Asthma is a common childhood illness, affecting about 6 million children.
And unfortunately, for many children, it is a chronic illness, causing symptoms that come and go throughout the year, leading to frequent asthma attacks, poor sleep, missed school days, visits to the emergency room, and even hospitalizations.
With proper long-term treatment, many of these children can have their asthma under better control, so that they rarely have asthma symptoms or bad asthma attacks.
This long-term treatment should usually include:
- an asthma action plan, which outlines which asthma medications your child should take and when he should take them and may include using peak flows to recognize when your child is having an asthma attack
- education about the proper use of asthma medications, recognizing asthma symptoms, and recognizing early signs of an asthma attack
- education about identifying and avoiding asthma triggers, such as dust mites, mold, pet dander, smoke, high ozone days, changes in the weather, etc.
- daily long-term controller medications, such as Singulair, Pulmicort Respules, Pulmicort Flexhaler, Advair, or Symbicort, etc., which are usually needed except for children with mild asthma
- treating other conditions that may trigger your child's asthma symptoms or make his asthma worse, include allergies, sinus infections, obesity, obstructive sleep apnea, and gastroesophageal reflux
Goals of Treating Asthma
Does your child have poorly controlled or hard to control asthma?
It can help to answer this question if you first understand what it means to have asthma under control and what your goals for asthma treatment should be.
Children with properly controlled asthma:
- don't have any chronic symptoms of asthma, such as a cough, which may be worse at night or when exercising, wheezing, or trouble breathing.
- don't often need to use their asthma controller or quick relief medication -- usually Albuterol or Xopenex -- to relieve their asthma symptoms. They definitely use them less than twice a week.
- have no restrictions in their routines or activity levels, and so sleep well, play sports, and rarely miss school because of asthma symptoms.
- have infrequent asthma attacks.
- don't have to visit the emergency room for severe asthma attacks and don't have any recent hospitalizations for asthma attacks.
- understand how and when to use their medications.
Parents of children whose asthma is under good control likely also understand how and when to use their medications and have some understanding of what triggers their child's asthma attacks.
Hard to Control Asthma
If your child's asthma is not under good control, especially if he is having frequent asthma attacks, be sure to see your pediatrician. It is likely that your child needs a "step up" in his long-term control medication regimen.
In addition to the Step 1 treatment of occasionally using a quick reliever medicine for intermittent asthma, the preferred treatments or steps for children who have persistent asthma symptoms include long-term controller medicines (there are many choices and combinations of these medicines, but your doctor can help you decide which asthma inhaler is the best for your child):
- Step 2 - a low-dose inhaled steroid
- Step 3 - a medium-dose inhaled steroid (children less than four years old) or low-dose inhaled steroid combined with another medication or a medium-dose inhaled steroid
- Step 4 - a medium-dose inhaled steroid combined with another medication
- Step 5 - a high-dose inhaled steroid combined with another medication
- Step 6 - a high-dose inhaled steroid combined with other medications, including oral steroids
Which step to use will typically depend on how well your child's asthma is being controlled. For example, if your six year old has to leave soccer practice early because he is coughing, wakes up twice a week coughing, and has two or three asthma attacks a year that send him to the doctor's office or emergency room, then he likely needs to move up one or two steps in treatment.
What You Need To Know
- Children should usually use a spacer, either with a mask (less than age 4) or without a mask (age 4or older) depending on their age, when they use a metered dose inhaler. Once they are five or older, some children can begin to learn to use a metered dose inhaler without a spacer.
- Allergy shots may be a good option for children who have persistent allergy induced asthma.
- An evaluation by an asthma specialist, such as a pediatric pulmonologist, can be a good idea if your child is requiring step 3 care or higher.
- Children shouldn't usually step down in their asthma treatment until they have been well-controlled for at least three months and they would usually go down one step at a time.
Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma - Summary Report 2007.