Medications

Medicine does not cure asthma. But it is an important part of managing the condition. Medicines for asthma treatment are used to:

• Prevent and control the airway inflammation to minimize long-term lung damage.
• Decrease the severity, frequency, and duration of asthma attacks.
• Treat the attacks as they occur.

Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks. Most children with persistent asthma need to use long-term medicines daily. Quick-relief medicines are used as needed and provide rapid relief of symptoms during asthma attacks.

Medicine delivery

Most medicines for asthma are inhaled, because a specific dose of the medicine can be given directly to the bronchial tubes. Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.

Many doctors recommend that every child who uses a metered-dose inhaler (MDI) also use a spacer, which is attached to the MDI. A spacer may deliver the medicine to your child's lungs better than an inhaler alone. And for many people a spacer is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and the need for oral corticosteroids.

Asthma: Using a Metered-Dose Inhaler

Asthma in Children: Helping a Child Use a Metered-Dose Inhaler and Mask Spacer

Asthma: Using a Dry Powder Inhaler

Medication choices

The most important asthma medicines are:

• Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. They reduce inflammation of your child's airways and are taken every day to keep asthma under control and to prevent sudden and severe symptoms (asthma attacks). Inhaled corticosteroids include beclomethasone, triamcinolone, fluticasone, budesonide, and flunisolide.
• Oral or injected corticosteroids (systemic corticosteroids) to get your child's asthma under control before he or she starts taking daily medicine. Your child may also need these medicines to treat asthma attacks. Oral corticosteroids include prednisone and dexamethasone.
• Short-acting beta2-agonists (quick-relief medicines) for asthma attacks. They relax the airways, allowing your child to breathe easier. These medicines include albuterol and pirbuterol.

Long-term medicines sometimes used alone or with other medicines for daily treatment include:

• Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
• Long-acting beta2-agonists (such as salmeterol and formoterol). They are always used with an inhaled corticosteroid.
• Less commonly, your doctor may recommend a mast cell stabilizer (such as cromolyn) or theophylline.

Other medicines may be given in some cases.

• Anticholinergics (such as ipratropium) are usually used for severe asthma attacks.
• Other medicine such as omalizumab or magnesium sulfate may be used if asthma does not improve with treatment.

Medicine treatment for asthma depends on your child's age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.

• Children up to age 4 are usually treated a little differently than those 5 to 11 years old.
• The least amount of medicine that controls your child's symptoms is used.
• The amount of medicine and number of medicines are increased in steps. So if your child's asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
• If your child's asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control your child's asthma.
• Quick-relief medicine is used to treat asthma attacks. But if your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.

Your child's doctor will work with you and your child to help find the number and dose of medicines that work best.

Concern about medicines and growth

There has been some worry that children who use inhaled corticosteroids may not grow as tall as other children. In the studies done so far, there was a very small difference in height and growth in children using inhaled corticosteroids compared to children not using them.

When these children stopped using inhaled corticosteroids, their growth increased. It is expected that even though using inhaled corticosteroids may slow growth at first, children will still grow to a normal height.¹⁹ But no study has gone on long enough for experts to be sure. The difference in height is very small, and this effect is rare. But children using inhaled corticosteroids should have their height checked once or twice a year.

What to think about

• Quick-relief medicines. Because these medicines quickly reduce symptoms, children sometimes overuse them instead of adding the slower-acting, long-term medicines. But overuse of quick-relief medicines may have harmful effects, such as decreasing how well these medicines work in the future.²⁰ Overuse of quick-relief medicine is also a sign that asthma symptoms are not being controlled. You should talk with your doctor right away.
• Corticosteroid pills. Research shows that the most important factor in reducing the severity and length of an asthma attack in children is giving a corticosteroid pill early in a severe attack. These pills work best when given at the first sign of symptoms.²¹
• Inhaled medicines. Try to avoid giving your child an inhaled medicine when he or she is crying, because not as much medicine is delivered to the lungs.