Understand how asthma drugs--both quick-acting and long-term--work to help your child breathe easier.
Even though asthma is a lifelong chronic condition, the right medications can help your child (and therefore you) breathe easier. An asthma treatment plan, developed with your child's specific symptoms and needs in mind, typically includes a combination of quick-acting and long-term medications such as these.
Short-Term (or "Rescue") Medications
Short-term medications provide quick relief for asthma symptoms by delivering inhaled medication directly to the lungs to open up the airways. They include:
Short-acting beta-agonists. This medication relaxes the smooth muscles around the airways for several six hours. Beta-agonists can be administered in several forms.
- A metered-dose inhaler or aerosol uses a pressurized canister to release a measured dose or mist of medicine into the mouth. Children should use an apparatus called a spacer with this device to control the amount of medicine that is breathed in.
- Dry powder inhalers use the force from a breath intake or inhalation (instead of an aerosol) to deliver a dry powder medication to the lungs. Breath-activated inhalers don't always work well for young children. "They can have hard time producing enough airflow to get an adequate dose of the medicine," says Stan Szefler, M.D., head of pediatric clinical pharmacology at National Jewish Health in Denver.
- Nebulizers deliver treatments via an air compressor machine. Air from the room is pressurized and mixed with a medication solution to create a mist that is then inhaled through a mouthpiece or mask for 5 to 10 minutes. "Nebulizers work especially well for children younger than 5," Dr. Szefler says.
Long-Term (or "Control") Medications
Long-term medications are called control medications because they're taken daily to control and prevent symptoms. They're not effective at relieving immediate asthma symptoms or an attack.
Inhaled corticosteroids, administered through a metered-dose inhaler or dry powder inhaler, are considered to be the most effective long-term controller medication. Steroids improve lung function and improve asthma symptoms by stopping and reducing swelling in the airways. They may also decrease mucus production. Some kids develop a cough, hoarseness, or thrush (a yeast infection of the mouth or throat) after using inhaled steroids. "Using a spacer with a metered-dose inhaler reduces the risk of thrush, as does rinsing with water," Dr. Szefler says. Although inhaled steroids can slow a child's growth during the first year of treatment, long-term research shows this is only temporary. Asthmatic kids who use inhaled steroids reach normal expected heights as adults.
Combination medications join an inhaled steroid with an inhaled long-acting beta-agonist. The steroid prevents and reduces swelling while the beta-agonist opens and relaxes the smooth muscle around the airways. This medication's effects can last for up to 12 hours.
Oral corticosteroids are given in pill or syrup form to treat frequent, severe attacks that often lead to hospitalization. They also help quick-relief medicines like beta-agonists work better. Unlike inhaled steroids--which go directly to the lungs--oral steroids circulate in your child's blood and therefore can cause more side effects such as weight gain, bloating, stomach ulcers, and high blood pressure. That's why oral steroids are typically given for only 5 to 14 days, a treatment plan known as a "steroid burst."
Anti-IgE injections may be given to children age 12 and older to help control year-round allergy symptoms that trigger asthma. IgE is an antibody in the immune system that causes allergic reactions and brings on symptoms like coughing, wheezing and nasal congestion. Anti-IgE shots may be given once or twice a month.
Leukotriene modifiers are taken daily as pills or liquids to reduce swelling and relax smooth muscles around the airways (much like inhaled steroids). They work by blocking the action of leukotrienes, substances made by your child's body that act as triggers for an asthma attack.
Theophylline is a stimulant that comes in a pill or liquid. It relieves chest tightness by dilating or opening airway tubes. This medication is rarely given to children because of a high risk of side effects, including irregular heartbeat, tremors, and seizures. Children and adults who take theophylline must have their blood levels checked regularly to decrease the risk of side effects.
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