Asthma in Children (cont.)

Treatment of Asthma

The goals of asthma therapy are to prevent your child from having chronic and troublesome symptoms, to maintain your child's lung function as close to normal as possible, to allow your child to maintain normal physical activity levels (including exercise), to prevent recurrent asthma attacks and to reduce the need for emergency department visits or hospitalizations, and to provide medicines to your child that give the best results with the fewest side effects. See Understanding Asthma Medications.

Medicines that are available fall into two general categories. One category includes medications that are meant to control asthma in the long term and are used daily to prevent asthma attacks (controller medications). These can include inhaled corticosteroids, inhaled cromolyn or nedocromil, long-acting bronchodilators, theophylline, and leukotriene antagonists. The other category is medications that provide instant relief from symptoms (rescue medications). These include short-acting bronchodilators and systemic corticosteroids. Inhaled ipratropium may be used in addition to inhaled bronchodilators following asthma attacks or when asthma worsens.

In general, doctors start with a high level of therapy following an asthma attack and then decrease treatment to the lowest possible level that still prevents asthma attacks and allows your child to have a normal life. Every child needs to follow a customized asthma management plan to control asthma symptoms. The severity of a child's asthma can both worsen and improve over time, so the type (category) of your child's asthma can change, which means different treatment can be required over time. Treatment should be reviewed every 1-6 months, and the choices for long- and short-term therapy are based on how severe the asthma is.

Talk to your doctor about the various medications available to treat asthma.

Severity of Asthma	Long-Term Control	Quick Relief
Mild intermittent asthma	Usually none	Inhaled beta-2 agonist (short-acting bronchodilator) If your child uses the short-acting inhaler more than 2 times per week, long-term control therapy may be necessary.
Mild persistent asthma	Daily use of low-dose inhaled corticosteroids or nonsteroidal agents such as cromolyn and nedocromil (anti-inflammatory treatment), leukotriene antagonists, montelukast	Inhaled beta-2 agonist (short-acting bronchodilator) If your child uses the short-acting inhaler everyday or starts using it more and more frequently, additional long-term therapy may be needed.
Moderate persistent asthma	Daily use of medium-dose inhaled corticosteroids (anti-inflammatory treatment) or low- or medium-dose inhaled corticosteroids combined with a long-acting bronchodilator or leukotriene antagonist	Inhaled beta-2 agonist (short-acting bronchodilator) If your child uses the short-acting inhaler everyday or starts using it with increasing frequency, additional long-term therapy may be needed.
Severe persistent asthma	Daily use of high-dose inhaled corticosteroids (anti-inflammatory treatment), long-acting bronchodilator, leukotriene antagonist, theophylline, omalizumab (for patients with moderate-to-severe asthma brought on by seasonal allergens despite inhaled corticosteroids)	Inhaled beta-2 agonist (short-acting bronchodilator) If your child uses the short-acting inhaler everyday or starts using it with increasing frequency, additional long-term therapy may be needed.
Acute severe asthmatic episode (status asthmaticus)	This is severe asthma that often requires admission to the emergency department or hospital.	Repeated doses of inhaled beta-2 agonist (short-acting bronchodilator) **Seek medical help

Acute severe asthmatic episode (status asthmaticus) often requires medical attention. It is treated by providing oxygen or even mechanical ventilation in severe cases. Repeat or continuous doses from an inhaler (beta-2 agonist) reverse airway obstruction. If the asthma isn't corrected using the inhaled bronchodilator, injectable epinephrine and/or systemic corticosteroids are given to reduce inflammation.

Fortunately, for most children, asthma can be well controlled. For many families, the learning process is the hardest part of controlling asthma. A child might have flares (asthma attacks) while learning to control asthma, but don't be surprised or discouraged. Asthma control can take a little time and energy to master, but it's worth the effort!

How long it takes to get asthma under control depends on the child's age, the severity of symptoms, how frequently flares occur, and how willing and able the family is to follow a doctor's prescribed treatment plan. Every child with asthma needs a doctor-prescribed individualized asthma management plan to control symptoms and flares. This plan usually has 5 parts.

Next: The Five Parts to an Asthma Treatment Plan »

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