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Reviewed by the Faculty of Harvard Medical School

Asthma Medications For Children

According to 2005 data from the Centers for Disease Control and Prevention, 9% of U.S. children suffer from asthma. That's more than six million children who have trouble breathing, some more frequently than others.

Medications can make the difference between a normal life and a limited life; sometimes they can be the difference between life and death. There are several types of medications to treat asthma. They fall into two categories: quick relief medications (used to treat an asthma attack) and controller medications (used to prevent asthma attacks).

Quick Relief Medications

  • Short-acting beta-2 antagonists (SABA) Albuterol is the most common SABA, but levalbuterol and pirbuterol also fall into this category. They relax the smooth muscle in the lungs, allowing air to flow in and out more easily. They are also the drug of choice for relief of acute symptoms. They can also be used before exercise to prevent exercise-induced bronchospasm (EIB). They are inhaled into the lungs. Pirbuterol is only available as an inhaler, while albuterol and levalbuterol can also be given through a nebulizer machine (which creates a mist that is inhaled). Their effects wear off in four to six hours. Common side effects include a rapid heart rate, tremor and headache.

  • Anticholinergics Ipratropium bromide is another short-acting inhaled medication that can relax the smooth muscle in the lung. It is often given in an emergency room along with a SABA during a severe asthma attack. An anticholinergic is sometimes given instead of a SABA when it causes a patient too many side effects. It is also available either as an inhaler or as a solution for use with a nebulizer machine.

  • Corticosteroids When the above medications are not helping an asthma attack, doctors usually prescribe steroids. They are usually given by mouth but may also be given intravenously to very ill patients. The patient generally feels better within an hour or so. The steroids are customarily continued for 3 to 5 days but may be prescribed longer in patients with particularly bad asthma.

Controller Medications

  • Corticosteroids These medications also play a role in preventing asthma attacks. Inhaled corticosteroids (ICS) help by reducing inflammation and irritation in the lungs, and are the first choice for prevention. They are usually given using an inhaler, although budesonide is available as a solution for a nebulizer. Some patients with hard-to-control asthma need to take higher doses by mouth, either as a pill or a liquid, for long periods of time — but this is rare. At the recommended low doses, there are very few side effects. (It's important to rinse out the mouth after using them, to prevent irritation of the mouth and thrush.) There is a risk of cateracts, thinning bones or poor growth with higher doses of inhaled steroids, or when steroids are taken by mouth.

  • Cromolyn sodium and necrodomil These also help reduce inflammation and irritation in the lungs, although not as effectively as corticosteroids. They can also be used before exercise to prevent EIB.

  • Leukotriene modifiers Montelukast, zafirlukast and zileuton fight inflammation in a different way, and are often given along with inhaled steroids in patients with difficult-to-control asthma. Alone they can help prevent EIB, and can prevent allergy symptoms.

  • Long-acting beta-2 antagonists (LABA) Salmeterol and formoterol relax the muscular lining of the lungs for up to 12 hours. They are used in combination with inhaled steroids for the treatment of moderate or severe persistent asthma. They should never be used alone, or as treatment for acute symptoms because of the small possibility that they may increase the risk of a severe asthma attack. But when combined with inhaled steroids, they can be very helpful.

  • Methylxanthines Theophylline (taken by mouth) used to be a mainstay of asthma treatment, but it's rarely used now. Taking too much can be dangerous, and anyone taking it needs regular blood tests to check the medication level.

  • Immunomodulators Omalizumab is an antibody treatment given as a shot that can help patients with allergy-related asthma. It blocks the action of specialized cells involved in the inflammation in the airways. Because of the rare possibility of a severe allergic reaction, it is given very carefully and only when there are staff and medications available to treat a severe allergic reaction if one occurs.

  • Antihistamines Many patients who suffer from allergies along with asthma benefit from taking antihistamines, such as diphenhydramine, cetirizine or loratadine. Antihistamines relieve the stuffy nose and scratchy eyes caused by allergies, and may help prevent wheezing.

When giving your child medications for asthma, make sure that:

  • You have a written Asthma Action Plan that clearly spells out which medications you should give, how much, and how often.

  • You follow the instructions to the letter! Giving too much or too little can make the medications dangerous — or useless.

  • You are giving the medications correctly. This is especially true of inhalers; you should always give those with an aerochamber. If you don't have an aerochamber, or you're not sure how to use the one you have, call your doctor.

  • You call your doctor with any questions or concerns you have about the medications (especially if you are thinking of stopping them).

  • You bring your child to the doctor regularly, not just when he or she is sick. Talk to the doctor about the best schedule of visits for your child.
Last updated May 6, 2008