Initial treatment depends on the severity of your child's asthma. The goal of asthma treatment is to keep symptoms under control, meaning that your child has:
- Minimal or no symptoms
- Few or no asthma flare-ups
- No limitations on physical activities or exercise
- Minimal use of quick-relief (rescue) inhalers, such as albuterol (ProAir HFA, Ventolin HFA, others)
- Few or no side effects from medications
Treating asthma involves both preventing symptoms and treating an asthma attack in progress. The right medication for your child depends on a number of things, including age, symptoms, asthma triggers and what seems to work best to keep his or her asthma under control.
For children younger than age 3 who have mild symptoms of asthma, the doctor might use a wait-and-see approach. This is because the long-term effects of asthma medication on infants and young children aren't clear.
However, if an infant or toddler has frequent or severe wheezing episodes, a medication might be prescribed to see if it improves symptoms.
Long-term control medications
Preventive, long-term control medications reduce the inflammation in your child's airways that leads to symptoms. In most cases, these medications need to be taken daily.
Types of long-term control medications include:
Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex HFA), ciclesonide (Alvesco), beclomethasone (Qvar Redihaler) and others. Your child might need to use these medications for several days to weeks before getting the full benefit.
Long-term use of these medications has been associated with slightly slowed growth in children, but the effect is minor. In most cases, the benefits of good asthma control outweigh the risks of possible side effects.
- Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). They help prevent asthma symptoms for up to 24 hours.
Combination inhalers. These medications contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include fluticasone and salmeterol (Advair Diskus, Advair HFA), budesonide and formoterol (Symbicort), fluticasone and vilanterol (Breo Ellipta), and mometasone and formoterol (Dulera).
In some situations, long-acting beta agonists have been linked to severe asthma attacks. For this reason, LABA medications should always be given to a child with an inhaler that also contains a corticosteroid. These combination inhalers should be used only for asthma that's not well-controlled by other medications.
- Theophylline. This is a daily pill that helps keep the airways open. Theophylline (Theo-24) relaxes the muscles around the airways to make breathing easier. It's mostly used with inhaled steroids. If you take this drug, you'll need to have your blood checked regularly.
- Immunomodulatory agents. Mepolizumab (Nucala), dupilumab (Dupixent) and benralizumab (Fasenra) might be appropriate for children over the age of 12 who have severe eosinophilic asthma. Omalizumab (Xolair) can be considered for children age 6 or older who have moderate to severe allergic asthma.
Quick-relief medications quickly open swollen airways. Also called rescue medications, quick-relief medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your child's doctor recommends it.
Types of quick-relief medications include:
- Short-acting beta agonists. These inhaled bronchodilator medications can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA). These medications act within minutes, and effects last several hours.
- Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. They can cause serious side effects when used long term, so they're only used to treat severe asthma symptoms on a short-term basis.
Treatment for allergy-induced asthma
If your child's asthma is triggered or worsened by allergies, your child might benefit from allergy treatment, such as the following, as well:
- Omalizumab (Xolair). This medication is for people who have allergies and severe asthma. It reduces the immune system's reaction to allergy-causing substances, such as pollen, dust mites and pet dander. Xolair is delivered by injection every two to four weeks.
- Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.
- Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your child's immune system reaction to specific allergens.
Don't rely only on quick-relief medications
Long-term asthma control medications such as inhaled corticosteroids are the cornerstone of asthma treatment. These medications keep asthma under control and make it less likely that your child will have an asthma attack.
If your child does have an asthma flare-up, a quick-relief (rescue) inhaler can ease symptoms right away. But if long-term control medications are working properly, your child shouldn't need to use a quick-relief inhaler very often.
Keep a record of how many puffs your child uses each week. If he or she frequently needs to use a quick-relief inhaler, take your child to see the doctor. You probably need to adjust the long-term control medication.
Inhaled medication devices
Inhaled short- and long-term control medications are used by inhaling a measured dose of medication.
- Older children and teens might use a small, hand-held device called a pressurized metered dose inhaler or an inhaler that releases a fine powder.
- Infants and toddlers need to use a face mask attached to a metered dose inhaler or a nebulizer to get the correct amount of medication.
- Babies need to a use a device that turns liquid medication into fine droplets (nebulizer). Your baby wears a face mask and breathes normally while the nebulizer delivers the correct dose of medication.
Asthma action plan
Work with your child's doctor to create a written asthma action plan. This can be an important part of treatment, especially if your child has severe asthma. An asthma action plan can help you and your child:
- Recognize when you need to adjust long-term control medications
- Determine how well treatment is working
- Identify the signs of an asthma attack and know what to do when one occurs
- Know when to call a doctor or seek emergency help
Children who have enough coordination and understanding might use a hand-held device to measure how well they can breathe (peak flow meter). A written asthma action plan can help you and your child remember what to do when peak flow measurements reach a certain level.
The action plan might use peak flow measurements and symptoms to categorize your child's asthma into zones, such as the green zone, yellow zone and red zone. These zones correspond to well-controlled symptoms, somewhat-controlled symptoms and poorly controlled symptoms. This makes tracking your child's asthma easier.
Your child's symptoms and triggers are likely to change over time. You'll need to observe symptoms and work with the doctor to adjust medications as needed.
If your child's symptoms are completely controlled for a time, your child's doctor might recommend lowering doses or stopping asthma medications (step-down treatment). If your child's asthma isn't as well-controlled, the doctor might want to increase, change or add medications (step-up treatment).