Understanding Asthma in Kids - Treatment & Medications

Does your child have asthma?

Asthma Treatment with Nebulizer
Asthma Treatment with Nebulizer. Photo (c) Kenneth C. Zirkel

Does your child have asthma? That seems like an easy enough question, but unless your child has classic asthma symptoms, like coughing, wheezing and trouble breathing, you might not know that he has asthma.

Many children have more subtle symptoms, including a nighttime cough, a cough that worsens with exercise or activity, or just a chronic cough that won't go away. In these children, especially for infants and toddlers, asthma can be hard to diagnose.

Parents often ask about 'testing' their children for asthma. In older children, pulmonary function tests and/or peak flows are tests that can help to diagnose asthma, but they are difficult to do in children under 4-5 years of age.

Other factors that may make it less likely for your Pediatrician to diagnose your child with asthma include that many younger children, especially infants and toddlers, can wheeze when they get a viral infection. Bronchiolitis, usually caused by RSV, is a common cause of wheezing in children. If it is your child's first episode of wheezing, and he also has a cough, runny nose, and fever, then it is likely that is bronchiolitis and not true asthma, especially during RSV season (late fall/winter/early spring).

Some children who wheeze a lot as infants are simply diagnosed with Reactive Airway Disease. I think RAD is often diagnosed in infants because they can wheeze when they have viral infections, and it doesn't mean that they will continue to wheeze or have problems as they get older.

If your child has RAD and has had more than a few episodes of wheezing and coughing, then he likely does have asthma.

A diagnosis of asthma is also likely if your child gets pneumonia, 'bronchitis' or bronchiolitis a lot, if it 'gets in his chest' every time he has a cold, or if he has a chronic cough, especially if it is worse at night.

Asthma Treatments

Treatments for asthma attacks usually include a bronchodilator type of medicines, such as albuterol, Proventil, Ventolin, or Xopenex, which can be given with a nebulizer, metered dose inhaler or syrup. For moderate or severe attacks, an oral steroid, such as prednisolone (Prelone) or Orapred, is also often needed.

Bronchodilator medications are also often called 'reliever' or 'quick relief' medications, since they relieve your child's asthma symptoms. They are usually only used on an 'as needed' basis and your child should not be needing to use them regularly if his asthma is being well controlled.

Although albuterol is available as a syrup, quick-relief medications are usually given with a nebulizer or a metered dose inhaler. Younger children can often use an inhaler if they also have a spacer and infant mask.

Preventative Medications

The other type of medications that are used to treat asthma are the preventative medications, which help to prevent asthma symptoms. These include long-acting bronchodilators, such as Serevent and Foradil, and steroids, such as Flovent, Qvar, Pulmicort, Asmanex, and Azmacort.

Pulmicort respules are a form of steroids that can be given with a nebulizer and are useful for younger children who can't yet use an inhaler or who don't tolerate using a mask and spacer. Advair is a newer combination asthma medication, which includes Flovent and Serevent into one easy to use dry powder inhaler.

Leukotriene antagonists are another type of preventative medicine and include Singulair, available as a chewable tablet for children over 2 years old and given just once a day, and Accolate, which is indicated for children over age 7. Intal is another preventative medication and it is available as a metered dose inhaler and nebulizer solution, but it usually needs to be used 3-4 times a day to be effective.

Does your child have asthma?

That seems like an easy enough question, but unless your child has classic asthma symptoms, like coughing, wheezing and trouble breathing, you might not know that he has asthma.

Many children have more subtle symptoms, including a nighttime cough, a cough that worsens with exercise or activity, or just a chronic cough that won't go away. In these children, especially for infants and toddlers, asthma can be hard to diagnose.

Parents often ask about 'testing' their children for asthma. In older children, pulmonary function tests and/or peak flows are tests that can help to diagnose asthma, but they are difficult to do in children under 4-5 years of age.

Reactive Airway Disease

Other factors that may make it less likely for your pediatrician to diagnose your child with asthma include that many younger children, especially infants and toddlers, can wheeze when they get a viral infection. Bronchiolitis, usually caused by RSV, is a common cause of wheezing in children. If it is your child's first episode of wheezing, and he also has a cough, runny nose, and fever, then it is likely that is bronchiolitis and not true asthma, especially during RSV season (late fall/winter/early spring).

Reactive Airway Disease or RAD is often diagnosed in infants because they can wheeze when they have viral infections, and it doesn't mean that they will continue to wheeze or have problems as they get older.

If your child has RAD and has had more than a few episodes of wheezing and coughing, then he likely has asthma, whether or not your pediatrician has formally labeled it as asthma.

A diagnosis of asthma is also likely if your child gets pneumonia, 'bronchitis' or bronchiolitis a lot, if it 'gets in his chest' every time he has a cold, or if he has a chronic cough, especially if it is worse at night.

Cough Variant Asthma

Asthma becomes more difficult to treat if your child only has a cough and is not wheezing. Many doctors seem hesitant to treat these children aggressively and might think that your child just has a cold or bronchitis. If your child has a chronic cough lasting more than a few weeks, especially if it is worse at night or following physical activity, then you should ask your doctor whether or not it could be asthma.

Like other types of asthma attacks, cough variant asthma usually has to be treated aggressively, with frequent use of a bronchodilator, such as albuterol or Xopenex, and an oral steroid. Just using an inhaler a few times a day might not be enough.

Exercise-Induced Asthma

Exercise is also a common asthma trigger.

Exercise-induced asthma (EIA) sometimes gets confused with kids who have poor conditioning, though.

Does your child have asthma symptoms that only get worse when he does sports or other types of exercise? Instead of avoiding physical activity, exercise-induced asthma symptoms can be improved or prevented by using a 'reliever' medicine before those activities.

Other Types of Asthma

Other types of asthma can include:

  • Allergic Asthma - asthma that is triggered by specific allergens, like mold or tree pollens
  • Nocturnal Asthma - asthma that is worse at night
  • Steroid-Resistant Asthma - asthma that doesn't respond to treatment with steroids

Although many people think that asthma is asthma, understanding that there are different types of asthma can help your child get diagnosed properly.

Sources:

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

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