Treating and Preventing Asthma in Children

Asthma Basics

A Child Getting a Nebulizer Treatment
A child with asthma getting a breathing treatment.. Photo by 2007 Vincent Iannelli, MD

Asthma is a serious and potentially life threatening illness that affects many children. Fortunately, there are many medications that can help control and prevent asthma attacks.

The symptoms of asthma for most children include coughing, wheezing and difficulty breathing, and they may be brought on or triggered by having a cold, changes in the weather, exercise or exposure to cigarette smoke, pollen, mold, animals, and pollution.

If you can learn the things that trigger your child's asthma problems, it can help to avoid them, although finding asthma triggers is often difficult.

Asthma is usually easy to diagnose in a child who is wheezing and having trouble breathing, but it becomes more difficult if the child only has a cough, or cough variant asthma. You should suspect that your child may have asthma if he has a chronic cough that is worse at night or when he is running and playing, even if he never seems to wheeze.

Asthma Treatments

The main treatment when your child is coughing or wheezing and having trouble with his asthma is to use a bronchodilator, such as Albuterol, Proventil, Ventolin or Xopenex (a newer medication). These are also called 'quick relief' or 'reliever' medications. These medications are available for use with a nebulizer, metered dose inhaler, or syrup (rarely used). Younger children may be able to use these asthma inhalers with a spacer or a spacer and mask.

These quick relief medications are usually used on and as needed basis. If you are usually them regularly, on a weekly or daily basis, then your child's asthma is likely being poorly controlled and he would benefit from a preventative medication.

During an asthma attack many children also have to take an oral steroid, such as prednisone or prednisolone.

Asthma Prevention

The goal of treating asthma is that your child be symptom free and able to perform his normal activities. Asthma should not usually limit your child's activities, unless he is having an asthma attack at the time.

In addition to avoiding triggers, asthma can often be prevented by taking a daily preventative medication. These include inhaled steroids, such as Flovent, Pulmicort, Qvar, Alvesco, Aerospan, and Asmanex, which are used every day, even when your child is not having any asthma symptoms. These are available as metered dose inhalers and newer dry powder inhalers. Pulmicort is also available in a form (Pulmicort Respules) that can be given with a nebulizer, which is convenient for younger children.

Other preventative medications combine a steroid with a long-acting broncholitator. They are used in children with moderate to severe asthma who aren't controlled with an inhaled steroid and can include Advair HFA, Advair Diskus, Dulera, and Symbicort.

The other main type of preventative medication is the leukotriene modifiers, such as Singulair (Monteleukast), available as granules and as a chewable tablet for younger children.

If your child is already on a preventative medication and continues to need to use a 'reliever' medication on a regular basis, then your child likely needs to take another preventative medication or a higher dosage of his current medications. For example, if he is already taking Advair 100/50, then he may need to be increased to a higher dose, such as the 250/50 form of Advair, and/or Singulair might be added to his treatment plan.

Asthma Monitoring

The easiest way to monitor how well your child's asthma is being treated is to see if he is having any symptoms. If your child is not coughing or having trouble breathing and is rarely using a reliever medicine, then he is likely under very good control. If he frequently has a cough, especially at night or with activities, or if he is using a reliever medicine on a daily or even weekly basis, then is asthma is probably under poor control.

Peak flows can help you monitor your child's asthma once he is 5-6 years old. A peak flow meter is a small device that your child blows into and based on the number he gets, it can sometimes help you know if he is having trouble with his asthma or if he is under good control.

Pulmonary function tests are another tool that can help to determine how well your child's asthma is under control, but can usually only be done in the office of an allergist or pulmonologist. Most pediatricians do not do this test in their office.

Asthma Treatment Plans

A treatment or action plan is a handy reference that your doctor should provide you with to help you know which medicines you should be using at different times. An asthma treatment plan usually outlines your child's daily medications and which ones to take when his peak flows are dropping or he is developing asthma symptoms.

Asthma Education

If your child's asthma is poorly controlled or if you still do not understand how to best manage his asthma, a referral to a Pediatric Pulmonologist might be helpful. You might also look into taking an asthma education class if they are available in your area. There are also many helpful books, including the American Academy of Pediatrics Guide to Your Child's Allergy and Asthma, and websites that can help you learn more about asthma.

Among the basic things about asthma that you should know include:

  • What medications you should be giving your child and when to use them. Having an asthma treatment plan can help you understand what you need to do.
  • How to manage an asthma attack.
  • How to use a nebulizer (if you have one) and/or a metered dose inhaler (MDI) with or without a spacer.
  • How to use a peak flow meter and how to interpret the results.
  • How to prevent your child from having an asthma attack, including understanding the proper use of preventative medications and avoiding triggers.

Uncontrolled Asthma

What do you do if your child's asthma is not under good control? Learning more about asthma is a good start, but you will likely need a follow-up visit with your doctor or get a referral to a specialist for more help. One big reason for a child's asthma to be under poor control is because he is not taking his medications or he is not taking them correctly. Bringing all of his medications to your next office visit and demonstrating how he uses them can help your Pediatrician decide if he is using them properly.

You might also consider that your child has allergies, especially if he also has a stuffy or runny nose when he gets his asthma problems. Many kids with allergies also have asthma, and uncontrolled or untreated allergies can make it difficult to effectively treat a child's asthma. Allergy testing might also be helpful if you can't figure out what triggers your child's asthma.

Gastroesophageal reflux can also complicate and trigger asthma in some children, even in those that don't obviously spit up.

Sources:

National Heart, Lung, and Blood Institute. Guidelines for the Diagnosis and Management of Asthma. July 2007.

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