Asthma in Children
Medications
Medicine does not cure asthma. But it is an important part of managing the condition. Medicines for asthma treatment are used to:
- Prevent and control the airway inflammation
to minimize long-term lung damage.
- Decrease the severity, frequency, and duration of asthma attacks.
- Treat the attacks as they occur.
Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks. Most children with persistent asthma need to use long-term medicines daily. Quick-relief medicines are used as needed and provide rapid relief of symptoms during asthma attacks.
Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, different medicines and doses of medicines may be used. Special consideration may be necessary before and during exercise and before surgery.
Medicine delivery
Most medicines for asthma are inhaled. Inhaled medicines are used because a specific dose of the medicine can be given directly to the bronchial tubes. Different types of delivery systems may be used to do this, and one type may be more suitable for certain people or age groups than another. Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.
Many doctors recommend that every child who uses a metered-dose inhaler (MDI) also use a spacer
If your child is younger than 3, he or she may not be able to use an MDI alone but, with assistance, may be able to use an MDI with a mask spacer. Most school-age children can use an MDI. If your child is having a hard time using an MDI with a spacer, he or she can use a nebulizer. Work with your doctor to find the best delivery system for your child.
It is important to keep track of the inhaler doses and discard the inhaler when your child has used the number of doses shown on the package label. This not only prevents your child from having an empty inhaler when he or she might need medicine, but it also prevents your child from inhaling only propellant after the medicine has run out. Some newer inhalers have built-in counters to keep track of doses left. For more information on using an inhaler, see:
Asthma: Using a metered-dose inhaler.
Medication choices
The most important asthma medicines are:
- Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. They reduce inflammation of your child's airways and are taken every day to keep asthma under control and to prevent sudden and severe symptoms (asthma attacks). Inhaled corticosteroids include beclomethasone, triamcinolone, fluticasone, budesonide, and flunisolide.
- Oral or injected corticosteroids (systemic corticosteroids) to get your child's asthma under control before he or she starts taking daily medicine. Your child may also need these medicines to treat asthma attacks. Oral corticosteroids include prednisone and dexamethasone.
- Short-acting beta2-agonists for asthma attacks. They relax the airways, allowing your child to breathe easier. These medicines include albuterol and pirbuterol.
Long-term medicines sometimes used alone or with other medicines for daily treatment include:
- Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
- Long-acting beta2-agonists (such as salmeterol and formoterol). They are always used with an inhaled corticosteroid.
- Less commonly, your doctor may recommend a mast cell stabilizer (such as cromolyn) or theophylline (such as Uniphyl).
Other medicines may be given in some cases.
- Anticholinergics (such as ipratropium) are usually used for severe asthma attacks.
- Other medicine such as omalizumab or magnesium sulfate may be used if asthma does not improve with treatment. An asthma specialist generally prescribes this medicine.
Medicine treatment for asthma depends on your child’s age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.
- Children up to age 4 are usually treated a little differently than those 5 to 11 years old.
- The least amount of medicine that controls your child’s symptoms is used.
- The amount of medicine and number of medicines are increased in steps. So if your child’s asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
- If your child’s asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control your child’s asthma.
- Quick-relief medicine is used to treat asthma attacks. But if your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.
Your child’s doctor will work with you and your child to help find the number and dose of medicines that work best.
What to Think About
Medicines are usually added one at a time to keep the number of medicines low. The dosage of each medicine should correspond to the severity of the child's asthma. In general, your doctor will start your child at a higher dose within an asthma classification so that the inflammation is immediately controlled. After symptoms have been under control for a period of time, the dose of the last medicine added may be reduced to the lowest possible dose for maintenance. This is known as step-down care. Step-down care is believed to be a better way to control inflammation in the bronchial tubes than starting at lower doses of medicine and increasing the medicine if the dose is not enough.
Because quick-relief medicine quickly reduces symptoms, children sometimes overuse these medicines instead of adding the slower-acting, long-term medicines. But overuse of quick-relief medicines may have harmful effects, such as decreasing the future effectiveness of these medicines.24 Overuse of quick-relief medicine is also an indication that asthma symptoms are not being controlled. You should talk with your doctor immediately.
Research indicates that the most important factor in reducing the severity and length of an asthma attack in children is giving a corticosteroid pill early in a severe attack. The corticosteroid pill works best when it is given at the first sign of symptoms.25 If your child needs oral corticosteroid according to his or her action plan, you should start that treatment right away.
There has been some worry that children who use inhaled corticosteroids may not grow as tall as other children. In the studies done so far, there was a very small difference in height and growth in children using inhaled corticosteroids compared to children not using them. When these children stopped using inhaled corticosteroids, their growth increased. It is expected that even though using inhaled corticosteroids may slow growth at first, children will still grow to a normal height.26, 27 But no study has gone on long enough for experts to be sure. The difference in height is very small and this effect is rare. But children using inhaled corticosteroids should have their height checked once or twice a year.
Your child may have to take more than one medicine daily to manage his or her asthma. It can be difficult to remember when your child needs to take medicine and which medicine to take. To help you and your child remember, understand the reasons people don't take their asthma medicines, and then find ways to overcome those obstacles, such as taping notes to the refrigerator.
Some children only have symptoms during certain times of the year (seasonal asthma). If you know when your child will most likely have symptoms, your doctor may have him or her start using a medicine to decrease inflammation before the symptoms start.
Try to avoid giving your child an inhaled medicine when he or she is crying, because not as much medicine is delivered to the lungs.
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| Author: | Maria G. Essig, MS, ELS | Last Updated: March 20, 2009 |
| Medical Review: |
Michael J. Sexton, MD - Pediatrics
Harold S. Nelson, MD - Allergy and Immunology |
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