Illness/Disease, Medications

23. A Quick Guide for Treating Asthma in Children

Medications commonly used to treat children with asthma include inhaled steroids (QVAR, Flovent, Asmanex, Pulmicort, etc.), bronchodilators (Proair/albuterol, Xopenex), and combination agents (Symbicort, Dulera, Advair, etc.). The latter contain both long-acting bronchodilators and steroids. In general, I don’t recommend combination agents for children due to safety concerns. Singulair (monteleukast) is a safe adjunctive agent that treats both asthma and allergies.

The inhaled steroids are controller agents that work best when used over long time periods. For children with severe asthma, inhaled steroids are generally taken every day. In children with mild asthma, inhaled steroids can be administered at the onset of cold and cough. Bronchodilators, on the other hand, work in the moment for wheezing and difficulty breathing, but they wear off quickly and aren’t particularly helpful for controlling underlying inflammation. Parents should be aware that bronchodilators cause a temporary increase in heart rate, but this is usually well tolerated in children.

When a child with asthma develops cough and cold symptoms, I usually recommend the following treatments:

Inhaled steroids: two puffs twice daily—remember to wean off the steroids once the cough is resolving. Children on a daily maintenance dose of inhaled steroids may be instructed to temporarily increase their dose during times of illness.

Proair/albuterol: two puffs every four hours as needed. Call your doctor if your child seems to be needing albuterol treatments more than once every four hours. Please note that liquid albuterol administered through a nebulizer machine is equivalent to approximately 6-8 puffs of an albuterol inhaler. For this reason, nebulized albuterol may be more effective than an inhaler for treating a severe asthma attack.

Unless specifically designed to be placed inside the mouth, inhalers should be used with an aerochamber for all age groups, even adults.