Asthma in Children - Treatment

What treatment is your child with asthma receiving?

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What is the treatment for asthma in children?

The goals for the treatment of asthma in children are to

  1. adequately control symptoms;
  2. minimize the risk of future exacerbations;
  3. maintain normal lung function;
  4. maintain normal activity levels; and
  5. use the least amount of medication possible with the least amount of potential side effects.

Inhaled corticosteroids (cortisone medication) are the most effective anti-inflammatory agents available for the chronic treatment of asthma and are generally first-line therapy per most asthma guidelines. It is well recognized that inhaled corticosteroids are very effective in decreasing the risk of asthma exacerbations. Furthermore, the combination of a long-acting bronchodilator and an inhaled corticosteroid has a significant additional beneficial effect on improving asthma control.

A complete list of commonly used asthma medications is as follows:

  1. Short-acting bronchodilators provide quick relief and are used for exercise-induced symptoms (for example, albuterol [Proventil, Ventolin, ProAir, Maxair, Xopenex]).
  2. Inhaled steroids are first-line anti-inflammatory therapy (for example, budesonide, fluticasone, beclomethasone, mometasone, ciclesonide).
  3. Long-acting bronchodilators can be added to inhaled corticosteroids as additive therapy (for example, salmeterol, formoterol).
  4. Leukotriene modifiers can also serve as anti-inflammatory agents (for example, montelukast, zafirlukast).
  5. Anticholinergic agents can help decrease sputum production (for example, ipratropium, tiotropium).
  6. Anti-IgE therapy can be used in adolescents with allergic asthma (for example, omalizumab).
  7. Chromones stabilize mast cells (allergic cells) but are rarely used in clinical practice (for example, cromolyn, nedocromil).
  8. Theophylline also helps with bronchodilation (opening the airways) but again is rarely used in clinical practice due to an unfavorable side effect profile.
  9. Systemic steroids are potent anti-inflammatory agents that are routinely used to treat asthma exacerbations but pose numerous unwanted side effects if used repeatedly or chronically (for example, prednisone, prednisolone, methylprednisone, dexamethasone).
  10. Numerous other monoclonal antibodies are being currently studied but none are currently commercially available for routine therapy of asthma.

There is often concern about potential long-term side effects for even inhaled corticosteroids. Numerous studies have repeatedly shown that even long-term use of inhaled corticosteroids has very few if any sustained clinically significant side effects, including growth in children. However, the goal always remains to treat children (and adults) with the least amount of medication that is effective.

Asthma medications can be administered via nebulized solution, which requires no technique and is very helpful in young children (often under 5 years of age). Around 5 years of age, children can transition to inhalers either with or without an aerochamber and/or a mask. It is important to note that if an individual has proper technique with an inhaler, the amount of medication deposition in the lungs is no different than with using a nebulized solution. When prescribing asthma medications, it is essential to provide the proper teaching on proper delivery technique.

Although the vast majority of children with asthma are treated as outpatients, treatment of severe exacerbations can require management in the emergency department or inpatient hospitalization. These children typically require use of supplemental oxygen, early administration of systemic steroids, and frequent or even continuous administration of bronchodilators via a nebulized solution. Children at high risk for poor asthma outcomes should be referred to a specialist (pulmonologist or allergist). Children with the following factors may be at high risk:

  1. History of ICU admission or multiple hospitalizations for asthma
  2. History of multiple visits to the emergency department for asthma
  3. History of frequent use of systemic steroids for asthma
  4. Ongoing symptoms despite the use of appropriate medications
  5. Significant allergies contributing to poorly-controlled asthma
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