Dr. Alan Greene on Asthma Medications

Should he be medicated even if he's not showing symptoms?

Question

Our son is 2 years old and has mild to moderate asthma. The doctor wants him on a continued daily inhaler -- Serevent -- even though he doesn't have any wheezing at all right now. What is your opinion on continuing medication when there are no asthma symptoms?

Answer

One of the most common mistakes in treating asthma is under-use of preventive medicines. Part of what happens with wheezing is a narrowing of the airways as a result of the muscles around them tightening. The other part of the problem is inflammation in the lungs, which includes swelling of the lining and extra, thickened mucus. It's important to keep this inflammation to a minimum to help prevent long-term damage and to help kids outgrow the asthma.

Serevent reverses muscle tightening, but does nothing to reduce inflammation. It makes sense to use when there is wheezing or just before a child would be expected to wheeze (such as before exercise in a child with exercise-triggered wheezing) but it is not usually needed for routine use in children who have good peak flows and no wheezing.

Some kind of anti-inflammatory is wise to use, however. There are many types, but Flovent is an excellent choice. You want to use the smallest amount that works to prevent flare-ups (and if the asthma is seasonal, the amount may vary seasonally -- he might even be off the medication in some seasons). Flovent as low as 44 mcg twice daily works for some kids (two puffs) or 50 mcg twice daily of the Flovent rotadisk.

 

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.

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