In general, children use the same types of medications for asthma as adults do. The amount and type of medication your child will need depends on the severity of the asthma. For mild cases, your doctor may only prescribe a bronchodilator, a medication that helps breathing by relaxing the tight ring of muscle around the airways, for quick relief as soon as symptoms begin. More serious cases will require daily medication to prevent attacks, as well as quick relief drugs to head off developing symptoms. As for adults, for children with moderate to severe asthma, inhaled corticosteroids are usually the primary medication prescribed. The long-term benefits of anti-inflammatory therapy (for example, inhaled steroids, nedocromil) have not yet been documented. There is some disagreement among doctors about the best treatment for children with milder asthma. The latest National Institutes of Health guideline recommends beginning treatment with cromolyn sodium (an anti-inflammatory medicine for the prevention of an asthma attack) or nedocromil sodium (another anti-inflammatory medicine), with careful monitoring, for four to six weeks. If these medications do not relieve symptoms and the child still has trouble breathing, then inhaled corticosteroids at a medium dose are started, which should be gradually tapered to the lowest dose that relieves symptoms. Some anti-leukotriene medications are also approved for use in children as young as 5. Recent studies on hundreds of children also found that montelukast (Singulair), a leukotriene modifier, the newest class of drugs to treat asthma, was effective in 6- to 14-year-olds with chronic mild to moderate asthma. Leukotriene modifiers are also anti-inflammatory drugs. Anti-inflammatory medicines are so important because the airways in a child or adult with asthma may be inflamed or edematous. Similar guidelines are recommended for infants and very young children. In general, daily multiple doses of anti-inflammatory medication such as cromolyn or nedocromil should be used for infants and young children who require treatment to relieve symptoms occurring more than twice a week. Results of any treatment should be monitored, and the treatment discontinued if benefits are not apparent. Although steroids must be used cautiously in young children because of potential side effects, some studies are now under way to learn whether earlier use may prevent some of the chronic airway inflammation that is associated with childhood asthma. The decision about medications for young children can be difficult. If your child has asthma, you should carefully review the benefits and possible adverse effects of each medication with your doctor and continue to closely monitor your child's progress. Other concerns in treating children with asthma relate to compliance and the delivery method for the medicine. Studies in groups of preschool children and inner city children with asthma have found poor compliance in use of medication. If medications do not appear to be working, the first thing to look at is whether they are being administered exactly as prescribed. Then it is important to assess if the delivery method is effective. This can be a particular problem with babies, and nebulizers have been used to overcome the limitations of metered-dose inhalers (MDIs) with young children. Use of spacers with MDIs has broadened their usefulness with young children, but these devices are not always effective with young children. However, a recent review of studies comparing nebulizer use with use of MDIs with spacers concluded that MDIs with spacers were more effective in relieving symptoms, safer, less expensive, easier to use and required less supervision from doctors or nurses than nebulizers did. Finally, when considering asthma medications for children, it is important to be aware of possible adverse side effects. There has been concern about the effects of inhaled steroids on children's growth. Studies have been somewhat conflicting, with some showing reduced growth velocity (which could result in growth suppression) after regular use of inhaled steroids and growth suppression in the first months of steroid usage. However, other studies have shown no long-term impairment, with children who take inhaled steroids eventually reaching standard height for their age group. As you might expect, children receiving larger doses are more likely to have growth impairments. If your child uses inhaled steroids, it is important that his or her growth be monitored regularly and that doses be at the minimal level needed to control symptoms. Your child's doctor will determine the best medication(s), doses and delivery systems for your child. If your child has an asthma attack, you can help by following these steps. - Act calm, be self-confident and speak to the child in a reassuring tone.
- Give the medication prescribed by your physician for the start of an attack.
- Give your child liquids to prevent dehydration.
- Try to determine what triggered the episode and remove it (or the child) from the area.
- Give your child a peak flow meter test and follow his or her action plan.
- Decide that the attack is under control or call the doctor.
As children get older, they're usually able to manage their asthma themselves. Make sure your child understands the plan outlined by the doctor for the management of asthma symptoms and has quick access to a bronchodilator. Also notify teachers, principals, school nurses, coaches and babysitters about what factors can trigger an attack and what to do should one occur. You should also provide written information describing asthma symptoms, a copy of the doctor's instruction for managing your child's asthma, the phone number where you can be reached during the school day and the physician's phone number if you're not available. Physical education teachers and coaches should also know that children with asthma may develop symptoms in response to exercise and may need to use their bronchodilators in school to prevent attacks. Last Updated: 9/24/2002
The Johns Hopkins University 1996-2003. All rights reserved. This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation. |
