Could My Child Have Asthma?

Inhalers & Nebulizers

I've heard some asthma medications may stunt growth. How do these drugs work, and are they safe?

The two most common types are fast-acting bronchodilators and inhaled corticosteroids.

Bronchodilators are used during asthma attacks to relax the muscles surrounding the airways. These "rescue medications" work quickly, usually within 20 minutes, to relieve wheezing, coughing, breathlessness, and other acute symptoms of asthma. They're usually delivered through a metered-dose inhaler or a nebulizer.

Bronchodilators can make your child irritable or restless, so if she does not respond well to them, ask your pediatrician about switching to a newer bronchodilator called Xopenex, suggests Dr. Chiu. It's an improved form of the widely used albuterol that should cause fewer effects. Some brochodilators are available as syrups, but they tend to be the least effective and produce stronger side effects, including fussiness, jitteriness, rapid heart rate, and insomnia.

If your daughter's asthma is mild and her symptoms are infrequent, she may be prescribed only a bronchodilator to be used as needed to relieve her occasional wheezing or coughing. But if she has even mild flare-ups two or more times weekly, she'll need to take a daily anti-inflammatory medication such as inhaled corticosteroids or leukotriene modifiers, says Dr. Chiu.

"Bronchodilators calm the symptoms of asthma but don't touch the underlying inflammation," she explains. "Unless you control the inflammation on a daily basis, your child's symptoms may flare whenever she encounters an allergic trigger, has a virus, or is very active."

Inhaled corticosteroids such as Pulmicort, Azmacort, and Flovent are the most effective drugs for reducing airway inflammation to prevent asthma attacks. Many parents worry about giving their child a daily drug, especially a steroid, but corticosteroids should not be confused with anabolic steroids, which are used to build muscle. Long-term studies have shown that in proper doses, inhaled corticosteroids do not adversely affect a child's growth or bone development, says Dr. Chiu. And they produce far fewer side effects than the oral versions like prednisone, used to control inflammation in acute attacks brought on by not taking a daily inhaled anti-inflammatory, she assures.

"Inhaled cortisone medicine is topically applied to the lungs with minimal risk," Dr. Chiu explains. "It's like applying an over-the-counter hydrocortisone cream on a rash."

Leukotriene modifiers (such as the chewable tablet Singulair, taken once daily) are nonsteroidal anti-inflammatories that may work for younger children.

"If a child has mild asthma, and if the parents are very nervous about steroids, it may be reasonable to start with a leukotriene modifier," says Dr. Chiu. "But if after a short trial a child is no better, we'll need to switch her to an inhaled cortisone."

I give my 2-year-old asthmatic son two nebulizer treatments a day. How can we get him to sit still for the 12 minutes it takes each time?

For babies and toddlers, doctors often recommend a nebulizer, which delivers the medications as a mist through a mask that fits over the child's mouth and nose. The downside, as you've realized, is that it may be difficult to persuade a squirming toddler to sit still for the 10 to 15 minutes it takes to deliver a dose.

"Many parents end up chasing their child around the room with the mask, and most of the medication is lost in the air," says Tina Tolomeo, an advanced practice registered nurse at the Yale School of Medicine, section of pediatric respiratory medicine, and president of the National Association of Asthma Educators.

You may want to try an inhaler with a spacer, she suggests. The spacer is essentially a tube, one end of which fits over the child's nose and mouth, while the other fits snugly around the inhaler. When you depress the inhaler, medication is released into the tube, where it's held, allowing the child to breathe it in over several breaths. The whole process takes about three minutes, says Tolomeo, and studies show that the metered-dose inhaler with spacer, when used correctly, is equivalent to or better than a nebulizer.

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