TREATMENT: “What care could my child receive?”

It used to be that children with asthma could not participate fully in sports and other physical activities. Fortunately, with the treatment strategies and medications available today, many more children with asthma can be as active as those who don’t.

The goal of asthma treatment for your child is long-term symptom control, meaning:

  • Few or no symptoms, attacks, or emergency visits to the doctor or hospital
  • No limits on physical activity
  • Minimal need to use a quick-relief inhaler
  • Few or no side effects from asthma medication

Overall, your child’s asthma treatment will be based on his or her:

  • Age
  • Symptom severity
  • Asthma triggers
  • Symptom control at diagnosis
  • Response to medications (which medications work best for your child)

There are four categories of childhood asthma severity:

  • Mild intermittent: Your child has mild asthma attacks (briefly wheezing, coughing, or being short of breath) one to two days per week.

o   Symptoms rarely occur between attacks except for one to two nights per month.

  • Mild persistent: Your child has mild asthma attacks more than twice per week but less than once per day, and at least twice per month at night.

o   Attacks may disrupt usual physical activities.

  • Moderate persistent: Your child has daily symptoms, needs daily asthma medication, and has asthma attacks more than twice per week, each lasting several days.

o   Symptoms occur at night more than once per week.

o   Attacks usually disrupt usual physical activities.

  • Severe persistent: Your child has symptoms continuously during the day and frequent attacks, which may result in emergency room visits and/or hospitalizations.

o   Symptoms may often occur at night.

o   Symptoms and attacks may limit physical activity.

Doctors use a “stepwise” approach to starting asthma treatment and managing the disease:

  • As your child’s asthma improves or worsens over time, treatment may be stepped down or up to help keep it under control.

As we’ve seen, the two main features of asthma are:

  • Chronic airway inflammation
  • Airway narrowing

Similarly, asthma treatment mainly involves two types of medications:

  • Controller medications, used daily over an extended period of time (long-term) to control asthma and keep it under control:

o   Reduce airway inflammation that can lead to symptoms

o   Help your child have fewer and milder attacks

o   Cannot be used, and are not intended, to treat an asthma attack

  • Quick-relief (rescue) medications, used as needed to treat symptoms and attacks when they occur:

o   Quickly restore normal breathing by opening narrowed airways

o   Relieve the symptoms of an asthma attack

o   Must be taken as soon as your child becomes aware of an asthma symptom

Your child should never stop taking asthma medication, or start taking it differently, unless the doctor has approved the change.

Help your child understand these important keys to long-term asthma control:

  • Taking long-term controller medication every day and, when symptoms start:

o   Using a quick-relief inhaler, as needed, to open airways

  • Knowing his or her asthma triggers, and avoiding them whenever possible
  • Recognizing the onset of asthma symptoms or an attack, and knowing:

o   What to do if they occur

o   When to call the doctor or get emergency medical help

  • Using the peak flow meter daily, as instructed, to keep track of whether or not his or her daily (long-term) controller medication is keeping the disease under control

o   Peak flow meter readings can reveal airway narrowing before your child’s symptoms worsen.

The bottom line: Your child needs continuous daily treatment with long-term controller medication, even when he or she is not having symptoms or an asthma attack.

If your child starts having to use quick-relief medication more often—meaning he or she is having more asthma symptoms and/or attacks:

  • Ask the doctor if a different controller medication may provide better control.

Your child’s asthma action plan

Work with your child’s doctor to create a written asthma action plan, a tool for:

  • Managing your child’s asthma day to day, with the goal of preventing or reducing symptoms and attacks
  • Providing clear, step-by-step instructions for:

o   Avoiding triggers

o   Identifying flare-up symptoms early and treating them so they don’t get worse

o   Managing severe symptoms

o   Recognizing an asthma attack and getting emergency care

Give a copy of your child’s action plan to everyone who sees him or her regularly, including:

  • Family members who don’t live with you

o   Also post a copy in your home where it will be easily available, such as in the kitchen

  • Child care providers
  • Your child’s friends’ parents
  • The school nurse
  • Teachers and coaches

Among many possible types of information, your child’s action plan should list:

  • Emergency phone numbers and facility locations
  • Early symptoms of a flare-up and proper steps to take
  • Your child’s daily asthma status

o   You may want to use a common method for recording this information: referring to your child, each day, as in the “green” zone (doing well), “yellow” zone (getting worse), or “red” zone (medical alert).

o   This color system is also used on peak flow meters.

  • His or her asthma triggers, and specific ways to prevent exposure to them
  • Steps to take if your child has asthma symptoms or an asthma attack, including when to 1) call the doctor and 2) seek emergency care
  • The names and dosages of all medications your child is using, the schedule and method(s) for taking them, and guidelines for when and how to increase the dose or add medication as needed
  • Guidelines for exercising or doing sports (if this applies to your child)
  • Permission for your child to take asthma medication at school
  • A schedule for using a peak flow meter to measure how well your child can breathe, day to day
  • Your child’s “personal best” peak flow meter reading (to compare with daily readings)
  • Guidelines for when to call the doctor about a peak flow reading

The information recorded in the action plan can provide early clues to how your child’s asthma symptoms, triggers, and level of control are changing (or not) over time.

  • With this knowledge, your child’s doctor can make treatment changes quickly in response to:

o   Worsening symptoms, calling for treatment to be stepped up

o   A period of good asthma control, which may mean treatment can be stepped down

Use this action plan every day. Update it each time your child sees the doctor or at least every six months.

  • Every time it’s changed, give a new copy to everyone on your child’s action plan “subscriber list.”

The chart below describes the medications used to treat childhood asthma.

Medications Used to Treat Childhood Asthma

Medications What Are They? How Do They Work? How Are They Given? What Else Should I Know?
Inhaled Corticosteroids Asthma symptom controllers Reduce airway:

  • Inflam-mation
  • Swelling and tightening
Inhalers The “gold standard” for long-term asthma controlNot all inhalers work the same way: If your child uses an inhaler, ask the doctor to demonstrate the correct way to use it.
Leukotriene Modifiers Asthma symptom controllers Block effects of immune-system chemicals (leukotrienes) that cause asthma symptoms Mostly tablets These medications are also used to treat allergies.The body releases leukotrienes in response to contact with allergens (allergy triggers).
Long-Acting Beta Agonists Asthma symptom controllers Reduces airway swellingOpens narrowed airways Inhaler Generally used only in combination with inhaled corticosteroids
Mast Cell Stabilizer Asthma symptom controllers Prevents release of mast cells, which cause inflammation NebulizerInjection
Theophylline Asthma symptom controllers Opens airways Tablets
Liquid
Not generally used alone, but may be added to other asthma medications to improve treatment results
Short-Acting Beta2-Agonists Quick asthma-symptom relievers Opens airways Varies Typically the first choice for quick relief of asthma symptoms
Ipratropium Bromide Quick asthma-symptom relievers Opens airways
  • Metered-dose inhaler  (MDI)
  • Nebulizer
The instructions for using this medication are complex and must be followed exactly.

  • Ask your child’s doctor to show you how to use it.
  • Read the Patient Informa-tion Leaflet.
  • Read the nebulizer instruct-tions.
Oral and Injectable Corticosteroids Quick asthma-symptom relievers Reduces airway inflammation Oral or injectable Because of side effects, these medications are generally used only to treat severe asthma attacks.
Medications for Allergy-Induced Asthma
Immunoglobulin E (IgE) Blocker—by prescription Helps block IgE, a naturally occurring substance in the body that can lead to asthma symptoms and attacks Helps reduce the number of asthma attacks in those with allergic asthma who still have asthma symptoms even though they are taking inhaled steroids. Injection Used when asthma is not adequately controlled with other asthma medications.
Antihistamines and Decongestants—by prescription and OTC Allergy-symptom relievers Antihistamines block allergic responses to immune system triggers.Decongestants shrink swollen tissues and blood vessels in your child’s nose. A wide variety of formulations is available, including combination products containing both an antihistamine and a decongestant. Always check with your child’s doctor before allowing your child to use any OTC asthma quick-relief products.
Allergy Shot Therapy (also called Immunotherapy) Allergy symptom reducerPotential asthma preventer

 

 

A series of injections is started with a very small amount of allergen (what the person is allergic to).The injected amount is increased over time.

If the therapy works, the result is a greater tolerance for the allergen, leading to less severe allergic reactions when they occur.

A series of injections, given on a regular basis—for example:

  • Once or twice a week for 3-6 months or until the maximum dose is reached, followed by:
  • Mainten-ance injections every 2 to 4 weeks for 3 to 5 years
Before starting allergy shot therapy, doctors do allergy testing to learn which allergens to use.Allergy shot therapy for asthma is not used in children under age 5.

(Learn more about allergy testing here and in the chart, “Commonly Used Tests to Diagnose Asthma in Children Age 6 and Older.”)