Once diagnosed with asthma, your child will probably be prescribed specific medication. Just as there are two main problems associated with asthma: bronchoconstriction and inflammation – there are two main types of asthma medications: bronchodilators and anti-inflammatories.
Bronchodilators usually come in the form of inhalers, or in liquid form for young children. (Check out the section on asthma medication delivery devices) Bronchodilators provide quick relief by easing bronchial muscle tension and constriction. These are considered “Short acting” medications, as they work immediately but their effect lasts only for a few hours. Tradenames of commonly used bronchodilators include Ventolin, Alupent and Bricanyl. Consult your health care professional for more details.
“Short acting” Bronchodilators should only be given as needed, for example during a cold, or for shortness of breath, or wheezing. Children with mild asthma symptoms can often be treated adequately with the occasional use of bronchodilators alone. The need for these short acting bronchodilators can act as a gauge of asthma control. Depending on the child’s particular condition, needing bronchodilator medication more than 3 or 4 times per week usually indicates the presence of inflammation and inadequate asthma control. At least 25% of asthmatic children have symptoms mainly due to inflammation. These children should also take anti-inflammatory medications.
Long Acting Bronchodilators
Recently the “Long Acting Bronchodilators” have been made available for use in children. These medications work in the same way as the short acting bronchodilators, but their effect lasts longer; up to 12 hours. Currently these medications are Salmeterol(known as Serevent) and Formoterol(known as Oxeze).
Long Acting Bronchodilator medications are reserved only for children who’s asthma is not well controlled despite the maximum use of inhaled steroids and short acting bronchodilators. When prescribed, these medications are given only in COMBINATION with an inhaled steroid and never alone. As a matter of fact they are currently available in “combination” puffers or inhalers with inhaled steroids.
When taking a long acting bronchodilators the need for the short acting bronchodilators is almost zero and the control usually improves. The use of short acting bronchodilators should be restricted to emergency(relief) use only.
One category of anti-inflammatory medications are the non-steroids which although are still available, are used less frequently than inhaled steroids(see below). These include sodium cromoglycate, know as Intal, and nedocromil sodium, known as Tilade, which are inhaled – and ketotifen, known as Zaditen, which is swallowed. Non-steroid anti-inflammatories can take longer to take effect – up to 8 to 10 weeks – and have few side-effects. In general, children with mild but frequent symptoms, may benefit from non-steroidal anti-inflammatory medication.
Another category of anti-inflammatory medication includes corticosteroids. Examples of corticosteroids given to children include: Prednisone and Predilisone(Pediapred), both which are swallowed. Orally-administered steroids are effective helping children with acute asthma. However, prolonged or daily use can result in negative side-effects such as growth delay.
Inhaled steroids such as fluticosone known as Flovent and budesonide, known as Pulmicort, are effective treating children with chronic asthma and are considered very safe. Indeed inhaled steroids are considered much safer than orally-administered steroids. In general, the goal of steroid treatment is to achieve as few symptoms as possible with the lowest possible dose. Recent studies have confirmed that inhaled steroids are safe in children and do not interfere with growth.
Thanks to today’s better understanding of asthma, scientists have been able to develop medications that specifically target inflammation at the molecular level. Leukotrienes, substances made during inflammation, are thought to contribute to the development of asthma symptoms. Zafirlukast(Accolate) and Montelukast(Singulair) are medications which block leukotrienes (Anti-Leukotrienes). As they have recently become available, there is not much experience with these in children. Anti-Leukotrienes are taken by mouth (therefore easy to take, without worrying about inhaler device technique) and are not corticosteroids. Whether or not an asthmatic is prescribed these medications depends entirely on the child’s age and specific situation.
For immediate or acute relief of asthma symptoms, bronchodilators are the best option. In time, as airway inflammation is decreased by preventative, anti-inflammatory medications, the occurrence of acute attacks will be reduced, as will the need for bronchodilators. However, regular use of anti-inflammatory medications may still be required on an on-going, maintenance basis.
Prescribed anti-inflammatory medications should be tried for at least 2 months, after which your child’s condition will need to be reevaluated. Some parents discontinue preventative anti-inflammatory medications on their own because their child seems better. But remember, your child is well because he or she has been taking preventative medication. Unfortunately, when medications are stopped too soon, symptoms may reappear. However, with the help of a healthy environment, some children do outgrow their symptoms and their need for medication. Do not discontinue medication unless advised to do so by your child’s doctor.
THE NAMES OF THE MEDICATIONS AND AVAILABILTY MAY VARY DEPENDING ON THE COUNTRY YOU LIVE IN. PLEASE SPEAK WITH YOUR HEALTHCARE PROFESSIONAL REGARDING THE AVAILABILTY OF THE MEDICATIONS IN YOUR COUNTRY.
Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.