Asthma treatment in children can be successful if you regularly monitor asthma symptoms and lung function, educate children on how to avoid asthma triggers, and teach children how and when to use asthma medications. In a majority of children asthma treatment can control symptoms, allowing them to participate in normal activities, including sports.
Categorizing asthma symptoms allows one to select proper treatment. Categories include intermittent asthma, persistent asthma and exercise-induced asthma in children.
Intermittent asthma in children is defined as asthma with:
- Mild symptoms that are easily controlled and do not interfere with daily activities
- Infrequent asthma flares that occur two or fewer times per week
- Baseline Pulmonary Function Tests (PFTs) are normal
- Usually treated alone with inhaled short-acting bronchodilators (short-acting beta-2 agonist, or SABA)
Persistent asthma in children is defined as asthma with:
- Regular symptoms, such as cough, wheeze, or shortness of breath
- Child has days when normal activities are limited due to asthma symptoms
- Awakenings during the night due to cough or wheeze
- Lung function tests are usually normal between episodes, but becomes abnormal during an asthma attack
- Require "long-term controller" medications
Exercise-induced asthma (exercise-induced bronchoconstriction, or EIB) occurs when exercise acts as an asthma trigger resulting in bronchial airway narrowing.
Medical Treatment for Asthma
Medication is an effective treatment for childhood asthma. Finding the right medication and dosage to control asthma and prevent side effects is an important process. Two types of medication are used to control childhood asthma:
- Long-Term Controller Medications
- Quick-Relief Medications for Asthma
Long-Term Controller Medications for Asthma
Medications taken daily for asthma are called "long-term controller" medicines and function to decrease inflammation (or swelling) of the small airways over time. Types of long-term control medications include:
- Inhaled corticosteroid (ICS) are anti-inflammatory medications most commonly used for long-term control
- Leukotriene modifiers like montelukast (Singulair) are added as a secondary medication when inhaled corticosteroids are not enough to control the asthma alone
- Long-acting bronchodilators (also called long-acting beta agonists, or LABA)
- Combination inhalers combine two medications (an inhaled corticosteroid and a long-acting beta-agonist LABA) in a single inhaler. Combination therapy is used as step-up therapy for children not well controlled on inhaled glucocorticoids or montelukast alone
- Theophylline is a bronchodilator that opens the airways but is not used as often now as in the past
Quick-Relief Medications for Asthma
- Short-acting bronchodilators (also inhaled short-acting beta-2 agonist, or SABA) are highly effective for relieving asthma symptoms by rapidly relaxing the muscles around narrowed airways. However, there is insufficient evidence about the safety of treating asthma with SABA alone. This option should be reserved for patients with infrequent symptoms (less than twice a month) of short duration, and with no risk factors for exacerbations. Albuterol (Ventolin, Proventil, ProAir, Xopenex) is the most commonly used short-acting bronchodilator.
Other Asthma Treatments
Treating Modifiable Risk Factors
- Skills and support for guided asthma self-management, such as self-monitoring of symptoms, a written asthma action plan and regular medical review
- Prescription medications or regimen that minimize exacerbations as with inhaled corticosteroid-containing controller medications
- Encourage avoidance of tobacco smoke by providing smoking cessation advice and resources at every visit
- Patients with confirmed food allergy should be educated on food avoidance and availability of injectable epinephrine for anaphylaxis
- Avoidance of environmental tobacco smoke (house, car)
- Physical activity should be encouraged because of its general health benefits
- Provide advice about exercise-induced bronchoconstriction, or EIB
- Avoid medications that may worsen asthma like non-steroidal anti-inflammatory drugs (NSAIDs) or beta-blockers
- Allergen avoidance is not recommended as a general strategy for asthma
Guided Asthma Self-management and Skills Training
- Skills training to use inhaler devices correctly
- Encouraging adherence with medications, appointments
- Asthma information
- Self-monitoring of symptoms and/or peak expiratory flow rate (PEFR)
- Written asthma action plan
- Regular review by a pediatric pulmonologist
Asthma Medication Delivery Devices for Children
Several types of devices make the delivery of asthma medication quick and effective. The device your child will use depends on the type of medication and the child’s age. There is no perfect device for delivering inhaled medications to pediatric patients because may not be able to consistently produce the same inspiratory flow required by these devices. Other considerations are ease of use and portability. Devices available for delivering inhaled medications include metered dose inhalers (MDIs) with and without a spacer device, ultrasonic nebulizers, jet nebulizers, and dry powder inhalers (DPIs).
Metered Dose Inhalers
Medication supplied as MDIs include long-acting beta agonists (LABA), inhaled corticosteroid (ICS), and anticholinergics (drying agents). Metered-dose inhalers dispense liquid or fine powder medications, which mix with the air that is breathed into the lungs.
Follow these instructions for Metered Dose Inhaler use:
- Shake the inhaler while holding it upright
- Place the inhaler in your mouth
- Tilt your head back slightly
- Breathe out slowly
- As you start to breathe in slowly (over 5 seconds), press down on the inhaler to release the medication
- Hold your breath for 10 seconds to allow the medicine to reach deeply into your lungs
Side effects of bronchodilators in children will decrease over time. They include an increased heart rate, feeling shaky, and hyperactivity after using a short-acting bronchodilator.
- Requires minimal patient cooperation
- Requires the breathing pattern to be slow and deep for optimal delivery
- An ultrasonic nebulizer device use compressed air to change a medication from liquid form to a fine spray that can be inhaled through a mask or mouthpiece, i.e. a breathable mist. Nebulizers deliver large doses of medications through a facemask. Often this is a better option for young children that may have trouble effectively using an inhaler.
Dry Powder Inhalers (DPIs)
- Dry powder inhaler device is required for certain medications. Proper usage requires that your child takes a rapid deep inhalation to receive an accurate dose
When asthma is caused by allergies, immunotherapy may be an effective treatment. Allergic triggers are typically identified by an allergy skin test. Then injections are given to gradually desensitize the child to those allergens.
In summary, tracking your child’s symptoms, asthma attacks and side-effects of medications can help determine if your child’s current treatment is effective or if changes and/or modifications need to be made. It is also important to control your child’s asthma triggers as much as possible.
The goal of treating a child with asthma should be to control the asthma and the symptoms that it causes. A key component of treatment should be having an action plan. Pediatric pulmonologists, Dr. Peter Schochet and Dr. Hauw Lie, will help you develop a plan for your child. For more information about pediatric respiratory disease please submit an online appointment request or contact the office of Dr. Peter Schochet and Dr. Hauw Lie at 972-981-3251.