Asthma in Children

Medication does not cure asthma. However, it is an important part of managing the condition. Medications for asthma treatment are used to:

• Prevent and control the underlying airway inflammation to minimize long-term lung damage.
• Decrease the severity, frequency, and duration of asthma attacks.
• Treat the attacks as they occur.

Asthma medications 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 medications daily. Quick-relief medications 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 medications and doses of medications may be used. Special consideration may be necessary before and during exercise and before surgery.

Medication delivery

Most medications for asthma are inhaled. Inhaled medications are used because a specific dose of the medication 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 health professionals recommend that every child who uses a metered-dose inhaler (MDI) also use a spacer, which is attached to the MDI. A spacer may deliver the medication to your child's lungs better than an inhaler alone, and for many people is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and result in less use of oral corticosteroids.

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 difficulty using an MDI with a spacer, he or she can use a nebulizer. Work with your health professional 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.

Asthma in children: Helping a child use a metered-dose inhaler and mask spacer.

Asthma: Using a dry powder inhaler.

Medication choices

The most important asthma medications are:

• Inhaled corticosteroids. These are the preferred medications 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 dipropionate, triamcinolone acetonide, fluticasone propionate, budesonide, and flunisolide.
• Oral or injected corticosteroids (systemic corticosteroids) to get your child's asthma under control before he or she starts taking daily medication. Your child may also need these medications 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 medications include albuterol and pirbuterol.

Long-term medications sometimes used alone or with other medications for daily treatment include:

• Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
• Long-acting beta2-agonists (such as salmeterol and formoterol). They are sometimes combined as a single medication with inhaled corticosteroids.
• Less commonly, your doctor may recommend mast cell stabilizers (such as cromolyn sodium or nedocromil), or theophylline (such as Theo-Dur, Slo-bid, Uniphyl, or Uni-Dur).

Other medications 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.

Medication treatment for asthma may differ based on age. See information on:

• Asthma medications for children age 5 and younger.
• Asthma medications for adults, teens, and children older than age 5.

What to Think About

Medications are usually added one at a time to keep the number of medications low. The dosage of each medication should correspond to the severity of the child's asthma. Generally, your health professional 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 medication 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 medication and increasing the medication if the dose is not enough.

Because quick-relief medication quickly reduces symptoms, children sometimes overuse these medications instead of adding the slower-acting, long-term medications. However, overuse of quick-relief medications may have harmful effects, such as decreasing the future effectiveness of these medications.²⁴ Overuse of quick-relief medication is also an indication that asthma symptoms are not being controlled. You should talk with your health professional immediately.

In children, research indicates that the most important factor in reducing the severity and length of an asthma attack 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 many different medications daily to manage his or her asthma. It can be difficult to remember when your child needs to take medication and which medication to take. To help you and your child remember, understand the reasons people don't take their asthma medications, 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 medication to decrease inflammation before the symptoms start.

Try to avoid giving your child an inhaled medication when he or she is crying; in this case, not as much medication is delivered to the lungs.