If your child has asthma, the goal of treatment is to minimize symptoms so they can participate in normal physical activities. It is also important to prevent emergency department visits and hospitalizations from asthma attacks.
Ideally, when asthma is well controlled, your child should not experience asthma symptoms more than once or twice per week. Also, asthma symptoms should not wake them at night more than twice per month. And, most importantly, your child should be able to participate in all play, sports, and physical education activities.
Different forms of asthma medicine
Asthma medications come in a variety of forms, including:
Note: Inhaled forms are preferred because they deliver the medication directly to your child's air passages with minimal side effects.
Which asthma medicine does my child need?
Asthma is different in every person, and symptoms can change over time. Your child's doctor will determine which asthma medication is best based on how severe and how often your child has symptoms, as well as your child's age. If your child has asthma symptoms that occur only occasionally, they'll be given medications for short periods. If their symptoms occur more often, your child may need a controller medication.
Sometimes, it's necessary to take several medications at the same time to control and prevent symptoms. Your child's doctor may give them several medications at first to get their asthma symptoms under control, and then decrease the medications as needed. The doctor may also recommend a peak flow meter for your child to use at home to monitor lung function. This can help you make decisions about changing therapy and track how changes made by your doctor affect your child.
Asthma medications are divided into two groups: Quick-relief medications and controller medications.
Quick-relief medications are taken for short-term relief, usually either with an inhaler or a nebulizer. They work rapidly to open up narrowed airways and help relieve the feeling of tightness in the chest, wheezing, and breathlessness. They can also be used to prevent exercise-induced asthma. The most commonly used quick-relief medication is albuterol.
These medications are taken only when your child needs them. They should be used for any asthma symptom, including wheezing, chest tightness, and cough, rather than just asthma attacks. Your child should have quick-relief medication available at home, school, and anywhere they are participating in sports.
For serious asthma attacks, your child may be given corticosteroids by mouth or injection to reduce inflammation inside the airways and speed recovery.
Controller medications are used on a daily basis to control asthma and reduce the number of days or nights that your child has symptoms. These medications are not used for relief of symptoms. Children who have symptoms more than twice per week or who wake up more than twice per month should be on controller medications. How many asthma attacks your child has and how severe they are also determine whether they need a controller medication.
Examples of controller medications include:
- Inhaled corticosteroids work by treating the inflammation in your child's lungs, which helps reduce asthma attacks. When used in the recommended dose, inhaled steroids are safe for most children. However, your child's doctor may recommend another type of controller medication instead based on your child's specific needs.
- Combination inhalers contain both corticosteroids and long-acting bronchodilators, also known as long-acting beta agonists (LABA). LABAs are similar to albuterol in that they work quickly to open up the airway, but they last much longer. Your doctor may prescribe a combination inhaler when inhaled steroids alone aren't keeping your child's asthma controlled.
- Theophylline. Usually taken by mouth as a timed-release pill, theophylline opens up the airways for an extended period. It can be used alone or together with inhaled corticosteroids. If your child has nighttime symptoms, theophylline can be particularly helpful in preventing these. Although it was once used extensively, theophylline isn't often prescribed for asthma anymore. This is mainly because it requires careful monitoring of blood levels to avoid side effects and because other asthma medications often work as well or better.
- Leukotriene receptor antagonists. Also known as leukotriene modifiers, leukotriene receptor antagonists work by decreasing the effects of an inflammatory chemical made by the body called leukotrienes. The two leukotriene modifiers currently in use, montelukast and zafirlukast, are very safe. They come in tablet form and for young children, chewable tablets or granules are available.
- Biologic injections. If your child has severe asthma and other medications aren't keeping it under control, your doctor may recommend adding a newer medication called a biologic. Biologic injections such as omalizumab and mepolizumab are given every 2 to 4 weeks to kids who are 6 years and older.
New asthma management guidelines: get SMART
For kids 4 years and older who have moderate to severe persistent asthma, updated guidelines now recommend using single maintenance and reliever therapy (SMART). With SMART, instead of using an inhaled steroid every day along with a quick-relief medication as needed, your child can use just one combination inhaler.
This inhaler contains both a corticosteroid and a specific LABA called formoterol. The formoterol relieves your child's symptoms quickly while the corticosteroid helps keep their asthma under control. Your child can use the same inhaler once or twice a day as directed by their doctor, as well as when they need quick relief for asthma symptoms.
The advantages of SMART include only needing one inhaler and decreased exposure to corticosteroids. Ask your doctor if SMART is a good option for your child.
Asthma action plan
Everyone with asthma should have a written asthma action plan. The plan shows your child's treatment information, such as what kind of medicines they take and when they take them. It also describes how to control asthma long term and how to handle an asthma attack. Additionally, the plan explains when to call your child's doctor or go to the emergency room.
All of the people who care for your child should have a copy of their asthma action plan. This includes family members, child care providers, schools, camps, team coaches, and instructors. In an emergency, these people can help your child follow their asthma action plan.
The Centers for Disease Control and Prevention (CDC) provides easy-to-use examples and forms for setting up your child's asthma action plan.