How do I know if my child has asthma?

The most common signs are recurrent dry cough (especially at night and during exercise), wheezing, shortness of breath, and chest tightness. If these episodes repeat, worsen with colds or exposure to dust and cold air, and improve with a bronchodilator, asthma is likely. The diagnosis is confirmed by a pediatrician based on clinical history and, for children over 6, spirometry.

Can childhood asthma be cured?

Asthma is a chronic condition that cannot be cured but can be excellently controlled. About 50-60% of children experience significant improvement or remission of symptoms by adolescence. Continuous treatment with inhaled corticosteroids keeps inflammation under control and allows the child to live a completely normal life, including playing sports.

Are asthma inhalers safe for children?

Yes. Inhaled corticosteroids (maintenance inhalers) are the safest and most effective treatment for asthma. In inhaled form, the dose is very low and acts directly on the lungs, with minimal systemic absorption. Studies show that children who use inhaled corticosteroids regularly have fewer crises, fewer hospitalizations, and better quality of life.

How do I use an inhaler with spacer for my child?

A spacer is mandatory for children — never use the inhaler directly in the mouth. For children up to 3 years: spacer with face mask. Over 4 years: spacer with mouthpiece. Shake the inhaler, attach to the spacer, press once, and let the child breathe slowly 6-8 times. Always have the child rinse their mouth after inhaled corticosteroids.

Can a child with asthma exercise?

Yes! Exercise is recommended for children with asthma. Physical activity improves lung capacity and fitness. Swimming is especially recommended due to the humid environment. If exercise triggers symptoms, the pediatrician may recommend using a bronchodilator 15-20 minutes before. Well-controlled asthma allows the child to practice any sport.

When should I take my child to the ER for an asthma attack?

Seek emergency care if: the child has difficulty speaking or eating due to breathlessness, ribs become visible when breathing (intercostal retraction), lips or nails turn blue/purple, the rescue bronchodilator has no effect after 2-3 puffs, or the child is very agitated or excessively drowsy. Do not wait — severe asthma attacks can escalate quickly.

Childhood Asthma: Complete Guide for Parents in Brazil

Asthma is the most common chronic disease in childhood, affecting approximately 20% of Brazilian children. For expat families in São Paulo, understanding how asthma is diagnosed and treated in Brazil is essential. Persistent cough, wheezing, and shortness of breath during play can be frightening, but asthma has effective treatment. With proper management, your child can live a completely normal life, including playing sports. This guide covers everything you need to know about identifying, treating, and preventing asthma attacks.

What Is Childhood Asthma?

Asthma is a chronic inflammatory disease of the airways. In children with asthma, the bronchi (tubes that carry air to the lungs) are chronically inflamed and hypersensitive. When exposed to triggers such as viruses, allergens, or cold air, the airways narrow (bronchospasm), swell, and produce excess mucus, making it hard to breathe. Children with allergic rhinitis or eczema (atopic dermatitis) are at higher risk of developing asthma, as these conditions are part of the “atopic march.”

If your child was not previously diagnosed with asthma before moving to Brazil, be aware that São Paulo's air pollution and seasonal weather changes can unmask or worsen respiratory conditions. Finding an English-speaking pediatrician who understands both international and Brazilian treatment guidelines is important for proper management.

Asthma in Brazil: Key Facts

20%

of Brazilian children are affected

50-60%

improve by adolescence

chronic disease in childhood

Symptoms: How to Recognize Asthma in Children

Asthma symptoms can vary from mild to severe. The classic signs include:

Classic Asthma Symptoms

Recurrent dry cough, especially at night or early morning

Wheezing (a whistling sound when breathing out)

Shortness of breath during play or exercise

Chest tightness — child may say 'my chest hurts'

Symptoms that worsen with colds or respiratory infections

Symptoms triggered by dust, cold air, or cigarette smoke

Cough that lasts longer than typical colds

Episodes that improve with bronchodilator (rescue inhaler)

Pediatrician's Tip

Not every child with asthma wheezes. Some children present only with chronic cough, especially at night, during exercise, or when laughing. If your child has a persistent cough that does not resolve with typical cold treatments, asthma should be investigated. Also keep in mind that bronchiolitis in infancy can be a precursor to asthma in some children.

Diagnosis in Brazil

In children under 6, asthma diagnosis is primarily clinical — based on symptom history, family history, and response to treatment. There is no single definitive test for young children. For children over 6, a spirometry test (pulmonary function test) can confirm the diagnosis by measuring how well the lungs work.

In São Paulo, spirometry is available at major hospitals (Hospital Israelita Albert Einstein, Hospital Sírio-Libanês, Hospital Sabará) and at specialized pulmonology clinics. Your pediatrician can refer you and explain results in English. Understanding the cost of pediatric care in advance helps with planning, especially if you are using international insurance with reimbursement.

Clinical Assessment (All Ages)

The pediatrician evaluates symptom patterns, triggers, family history of allergy/asthma, and response to bronchodilator. A therapeutic trial with inhaled medication may be used to confirm the diagnosis.

Spirometry (Children 6+ Years)

Measures airflow before and after bronchodilator use. A significant improvement after bronchodilator confirms reversible airway obstruction, the hallmark of asthma.

Allergy Testing

Skin prick tests or specific IgE blood tests identify which allergens trigger symptoms. This guides environmental control measures and helps distinguish asthma triggers from those causing allergic rhinitis.

Asthma Attack: What to Do

An asthma attack (exacerbation) is a sudden worsening of symptoms. Every family with an asthmatic child should have an action plan prepared with their pediatrician. Here is what to do during an attack:

Step-by-Step During an Attack

Stay calm— your anxiety can increase the child's distress
Give rescue bronchodilator (salbutamol/albuterol) via spacer: 2-4 puffs, wait 20 minutes
Observe the response — if symptoms improve, repeat every 4 hours as needed
If no improvement after 2-3 rounds of rescue inhaler, seek emergency care
Keep the child sitting upright — this helps breathing

GO TO THE ER IMMEDIATELY If:

The child cannot speak in full sentences due to breathlessness
Speaking only in words or short phrases indicates severe obstruction
Visible rib retraction when breathing (intercostal retraction)
The skin between or below the ribs pulls in with each breath
Blue or purple lips, fingertips, or nails (cyanosis)
Indicates dangerously low oxygen levels — call emergency services
Rescue inhaler provides no relief after 2-3 puffs
The attack may be too severe for home management
The child is excessively drowsy or agitated
Both can indicate low oxygen or respiratory fatigue

In São Paulo, major hospitals with pediatric emergency departments include Hospital Sabará (children-only), Hospital Albert Einstein, and Hospital Sírio-Libanês. If you are on international insurance, see our guide on the Brazilian healthcare system for expats.

Need urgent guidance about your child's breathing?

Dr. Paula is available via WhatsApp for quick assessments and can guide you on whether emergency care is needed.

Talk to the Pediatrician

Treatment: Controller vs Rescue Medications

Asthma treatment involves two types of medication. Understanding the difference is crucial:

Controller (Daily Maintenance)

Inhaled corticosteroids (budesonide, fluticasone, beclomethasone)
Used daily, even when symptom-free
Reduces airway inflammation and prevents attacks
Very safe in inhaled form — minimal systemic absorption

Rescue (As Needed)

Short-acting bronchodilators (salbutamol/albuterol)
Used only during symptoms or attacks
Opens airways quickly (relief in 5-15 minutes)
Using rescue inhaler >2x/week = asthma not well controlled

Inhaler with Spacer: Proper Technique

A spacer device is mandatory for children — never use the inhaler directly in the mouth. The spacer traps the medication in a chamber, allowing the child to breathe it in gradually, which dramatically improves how much medicine reaches the lungs.

Spacer Technique by Age

Under 3 years: Spacer with face mask — ensure a tight seal around nose and mouth. Let the child breathe 6-8 times.

4 years and older: Spacer with mouthpiece — child places lips around the mouthpiece and breathes slowly and deeply 6-8 times.

Important: Shake the inhaler, attach to spacer, press one puff at a time. Wait between puffs if multiple are prescribed.

After corticosteroid: Always have the child rinse their mouth with water and spit to prevent oral thrush.

Spacers are widely available at pharmacies (farmácias) in São Paulo. Common brands include Aerochamber and Vortex. Your pediatrician can demonstrate the technique during a consultation.

Common Triggers and Prevention

Identifying and avoiding triggers is a key part of asthma management. In São Paulo, the most common triggers include:

Indoor Triggers

• Dust mites — the #1 trigger in Brazil
• Mold — common in humid apartments
• Pet dander — cats more than dogs
• Cigarette smoke — including secondhand
• Strong cleaning products and perfumes

Outdoor / Other Triggers

• Air pollution— a major issue in São Paulo
• Cold, dry air — winter months (May-August)
• Viral infections — colds and flu
• Exercise — especially in cold, dry conditions
• Emotional stress — crying, laughing hard

Environmental Control Checklist

Dust mite-proof covers on mattress and pillow

Wash bedding weekly in hot water (60°C / 140°F)

Remove stuffed animals or wash them weekly

Use HEPA-filter vacuum (do not sweep)

Keep rooms well-ventilated (prevent mold)

Avoid strong cleaning products and air fresheners

No smoking anywhere inside the home or car

Keep vaccinations up to date

Can Children with Asthma Exercise?

Yes! Exercise is not only allowed but recommended for children with asthma. Physical activity improves lung capacity, cardiovascular fitness, and overall well-being. Swimming is especially beneficial because the warm, humid environment is less likely to trigger symptoms.

If exercise triggers symptoms, the pediatrician may recommend using the rescue bronchodilator 15-20 minutes before activity. With well-controlled asthma, your child can participate in any sport — many elite athletes have asthma. The key is that asthma should never limit physical activity; if it does, the treatment plan needs adjustment.

Managing Asthma in São Paulo: Tips for Expat Families

Practical Tips

Medications: Asthma inhalers are available at any pharmacy in Brazil, often without a prescription for common brands. Prices are generally lower than in the US or Europe.
Brand names differ: Salbutamol (called albuterol in the US) is the rescue bronchodilator. Your pediatrician can provide equivalent medication names.
Pollution alerts: Monitor the CETESB air quality index. On high-pollution days, limit outdoor activities.
Winter preparation: May through August is critical. Increase controller medication if advised by your doctor. Children in daycare are more exposed to viral triggers.
Insurance: Asthma medications and consultations are typically reimbursable by international health plans. Telemedicine follow-ups can help with ongoing management.

Scientific References

Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2024 Update.
Sociedade Brasileira de Pediatria. Asma na Infância: Guia Prático de Atualização. 2023.
Sociedade Brasileira de Pneumologia e Tisiologia. Diretrizes da SBPT para o Manejo da Asma. J Bras Pneumol. 2020.
Solé D, et al. International Study of Asthma and Allergies in Childhood (ISAAC): Prevalence in Brazilian children. J Pediatr (Rio J). 2006;82(5):341-346.