Dr.Kamini Silvarajan MD/AAAM

Editorial Board: Dr.Kamini Silvarajan MD/AAAM

Controlling Child’s Asthma

Asthma is the commonest childhood illness, affecting many children globally.

And statistically, for many children asthma is a chronic illness, causing asthma symptoms that come and go throughout the year, leading to frequent asthma attacks, poor sleep, missed school days, emergency visits to a doctor and even hospitalizations.

With good guidance long term asthma treatment, many of these children can have their asthma under better control, so that they rarely have asthma symptoms or bad asthma attacks.

Long term asthma treatment usually include:- 
  1. An asthma action plan, which outlines which asthma medications your child should take and when child should take them and may include using peak flows to recognize when your child is having an asthma attack.
  2. Education about the proper use of asthma medications, recognizing asthma symptoms and early signs of an asthma attack
  3. Education about identifying and avoiding asthma triggers,such as dust mites, mold, pet dander, smoke, high ozone days,changes in the weather, etc.
  4. Daily long term asthma controller medications such as:-
1) Singulair (Montelukast (trade name Singulair), is a leukotriene receptor antagonist (LTRA) used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies. It is usually administered orally.)

2) Pulmicort Respules [(Budesonide is a glucocorticoid steroid for the treatment of asthma, non-infectious rhinitis (including hay fever and other allergies), and for treatment and prevention of nasal polyposis. Additionally, it is used for Crohn’s disease (inflammatory bowel disease)]

3) Pulmicort Flexhaler (or Pulmicort Turbuhaler is a steroid dry powder inhaler that can help prevent asthma attacks if used daily.)

4) Advair [(the combination preparation fluticasone/salmeterol is a formulation containing fluticasone propionate and salmeterol xinafoate used in the management of asthma and Chronic Obstructive Pulmonary Disease (COPD)] or

5) Symbicort (Budesonide/Formoterol is a combination formulation containing budesonide and formoterol used in the management of asthma and chronic obstructive pulmonary disease (COPD) ) – etc., which are usually needed except for children with mild asthma. 
treating other conditions that may trigger your child’s asthma symptoms or make your child asthma worse, include allergies,sinus infections,obesity,obstructive sleep apnea and gastroesophageal reflux.

Treating Asthma Towards Achieving The Goal

Does your child have poorly controlled asthma or hard to control asthma.

Your question can be answered if you first understand what it means to have asthma under control and what your goals for asthma treatment should be.

Children with properly controlled asthma,normally:- 

  1. Do not have any chronic symptoms of asthma, such as a cough which may be worse at night or when exercising, wheezing or trouble breathing.
  2. Do not frequently need to use their asthma controller or quick relief medication usually Albuterol or Xopenex to relieve their asthma symptoms. They definitely use them less than twice a week.
  3. Have no restrictions in their routines or activity levels, and so sleep well, play sports, and rarely miss school because of asthma symptoms.
  4. Have infrequent (not occurring often) asthma attacks.
  5. Do not have to make emergency visits to the doctor for severe asthma attacks and do not have any recent hospitalizations for asthma attacks.
  6. Understand how and when to use their asthma medications.
Parents of children whose asthma is under good control likely also understand how and when to use their asthma medications and have some understanding of what triggers their child’s asthma attacks.

Hard To Control Asthma

If your child’s asthma is not under good control, especially if your child is having often asthma attacks, be sure to see your pediatrician. It is likely that your child needs a improvement in his long term control medication prescriptions.

Steps of Asthma Treatment

In addition to the Step 1 treatment of occasionally using a quick reliever medicine for intermittent asthma, the preferred treatments or steps for children who have persistent asthma symptoms include long term controller medicines (there are many choices and combinations of these medicines, but your doctor can help you decide which asthma inhaler is the best for your child) 

Other following steps:- 

  1. Step 2 – a low dose inhaled steroid
  2. Step 3 – a medium-dose inhaled steroid (children less than four years old) or low-dose inhaled steroid combined with another medication or a medium dose inhaled steroid
  3. Step 4 – a medium-dose inhaled steroid combined with another medication
  4. Step 5 – a high-dose inhaled steroid combined with another medication
  5. Step 6 – a high-dose inhaled steroid combined with other medications, including oral steroids
Which step to use will typically depend on how well your child’s asthma is being controlled. For example, if your six year old has to leave tennis practice early because he/she is coughing, wakes up twice a week coughing, and has two or three asthma attacks a year that send him/her to the doctor under emergency situation, then he likely needs to move up one or two steps in his or her asthma treatment.

As A Parent What You Need To Know:- 

  1. Children should usually use a spacer either with a mask(less than age four) or without a mask (age four or older) depending on their age, when they use a metered dose inhaler. Once they are five or older, some children can begin to learn to use a metered dose inhaler without a spacer.
  2. Allergy Shots (immunotherapy is the medical term your doctor uses for what you may refer to as “allergy shots.”- https://whatasthmais.com/new-asthma-medications/ ) may be a good option for children who have persistent allergy induced asthma.
  3. An evaluation by an asthma specialist, such as a pediatric pulmonologist, can be a good idea if your child is requiring step 3 care or higher.
  4. Children shouldn’t usually step down in their asthma treatment until they have been well-controlled for at least three months and they would usually go down one step at a time.
Many experts think that if you are using very good technique, an inhaler with a spacer and mask can be as good as using a nebulizer to deliver asthma medications.

Asthma Inhaler With A Spacer And A Mask

A nebulizer also can have many disadvantages. In addition to taking almost 10 minutes to complete a breathing treatment, many younger children cry if they have to wear a mask to deliver the nebulizer treatment. Nebulizers also aren’t as convenient or portable as an inhaler.

Keep in mind that while many experts believe that an MDI with a spacer is as good as a nebulizer treatment, some parents prefer a nebulizer.