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Treating asthma in children ages 5 to 11

Asthma treatment

The doctor will want your child to take just the right amount and type of medication needed to control his or her asthma. This will help prevent side effects. Based on your record of how well your child's current medications seem to control signs and symptoms, your child's doctor may "step up" treatment to a higher dose or add another type of medication. If your child's asthma is well controlled, the doctor may "step down" treatment by reducing your child's medications. This is known as the "stepwise" approach to asthma treatment.

If your child's asthma symptoms are severe, your family doctor or pediatrician may refer your child to see an asthma specialist.

Long-term control medications
Known as maintenance medications, these are generally taken every day on a long-term basis to control persistent asthma. In some cases, these medications are taken seasonally if your child's asthma symptoms become worse during certain times of the year.

Types of long-term control medications include:

  • Inhaled corticosteroids, the most common long-term control medications for asthma, and the ones proved to work best in younger children. These anti-inflammatory drugs include fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar) and mometasone (Asmanex).
  • Combination inhalers, which contain inhaled corticosteroids plus a long-acting bronchodilator. Advair combines the corticosteroid fluticasone and the bronchodilator salmeterol. Symbicort contains the corticosteroid budesonide plus the bronchodilator formoterol.
  • Leukotriene modifiers, which include montelukast (Singulair) and zafirlukast (Accolate), and are sometimes prescribed for mild persistent asthma. These medications are also considered a secondary addition to treatment with inhaled corticosteroids.
  • Theophylline, a daily pill that opens the airways (bronchodilator). It relaxes the muscles around the airways to make breathing easier. This medication is not used as often now as in past years.
  • Long-acting beta agonists (LABAs) may be used along with corticosteroids if your child has moderate or severe persistent asthma symptoms at night. LABA medications include salmeterol (Serevent Diskus) and formoterol (Foradil). The FDA is currently evaluating the safety of these medications, as they have been shown to cause a slight increase in serious asthma attacks and hospitalizations when taken without an inhaled corticosteroid. The LABA mediations Advair HFA and Symbicort are considered safer because they also contain an inhaled corticosteroid.

Quick-relief 'rescue' medications
These medications — called short-acting bronchodilators — provide immediate relief of asthma symptoms and last four to six hours. The most commonly used short-acting bronchodilator for asthma is albuterol. Other short-acting bronchodilators include pirbuterol and levalbuterol. Although these medications work quickly, they can't keep your child's symptoms from coming back if the asthma is not well controlled. If your child has frequent or severe symptoms, he or she will also need to take a long-term control medication as well.

Using quick-relief medications more often than your child's doctor recommends is a sign that your child's asthma is not under control. Record your child's use of these medications and share information about short-term asthma control medications with your child's doctor at every visit.

Immunotherapy for allergy-induced asthma
Allergy-desensitization shots (immunotherapy) may help if your child has allergic asthma that can't be easily controlled by avoiding asthma triggers or by medications. Your child's doctor will start with skin tests to determine which allergens trigger your child's asthma symptoms. Once the triggers are identified, your child will get a series of injections containing small doses of those allergens. Your son or daughter will probably need injections once a week for a few months, then once a month for a period of three to five years. Your child's allergic reactions will gradually diminish, lessening symptoms of allergy-induced asthma.

Medication delivery devices
Most asthma medications are given with a device that allows a child to breathe medication directly into the lungs. Your child's medication may be delivered with one of these devices:

  • Metered dose inhaler. Small hand-held devices, metered dose inhalers (MDIs) are a common delivery method used for asthma medication. To make sure your child gets the correct dose, he or she may also need a hollow tube (spacer) that attaches to the inhaler.
  • Dry powder inhalers. For certain asthma medications, your child may have a dry powder inhaler (DPI). This device requires a deep, quick inhalation to work correctly.
  • Nebulizer. Nebulizers are electrical devices that turn medications into a fine mist your child breathes in through a face mask This mist can deliver larger doses of medications into the lungs than can medications that are delivered in other ways. Young children often need to use a nebulizer because it's difficult or impossible for them to use other inhaler devices.

HFA inhalers: A recent change
The chlorofluorocarbon (CFC) propellant in quick-relief asthma inhalers is being replaced with a propellant called hydrofluoroalkane (HFA). Unlike CFCs, HFAs don't harm the environment. The spray from the new inhalers may taste different. Although the spray from an HFA inhaler may not seem as strong, your child is still getting the full dose of medication.

Asthma control: 4 basic steps for children ages 5 to 11

Managing asthma can seem like an overwhelming responsibility. Following a few structured steps makes it a lot easier.

Step 1: Monitor symptoms with a written plan. A written plan is an important tool to track your child's asthma and monitor how well treatment is working. Your doctor will help you come up with a plan for you and your child to:

  • Measure how much your child's symptoms affect normal activities such as play, school, sports and sleep
  • Note how often asthma flare-ups occur
  • Track how well medications seem to reduce symptoms, and note any side effects
  • Regularly check how well your child's lungs are working with a hand-held peak flow meter
  • Adjust medications as directed by the action plan when symptoms get worse

Step 2: Learn about asthma. A critical part of managing your child's asthma is learning exactly what steps to take on a daily, weekly, monthly and yearly basis. It's also important that you understand the purpose of each part of monitoring and treatment. You and your child's caretakers (such as child care providers and preschool teachers) need to:

  • Understand the different types of medications for asthma, which include long-term medications (such as inhaled corticosteroids) and short-acting "rescue" medications (such as albuterol)
  • Keep a written record of signs and symptoms and medication use
  • Know what to do when your child's asthma gets worse

Step 3: Control outside triggers. Work with your child's doctor to identify triggers, and what steps you need to take to help your child avoid them. Asthma triggers can include:

  • Colds or other respiratory infections, a common cause of asthma attacks in children
  • Allergens such as dust mites or pollen
  • Exercise
  • Cold weather
  • Cigarette smoke and other irritants in the air

Step 4: Monitor medications. Effective asthma treatment requires tracking how well medications are working on an ongoing basis. You will need to:

  • Work with the doctor to determine what types and doses of medications work best for your child, and make adjustments needed
  • Watch for side effects such as irritability, shaking, trouble sleeping or excitability, and report them to your child's doctor

The key to asthma control: Follow the action plan

Following your child's asthma action plan may be the single most important thing you can do to keep your child's asthma under control. Carefully track your child's lung function and symptoms, and make medication changes as soon as they're needed. If you act quickly, your child is less likely to have a severe attack and you won't need as much medication to control asthma symptoms.

Diligently using an asthma plan can make a big difference in asthma control — and keep asthma symptoms from becoming a serious and disruptive problem. With monitoring and careful management, your child should be able avoid flare-ups and enjoy life with minimal symptoms.

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References
  1. Schatz M. Pharmacotherapy of asthma: What do the 2007 NAEPP guidelines say? Allergy and Asthma Proceedings. 2007;28:628.
  2. Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Bethesda, Md.: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed Dec. 1, 2008.
  3. Liu AH. Childhood asthma. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/100024376-12/727446153/1608/440.html#4- 1.0-B978-1-4160-2450-7..50145-6--cesec11_3422. Accessed April 23, 2008.
  4. Szfler SJ. Advances in pediatric asthma in 2007. Advances in Asthma, Allergy, and Immunology Series 2008. Journal of Clinical Immunology. 2008:121:614.
  5. Stewart LJ. Pediatric asthma. Primary Care. 2008;35:25.

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