Asthma can be effectively treated with a variety of medications, which are divided into two groups: rescue and controller. Your child’s asthma medication should be part of an asthma action plan.
Albuterol (Proair, Ventolin, Proventil)
Given by inhaler or nebulizer, albuterol relaxes the muscles inside the lungs and opens airways quickly. Side effects may include jitters, racing heart, shakiness and agitation. This is the first medication to grab if your child has an asthma attack.
If your child requires albuterol treatment more than every three hours or needs it for more than a few days, consider it an urgent situation and contact us. If your child remains wheezy, even after an albuterol treatment, see us immediately or go the emergency room. If your child is unable to breathe, agitated, or comatose during an asthma attack, call 911.
Oral steroids prednisolone, prednisone (Prelone and Orapred)
These are pills or liquid given once a day for 5 to 10 days to end a severe asthma episode. Oral steroids begin to act within 4 to 6 hours after they are administered and, thus, are not appropriate to give during an asthma attack without also providing a rescue inhaler or albuterol nebulizer treatments.
Parents of severely asthmatic children may keep oral steroids on hand to start at night after consulting our on-call doctor. Side effects during 10 day or shorter courses include moodiness, aggressive or hyperactive behavior. Longer or frequent courses can cause immune suppression, weight gain, “moon face” appearance, stretch marks, bruising, thinning of the skin and bone loss.
Inhaled steroids (Flovent, Pulmicort, Qvar)
Given by inhaler or nebulizer, these medications are viewed as the gold standard preventive medications for children with asthma. They act directly on the lungs to decrease inflammation and prevent the “twitchiness” of asthmatic airways.
The National Institute of Health’s most recent guidelines for asthma and allergies point out the vast body of research showing these medicines to be safe and effective for children of all ages with asthma. Concerns of permament growth retardation, immune suppression, and other fears about commonly used doses of inhaled steroids simply are not supported by scientific evidence.
Uncontrolled asthma, however, can make children grow poorly and suffer frequent illnesses, so if your child needs inhaled medications and you are worried about the use of inhaled steroids, please talk to us.
To be effective, steroids must be inhaled into the lungs, where the medicine acts topically. Therefore, they should be given to a child who is calm (not crying), or it is likely he will swallow the medicine, which will not alleviate the symptoms. Be sure to wash your child’s mouth after use to remove any excess medication that can otherwise cause oral thrush (yeast infection) or hoarse voice. Side effects may include thrush, hoarse voice and, rarely, moody behavior.
Zafirkulast, Montekulast (Singulair, Accolate)
Pills that can be chewed or swallowed whole to decrease inflammation. Used to prevent both asthma and allergies, these medications may be ideal for children who cannot take inhaled steroids properly or who have significant allergies with their asthma. Side effects are rare.
Combination drugs (Advair, Symbicort)
Inhaled from a hand-held device or nebulizer, these drugs combine an inhaled steroid with a long-acting form of albuterol. This type of medication is reserved for children whose symptoms are not adequately controlled using either inhaled steroids alone or in combination with Singulair or Accolate. There are safety issues and potential side effects with these medications that you need to review with your child’s doctor before starting.