Asthma in Children
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 Reference airway inflammation Opens New Window Reference Opens New Window 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.
Most medicines for asthma are inhaled, because a specific dose of the medicine can be given directly to the bronchial tubes. Reference Delivery systems include metered-dose and dry powder Reference inhalers Opens New Window and Reference 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 Reference spacer Opens New Window Reference Opens New Window, which is attached to the MDI. A spacer may deliver the medicine to your child's lungs better than an inhaler alone. And for many people a spacer is easier to use than an MDI alone. Using a spacer with inhaled Reference corticosteroids Opens New Window can help reduce their side effects and the need for oral corticosteroids.
- Reference Reference Asthma: Using a Metered-Dose Inhaler
- Reference Reference Asthma in Children: Helping a Child Use a Metered-Dose Inhaler and Mask Spacer
- Reference Reference Asthma: Using a Dry Powder Inhaler
The most important asthma medicines are:
- Reference 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.
- Reference 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.
- Reference Short-acting beta2-agonists (quick-relief medicines) 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:
- Reference Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
- Reference Long-acting beta2-agonists (such as salmeterol and formoterol). They are always used with an inhaled corticosteroid.
- Less commonly, your doctor may recommend a Reference mast cell stabilizer (such as cromolyn) or Reference theophylline.
Other medicines may be given in some cases.
- Reference Anticholinergics (such as ipratropium) are usually used for severe asthma attacks.
- Other medicine such as Reference omalizumab or magnesium sulfate may be used if asthma does not improve with treatment.
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.
Concern about medicines and growth
Some parents worry that children who use inhaled corticosteroids may not grow as tall as other children. A very small difference in height and growth was found in children using inhaled corticosteroids compared to children not using them.Reference 19 And one study showed a very small difference in height [about 0.5 in. (1.3 cm)] in adults who used inhaled corticosteroids as children compared to adults who did not use inhaled corticosteroids.Reference 20 But the use of inhaled corticosteroids has important health benefits for children who have asthma. If you are worried about the effects of asthma medicines on your child, talk with your doctor.
What to think about
- Controller medicines. One of the best tools for managing asthma is a daily controller medicine that has a corticosteroid ("steroid"). But some people worry about using steroid medicines because of myths they've heard about them. If you're making a decision about a steroid inhaler, Reference it helps to know the facts.
- Quick-relief medicines. Because these medicines quickly reduce symptoms, children sometimes overuse them instead of adding the slower-acting, long-term medicines. But Reference overuse of quick-relief medicines may have harmful effects, such as decreasing how well these medicines work in the future.Reference 21 Overuse of quick-relief medicine is also a sign that asthma symptoms are not being controlled. You should talk with your doctor right away.
- Corticosteroid pills. Research shows 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. These pills work best when given at the first sign of symptoms.Reference 22
- Inhaled medicines. 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.
|By:||Reference Healthwise Staff||Last Revised: Reference November 8, 2012|
|Medical Review:||Reference Kathleen Romito, MD - Family Medicine
Reference Adam Husney, MD - Family Medicine