet still smiling

Tomairangi's severe brittle asthma has sent her to hospital 89 times. Here, her mum Sharon talks about her daughter's resilience and the effect her condition has had on the whole family, both good and bad.

"Our daughter Tomairangi is 12 years old. She's been in hospital 89 times – that's 272 days of her life. That makes you question things, like the amount of school she’s missed out on. Not just from an academic perspective, but everything else that she misses out on. She has friends, but these are friends for school. She never has enough time to develop her friendships. Never had a best friend. Doesn’t get invited to parties or birthdays. Never gets a visit from any of her friends while she’s in hospital. Friendships need time to grow, to nurture and deepen. You can’t really do that when you’re in hospital. Her best friends are probably the nurses and the play therapist.

My daughter’s asthma is classed as severe brittle. It’s unpredictable. It’s stubborn. It takes on a life of its own. It keeps trying to kill her, again and again. It nearly succeeded last year, but our daughter is strong, so resilient. When you have two respiratory arrests, and lose a cardiac output twice and need CPR for a total of 11 minutes and it still can’t take you, you’re superhuman. That day was the worst. I play it over and over in my head at times.

The fear is always there. Stuff like that plays with your head and makes things so much harder to cope with. The post-traumatic stress is in all of us. Me, Tomairangi, my husband and our other children. Every time Tomairangi has a bad asthma attack, every time she looks at me with sheer panic in her eyes that she can’t breathe. Every time the phone rings and the caller ID says it’s either school or the hospital, my heart skips a beat, my stomach drops and I lose my breath.

We sleep in power nap mode with one ear always open. Every cough, every cry, every wheeze, I hear them all. We probably get two to three hours of uninterrupted sleep every night, from 1 to 3 am. In between those times it’s puffers, and drinks of water, breathing exercises and coughing up phlegm. It’s tears, and fears of not being able to breathe. It’s relentless.

Our other children manifest their fear in different ways. One misbehaves at school, starts fights, gets frustrated and angry and tearful. The other goes quiet. Doesn’t get in the way, doesn’t bother anyone, retreats back into herself. They’ve seen a lot over their few short years. Spent far too much time in hospitals. Their relationship with their sister is difficult. Like friendships, it’s hard to maintain a healthy relationship when one half is never there. So when they do end up all together, it’s chaotic. Laughs, fights, tears all in the space of a few minutes. It’s an extreme roller coaster of emotions and these kids don’t know whether to laugh and enjoy it or cry and get off the damn thing.

Work is very understanding. Allowing me the time I need to look after our daughter. My husband’s work not so. It’s the same with every manager he’s ever had. Sure they’re understanding and sympathetic to start with, really feel sorry for our situation. But then one absence turns into another and another and another, and then the questioning starts.

It’s not like this for every child with asthma, but it is like this for us. It’s a hard road to travel. But you know what? Through all of this our little family is so strong. We know what’s important and what isn’t. Determined to do what we can to give our daughter the life she deserves.

We’re excited by the prospect that a cure for asthma may be found in her lifetime. We hold onto that hope. So that she can be her own person and not someone defined by her medical condition."

To help manage you or a family members' asthma, it's important to have an asthma plan(external link) in place. See your doctor and ask for an asthma plan.

Source: Asthma & Respiratory Foundation NZ(external link)

This page has information for parents and for teachers and other staff to help manage asthma in children.

Managing asthma at school – for parents

There are things you can do to help your child and the school staff to manage your child's asthma while they are at school.

Talk to the staff

  • Discuss your child's asthma with their teacher and school nurse or health representative.
  • Explain how they can prevent or recognise symptoms of asthma.
  • Give them a copy of your child's asthma action plan(external link) to follow if they have an asthma attack.
  • Ask the school to become an asthma friendly school and put an asthma policy in place.

Provide your permission and contact details

  • Give the school your written permission for them to give reliever medicine to your child in an emergency.
  • Make sure your contact phone numbers are kept up to date in school records.
Plan for trips and special activities
  • Check to see if the school has an asthma policy.
  • Make sure there is a plan for school trips, camps, sports clubs and all activities your child is taking part in.

Managing asthma at school – for teachers and other staff

The Asthma & Respiratory Foundation NZ recommend that every school has a School Asthma Policy(external link) to maintain the wellbeing and safety of all students with asthma, both at school and during extra-curricular activities. 

You can take steps to make sure your school is an asthma friendly school.

An asthma friendly school:

  • identifies children with asthma when they enrol at the school
  • knows the asthma action plan(external link) for each child
  • has staff educated in asthma safety
  • has an asthma policy
  • maintains a smokefree environment 24 hours a day, 7 days a week.

Advantages of asthma friendly schools include the following:

  • Children with asthma are supported, learn more in the classroom and get more out of their school life.
  • Some 550,000 school days are lost to asthma each year in New Zealand. Asthma friendly schools have fewer absences to cope with and more children are at school learning, rather than unwell at home.
  • The risks of an asthma attack (or at least an attack nobody at the school can deal with) are reduced.
  • It means there is fuller student participation in physical activities. Children with asthma are often kept on the sidelines because their asthma is not managed. If everyone is more informed, it is much more likely that children with asthma will be able to take part in physical activities.

Schools that meet the criteria for an asthma friendly school receive an Asthma Emergency Kit, including a letter allowing access to a reliever inhaler and a certificate stating they are an asthma friendly school from the Asthma & Respiratory Foundation NZ. For more information on asthma friendly schools contact Asthma & Respiratory Foundation NZ(external link).

Teachers' Asthma Toolkit

The information in this toolkit will help you and your learning community understand more about asthma and how you can support people with asthma to manage their condition.

Throughout this toolkit, you will find suggestions for using some of the materials in staff meetings. There are also links to resources and lesson plans you can use in your classroom, particularly in the context of Strands A and D of the Health and Physical Education learning area.

Resources for schools


Many of the resources below are translated into multiple languages. Please note that some of these resources are from overseas and the support and services information will be different to those used in New Zealand. 

See also asthma action plans for children(external link).

All resources from Asthma and Respiratory NZ can be found here.(external link) Below are some commonly used ones.

Managing your child's asthma(external link) Asthma Foundation, NZ te reo Māori(external link), Samoan(external link)
Parent's asthma toolkit – read, watch, listen(external link) Asthma Foundation, NZ
Teacher's asthma toolkit(external link) Asthma Foundation, NZ
Understanding your inhaler(external link) The Asthma Foundation, NZ, 2013
Home sweet healthy home (external link)Asthma & Respiratory Foundation NZ

These resources is from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.

Asthma – the basic facts(external link) Asthma Australia
Asthma and wheezing in the first years of life [PDF, 481 KB] NSW Multicultural Health Communication Service, Australia Arabic(external link) (PDF file - 330 KB), Chinese (Simplified)(external link) (PDF file - 480 KB), Korean(external link) (PDF file - 406 KB), Spanish(external link) (PDF file - 301 KB), Vietnamese(external link) (PDF file - 305 KB)

Guidelines and clinical pathways

NZ child asthma guidelines 2020(external link) Asthma and Respiratory Foundation NZ, 2020
Pharmacological management of asthma in children aged 5–11 years(external link) BPAC, NZ, 2020
Is it asthma? Assessing and managing wheeze in pre-school children(external link) BPAC, NZ, 2020
Asthma Control Test (external link) GSK
He māramatanga huangō – asthma health literacy for Māori children in NZ(external link) Ministry of Health, NZ
The international study of asthma and allergies in childhood(external link) The Global Asthma Network

See also the clinician's page on asthma in adults for guidelines and other resources for adults with asthma, and Long-term conditions for healthcare providers

Continuing medical education


Asthma management in children(external link) Goodfellow eLearning, NZ, 2020


Asthma in under five-year-olds(external link) Goodfellow Podcast, NZ, 2020
Dr David McNamara talks through addressing the challenges and barriers to diagnosis of asthma in the under five-year-old child.

Videos or webinars

Asthma and COPD in children updates (10 videos)(external link) PHARMAC Seminar Series, NZ, October 2015

Video: Goodfellow Unit MedTalk: Paediatric Asthma

"Dr Diana North, (Goodfellow Unit GP Advisor) talks with Dr David McNamara, (Paediatric Respiratory and Sleep Medicine Specialist employed at Auckland's Starship Children's Hospital) about what is new in the diagnosis and management of asthma in children up to 16 years of age." This video may take a few moments to load.

(Goodfellow Unit, NZ, 2017)


Asthma and COPD Fundamentals Course(external link) Asthma & Respiratory Foundation NZ 
This course aligns the latest research with specific information for the New Zealand context, such as recently funded medications, treating Māori and Pasifika peoples, and best practice health literacy. The course aligns with the latest New Zealand asthma guidelines. It includes two half day workshops covering the key aspects of COPD and asthma pathophysiology, management and practice.


child asthma action plan asthma resp foundation nz

Child asthma action plan

Asthma and Respiratory Foundation, NZ, 2022
English, te reo Māori, Samoan, Tongan

child asthma symptom diary asthma resp foundation nz

Child asthma symptom diary

Asthma and Respiratory Foundation, NZ, 2022
English, te reo Māori, Samoan, Tongan

managing your childs asthma asthma and respiratory foundation

Managing your child's symptoms
Asthma and Respiratory Foundation NZ, 2017

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