Albuterol side effects in kids: What's normal?

My 4-year-old daughter is taking albuterol for mild allergic asthma. Although the albuterol seems to help her asthma symptoms, it makes her irritable and unable to concentrate on activities she normally enjoys. Is there another medication she can switch to?

- Kerry / Texas

Mayo Clinic asthma and allergy specialist James Li, M.D., and colleagues answer select questions from readers.

Answer

Other treatment options are available, but you need to discuss them with your child's doctor. Albuterol taken orally or delivered by metered dose inhaler or by nebulization is commonly used to treat mild allergic asthma. A short-acting bronchodilator, albuterol relaxes muscles that tighten around the airways during an asthma attack.

But the drug does have potential side effects. The most common albuterol side effects in children include restlessness, irritability and nervousness. The risk of side effects increases with higher doses of albuterol. Also, the liquid (oral) form of albuterol is more likely to cause side effects than is the inhaled form. Albuterol delivered by metered dose inhaler is least likely to cause side effects.

Talk to your doctor about your child's symptoms. Children may experience irritability or difficulty concentrating for a variety of reasons. Your doctor can evaluate whether the problem is related to the albuterol — or perhaps some other cause.

If albuterol is the likely culprit, your doctor may recommend reducing the dose or switching to a metered dose inhaler to see if this decreases the side effects while still controlling your daughter's asthma. It may also be reasonable to switch your daughter to a different short-acting bronchodilator, such as levalbuterol (Xopenex). Like albuterol, inhaled levalbuterol opens up airways, but it may cause fewer side effects in some people.

Your doctor may recommend adding a daily asthma medication to better control asthma and reduce the need for albuterol. Options may include:

Inhaled corticosteroids. These drugs reduce airway inflammation. However, long-term use of inhaled corticosteroids may affect growth.
Oral leukotriene modifiers, such as montelukast (Singulair). Although not as effective as inhaled corticosteroids, leukotriene modifiers reduce airway inflammation. Also, these medications are available in chewable tablets for younger children.