Asthma Treatment
A child of any age with asthma needs a team of attentive parents and health-care providers on his side.
Articles within this series
- Overview
- Asthma Treatment
- Preventing Asthma Attacks
- Next Steps / Related Information
A child of any age with asthma needs a team of attentive parents and health-care providers on his side. Good rapport among all concerned is essential. The specific approaches used for your child will depend upon the frequency and severity of the asthma episodes and the triggers that set if off. Treatment may be needed sporadically or year-round.
The most important intervention for asthma may be daily medication that prevents wheezing, not the sporadic treatment of flare-ups.
Several types of medications are prescribed to treat asthma, but patients (or the parents of young children) must clearly understand their specific functions and when and how they should be used.
Medications called bronchodilators — for example, albuterol (Proventil or Ventolin) or terbutaline (Brethaire) — immediately relieve wheezing and usually maintain improved airflow for four to six hours. These are usually taken through metered dose inhalers (MDIs), which dispense measured bursts of medication.
For very young children, as well as older children with more severe asthma, a home nebulizer device may be more appropriate. This converts liquid medication into an aerosol form that is easily inhaled using a face mask or mouthpiece. Because bronchodilators are distantly related to adrenaline, they may cause tremors or rapid heart rate, especially if taken more often than prescribed. (These symptoms are more likely if the pill or syrup forms are used rather than an inhaler.) In children 12 years or older, the inhaled bronchodilator salmeterol (Serevent) may be used for maintenance to prevent attacks, since it is active for up to 12 hours. However, salmeterol cannot be used to treat an acute asthma attack.
Because they help asthmatic children feel much better right away, bronchodilators are frequently overused. Repeated doses of this type of medication may cause enough temporary relief to delay more definitive care while the overall situation is actually deteriorating. If your child is using the bronchodilator four or five times a day regularly, his asthma is likely out of control, and you should see his doctor about additional treatment.
Do not buy and use over-the-counter asthma inhalers as a substitute for proper medical care and supervision.
Steroids in various forms more directly quiet down the inflammation that underlies the reactive airway response. Your child’s doctor might prescribe a brief course of oral steroids to bring an intense wheezing episode under rapid control. Long-term oral steroid treatment can pose a major dilemma because of its combination of lifesaving benefits and major side effects. The same treatment given by an inhaler does not risk the same side effects.
Using a steroid inhaler daily for weeks or months to prevent wheezing will generally be safer and more effective than intermittent doses of bronchodilators to stop acute asthma attacks.
Cromolyn (Intal and other brands) is another option for long-term prevention, especially for a child with exercise-induced wheezing or a strong allergic component to his asthma. This medication is given by an inhaler. While it is not as potent as a steroid, cromolyn can help prevent or minimize wheezing in a child who is already stabilized.
All inhalers are usually more effective in children if spacers such as the AeroChamber or InspirEase are used with them. A spacer is purchased separately (or provided by the physician), and the inhaler canister inserted into it prior to each use. (One steroid product, Azmacort, comes with a built-in spacer.) These devices eliminate the need for precise coordination of the child’s deep inhalation and the actuation (firing the puff) of the inhaler.
Spacers also prevent larger droplets of the medication from being deposited in the mouth and throat and improve the overall delivery of the drug to the lower airways. If your child is going to use a bronchodilator and a steroid and/or cromolyn inhaler at the same time, the bronchodilator should be given first because it will open up the airways and allow better distribution of the other medication. Holding the breath for a few seconds after inhaling a puff will help more of it arrive at its destination.
Leukotriene modifiers are oral medications (such as montelukast, zafirlukast and zileuton) that have been recently approved for use in children over the age of 5. They may supplement the use of inhaled steroids for moderate cases of asthma, or they may be used as an alternative to inhaled steroids in milder cases. Some monitoring of liver enzymes may be necessary, but generally these medications are safe, effective and have few side effects.
Theophylline has been used to treat asthma for years and may still be helpful for some children, though more often for maintenance than for acute care. Usually given in liquid, tablet or powdered form (which is shaken into food such as cereal or applesauce), most theophylline given today is in time-release forms that last for eight to 12 hours. Side effects are more common with ths medication and can include nausea, vomiting and jitteriness. Checking blood levels will usually be necessary to confirm that the right dose is being given.
Antibiotics may be needed at some point to treat a bacterial infection of the bronchial tubes or the sinuses. If your asthmatic child has a cold, check with the doctor before giving a decongestant and/or antihistamine formula. Some of these — especially certain antihistamines that can cause bronchial mucus to thicken — may interfere with the action of other medications.
Because so many medications are potentially helpful in treating wheezing, sometimes your asthmatic child may appear to be taking too many drugs. But if wheezing is intense, chronic or difficult to control, a number of different medications might be needed, and it is extremely important that you understand how and when each is to be used.
If you feel confused about the mechanism of an inhaler or a spacer device, don’t leave the pharmacy or doctor’s office until you understand exactly what to do with whatever device you have been given, since your child’s ability to breathe may depend on it. You may also need to learn how to use a peak flow meter, which will give everyone a better feel for how your child is doing.
Make sure you and your child (if he’s old enough) understand the purpose, dose timing and precautions for every medicine he is going to use. You should have written directions in your hand before you leave the doctor’s office or pharmacy, as well as an invitation to call back if you have questions. You should know whom to call and where to go in case the problem increases after office hours, since asthma has a tendency to worsen during the night.
You and your child’s doctor should discuss the basic goals of therapy, which should not be limited merely to stopping acute wheezing episodes but should address preventing them as well. Ultimately, your child should be able to sleep through the night, feel normal during the day and enjoy reasonable strenuous activity without coughing or wheezing. He should not think of himself as the sick kids who can’t play ball or participate in sports because of his condition.
Bronchodilators and cromolyn each have the capacity to reduce or prevent exercise-induced wheezing. A child or adolescent who coughs or wheezes during vigorous exercise may have less difficulty breathing and better endurance if one of these inhalers is used about a half-hour before the activity begins.