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Treatments and drugs
By Mayo Clinic staffThe goal of asthma treatment is to get the asthma under control.
Well-controlled asthma means that your child has:
- Minimal or no symptoms
- Few or no asthma flare-ups
- No limitations on physical activities or exercise
- Minimal use of fast-acting "rescue" inhalers
- Few or no side effects from medications
Treating asthma involves both preventing asthma symptoms and treating an asthma attack in progress. Preventive medications reduce the inflammation in your child's airways that can lead to symptoms. Quick-relief (rescue) medications quickly open airways that are swollen and limiting breathing.
While quick-relief medications work quickly, they can't keep your child's symptoms from coming back. If your child has frequent or severe symptoms, he or she will need to take a long-term control medication as well. Your child's symptoms and triggers are likely to change over time. You and your child will need to carefully monitor asthma symptoms and work with your doctor to adjust medications as needed.
Long-term control medications
These preventive anti-inflammatory medications are generally taken every day on a long-term basis to control persistent asthma. In some cases, these medications are taken seasonally if asthma symptoms get worse at certain times of the year. These medications include:
- Inhaled corticosteroids, used to treat persistent asthma. These medications reduce chronic inflammation in the airways and reduce the need for other medications. Examples include fluticasone (Flovent), budesonide (Pulmicort), mometasone (Asmanex), triamcinolone (Azmacort), flunisolide (Aerobid) and beclomethasone (Qvar). Continuous inhaled corticosteroids have been associated with slightly slowed growth in children, but research has shown that the effect is minor. In most cases, the benefits of good asthma control outweigh the risks of possible side effects.
- Combination inhalers, which contain inhaled corticosteroids plus a long-acting bronchodilator. Advair combines the corticosteroid fluticasone and the bronchodilator salmeterol. Symbicort contains the corticosteroid budesonide plus the bronchodilator formoterol.
- Leukotriene modifiers, which include montelukast (Singulair) and zafirlukast (Accolate) and zileuton (Zyflo).
- Cromolyn, which may help prevent mild to moderate asthma attacks. Cromolyn needs to be taken two to four times a day and is usually taken along with an inhaled corticosteroid.
- Theophylline, a daily pill that opens the airways (bronchodilator). It relaxes the muscles around the airways to make breathing easier.
Quick-relief (rescue) medications
These medications — called short-acting bronchodilators — provide immediate relief of asthma attack signs and symptoms such as coughing, wheezing, chest tightness or shortness of breath. These inhaled medications are delivered using a small, hand-held device called a metered dose inhaler. Albuterol is the most commonly used short-acting bronchodilator. Others include pirbuterol and levalbuterol. These bronchodilators begin working within minutes and last four to six hours.
Allergy-desensitization shots (immunotherapy)
Immunotherapy may help if your child has allergic asthma that can't be controlled by avoiding triggers. With immunotherapy, your child will probably need injections once a week for a few months, then once a month for a period of three to five years. Your child's allergic reactions will gradually diminish, lessening the immune system response that triggers asthma symptoms.
Inhaled medication devices
Inhaled short- and long-term control medications are used by inhaling a measured dose of medication.
- Older children and teens may use a small, hand-held device called a pressurized metered dose inhaler or an inhaler that releases a fine powder.
- Infants and toddlers need to use a face mask attached to a metered dose inhaler or a nebulizer to get the correct amount of medication.
- Babies need to a use a device called a nebulizer, a machine that turns liquid medication into fine droplets. Your baby wears a face mask and breathes normally while the nebulizer delivers the correct dose of medication.
HFA inhalers: A recent change
The chlorofluorocarbon (CFC) propellant in quick-relief asthma inhalers has been replaced with a propellant called hydrofluoroalkane (HFA). Unlike CFC inhalers, HFA inhalers don't harm the environment. The spray from the new inhalers may taste different. Although the spray from an HFA inhaler may not seem as strong, your child is still getting the full dose of medication.
