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Treating Asthma in Children

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The goals of asthma therapy are:

  • To prevent your child from having chronic and troublesome symptoms
  • To maintain your child's lung function as close to normal as possible
  • To allow your child to maintain normal physical activity levels (including exercise)
  • To prevent recurrent asthma attacks and to reduce the need for emergency department visits or hospitalizations
  • To provide medications to your child that give the best results with the fewest side effects

Medications that are available fall into two general categories.

One category includes drugs taken daily that are meant to control asthma in the long term and reduce the frequency of asthma attacks (controller or maintenance medications). These can include inhaled corticosteroids like budesonide (Pulmicort) and fluticasone (Flovent) and leukotriene antagonists like montelukast sodium (Singulair) or zileuton (Zyflo). Less common controller medications include long-acting bronchodilators (in combination with corticosteroids) and theophylline.

The other category is medications that provide instant relief from symptoms (rescue medications). These include short-acting bronchodilators like albuterol (ProAir, Ventolin, and many others) and levalbuterol (Xopenex). Short courses of systemic corticosteroids -- drugs like prednisone and prednisolone (Orapred) given by mouth -- are often used with bronchodilators during asthma attacks. Inhaled ipratropium may be used in addition to inhaled bronchodilators following asthma attacks or when asthma worsens.

In general, doctors start with a high level of therapy during an asthma attack and then decrease treatment to the lowest possible level that still prevents asthma flare-ups and allows your child to have a normal life. Every child needs to follow a customized asthma management plan to control asthma symptoms. The severity of a child's asthma can both worsen and improve over time, so the type (category) of your child's asthma can change, which means different treatment can be required over time. Treatment should be reviewed every one to six months, and the choices for long- and short-term therapy are based on how severe the asthma is.

Talk to your doctor about the various medications available to treat asthma.

Severity of Asthma
Long-Term Control
Quick Relief
Intermittent asthmaUsually none

Inhaled beta-2 agonist (short-acting bronchodilator)

If your child has coughing/wheezing requiring him to use the short-acting inhaler more than two times per week, or has nighttime symptoms more than twice per month, long-term control therapy may be necessary.

Mild persistent asthmaDaily use of low-dose inhaled corticosteroids, leukotriene antagonists, or, less commonly, nonsteroidal agents such as cromolyn and nedocromil (anti-inflammatory treatment)

Inhaled beta-2 agonist (short-acting bronchodilator) as needed

If your child needs to use the short-acting inhaler every day or starts using it more and more frequently, additional long-term therapy may be needed.

Moderate persistent asthmaDaily use of medium-dose inhaled corticosteroids or low- or medium-dose inhaled corticosteroids combined with a long-acting bronchodilator (such as Advair or Symbicort) or leukotriene antagonistInhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler every day or starts using it with increasing frequency, additional long-term therapy may be needed.
Severe persistent asthmaDaily use of high-dose inhaled corticosteroids (anti-inflammatory treatment), long-acting bronchodilator, leukotriene antagonist, theophylline, omalizumab (Xolair, for patients with moderate-to-severe asthma brought on by seasonal allergens despite inhaled corticosteroids)Inhaled beta-2 agonist (short-acting bronchodilator)
Acute severe asthmatic episode (status asthmaticus)This is severe asthma that will not respond to the usual treatments at home. It requires admission to the hospital.Repeated doses of inhaled beta-2 agonist (short-acting bronchodilator)

**Seek immediate emergency medical help
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