What are the early warning signs that my child's asthma is getting worse?

The earliest signs are often subtle and easy to miss, including a persistent night-time cough that is new or different from usual, increased reliance on the reliever inhaler, reduced energy or breathlessness during play that wasn't there before, and disturbed sleep due to coughing or wheeze. These signs typically appear before visible breathing difficulty sets in, which is exactly why I encourage parents not to wait for obvious distress before acting. Following the child's individualised asthma action plan at this early stage, rather than waiting to see if symptoms settle on their own, is usually what keeps a flare-up from escalating into an attack that needs emergency care. If early signs are not responding to the usual reliever dose within the timeframe set out in the action plan, that is the signal to seek medical assessment rather than continuing to manage it at home.