The goal of asthma treatment is to keep symptoms under control all of the time. Well-controlled asthma means that your child has:
- Minimal or no symptoms
- Few or no asthma flare-ups
- No limitations on physical activities or exercise
- Minimal use of quick-relief (rescue) inhalers, such as albuterol
- Few or no side effects from medications
Treating asthma involves both preventing symptoms and treating an asthma attack in progress. The right medication for your child depends on a number of things, including his or her age, symptoms, asthma triggers and what seems to work best to keep his or her asthma under control.
Long-term control medications
Preventive, long-term control medications reduce the inflammation in your child's airways that leads to symptoms. In most cases, these medications need to be taken every day.
Types of long-term control medications include:
Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), ciclesonide (Alvesco), beclomethasone (Qvar) and others. Your child may need to use these medications for several days to weeks before they reach their maximum benefit.
Long-term use of these medications has been associated with slightly slowed growth in children, but the effect is minor. In most cases, the benefits of good asthma control outweigh the risks of any possible side effects.
Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). They help prevent asthma symptoms for up to 24 hours.
In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away if your child has any unusual reaction.
Combination inhalers. These medications contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include fluticasone and salmeterol (Advair Diskus, Advair HFA), budesonide and formoterol (Symbicort), fluticasone and vilanterol (Breo), and mometasone and formoterol (Dulera).
In some situations, long-acting beta agonists have been linked to severe asthma attacks. For this reason, LABA medications should always be given to a child with an inhaler that also contains a corticosteroid. These combination inhalers should be used only for asthma that's not well-controlled by other medications.
- Theophylline. This is a daily pill that helps keep the airways open. Theophylline (Elixophyllin, Theo-24, Uniphyl, others) relaxes the muscles around the airways to make breathing easier. It's not used as often now as in past years.
Quick-relief medications quickly open swollen airways that are limiting breathing. Also called rescue medications, quick-relief medications are used as needed for rapid, short-term symptom relief during an asthma attack or before exercise if your child's doctor recommends it.
Types of quick-relief medications include:
- Short-acting beta agonists. These inhaled bronchodilator (brong-koh-DIE-lay-tur) medications can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA). These medications act within minutes, and effects last several hours.
- Ipratropium (Atrovent HFA). Your doctor might prescribe this inhaled medication for immediate relief of your child's symptoms. Like other bronchodilators, it relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks.
- Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. They can cause serious side effects when used long term, so they're only used to treat severe asthma symptoms on a short-term basis.
- Immunomodulatory agents. Mepolizumab (Nucala) may be appropriate for children with severe eosinophilic asthma.
Treatment for allergy-induced asthma
If your child's asthma is triggered or worsened by allergies, your child may benefit from allergy treatment as well. Allergy treatments include:
- Omalizumab (Xolair). This medication is specifically for people who have allergies and severe asthma. It reduces the immune system's reaction to allergy-causing substances, such as pollen, dust mites and pet dander. Xolair is delivered by injection every two to four weeks.
- Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.
- Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your child's immune system reaction to specific allergens.
Don't rely only on quick-relief medications
Long-term asthma control medications such as inhaled corticosteroids are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely your child will have an asthma attack.
If your child does have an asthma flare-up, a quick-relief (rescue) inhaler can ease symptoms right away. But if long-term control medications are working properly, your child shouldn't need to use a quick-relief inhaler very often.
Keep a record of how many puffs your child uses each week. If he or she frequently needs to use a quick-relief inhaler, take your child to see the doctor. You probably need to adjust his or her long-term control medication.
Inhaled medication devices
Inhaled short- and long-term control medications are used by inhaling a measured dose of medication.
- Older children and teens may use a small, hand-held device called a pressurized metered dose inhaler or an inhaler that releases a fine powder.
- Infants and toddlers need to use a face mask attached to a metered dose inhaler or a nebulizer to get the correct amount of medication.
- Babies need to a use a device called a nebulizer, a machine that turns liquid medication into fine droplets. Your baby wears a face mask and breathes normally while the nebulizer delivers the correct dose of medication.
Asthma action plan
Work with your child's doctor to create a written asthma action plan. This can be an important part of treatment, especially if your child has severe asthma. An asthma action plan can help you and your child:
- Recognize when you need to adjust long-term control medications
- Keep tabs on how well treatment is working
- Identify the signs of an asthma attack and know what to do when one occurs
- Know when to call a doctor or seek emergency help
Children who have enough coordination and understanding may use a hand-held device to measure how well they can breathe (peak flow meter). A written asthma action plan can help you and your child remember what to do when peak flow measurements reach a certain level.
The action plan may use peak flow measurements and symptoms to categorize your child's asthma into zones, such as the green zone, yellow zone and red zone. These zones correspond to well-controlled symptoms, somewhat-controlled symptoms and poorly controlled symptoms. This makes tracking your child's asthma easier.
Your child's symptoms and triggers are likely to change over time. You'll need to carefully observe symptoms and work with the doctor to adjust medications as needed.
If your child's symptoms are completely controlled for a period of time, your child's doctor may recommend lowering doses or stopping asthma medications (stepping down treatment). If your child's asthma isn't as well-controlled, the doctor may want to increase, change or add medications (stepping up treatment).