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| Main > Asthma Center > Asthma Treatments
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Asthma Treatments
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| The medications that are used to control asthma include bronchodilators and anti-inflammatories (including steroids). Do not use over the counter medicines to control your wheezing.
The goals of treating children with asthma include reducing (or preferably eliminating) symptoms, limiting how often and how severe his asthma attacks (or exacerbations) are, and allowing him to participate in normal activities, including sports and other physical activities.
Most Pediatricians practice a step wise approach to treating asthma, with a step up in the amount of medications for uncontrolled asthma and a step down in the amount of medications for well controlled asthma.
For acute asthma attacks or exacerbations, your child may also need to be on a short course of an oral steroid medication, such as Prelone or Prednisone.
A common reason for not getting better despite being on a good medical regimen is noncompliance. The medications can't help if your child isn't taking them appropriately.
If your child is having frequent symptoms, frequent asthma attacks or he has a limitation in his physical activities, then you should see your Pediatrician or Pediatric Lung Specialist (Pulmonologist) to reevaluate his treatment plan and possibly change or increase the amount of daily medication he is taking.
Your child may also need treatment for other medical problems, including allergic rhinitis and gastroesophageal reflux, both of which can make asthma worse.
New Treatments:
- Advair Diskus: available in three strengths, 100/50, 250/50, and 500/50, Advair is a dry powder inhaler that contains fluticasone propionate (Flovent) and salmeterol (Serevent) and is indicated for the treatment of persistent asthma.
- Pulmicort Respules: or budesonide, this is a new suspension form of this steroid medication that can be used with a nebulizer for children over 12 months of age for the treatment of persistent asthma.
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Bronchodilators
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| These are medications that help to relieve acute symptoms, such as coughing, wheezing or difficulty breathing by relaxing tight breathing tubes in the lung. They are available in different forms, including syrup, tablet, MDI and solution for use with a nebulizer. Names for commonly used bronchodilators include: Albuterol, Ventolin, and Proventil. Albuterol is the generic name, while Proventil and Ventolin are different brand names, but they are all the same type of medication (beta 2 agonist).
There is a newer form of albuterol now available that has less side effects. It is called levalbuterol (Xopenex) and it may be useful for children who can not tolerate albuterol nebulizer treatments. A recent study has also shown that Xopenex may be more effective for some children, including those in the emergency room, where it decreased hospital admissions by 11% as compared to regular Albuterol.
Another type of bronchodilator, called Atrovent (ipratropium bromide) is sometimes used with albuterol for acute asthma attacks. Unlike albuterol, atrovent is an anticholinergic medicine.
High doses of magnesium sulfate given intravenously have been shown recently to help with smooth muscle dilation in children with acute asthma attacks who aren't improving with conventional therapy. As more is learned about this treatment, using magnesium may be more common in the treatment of moderate to severe asthma attacks.
This type of medication is also commonly referred to as:
- quick-relief medication
- relievers
- short acting bronchodilators
- rescue inhaler or rescue medication
Bronchodilators are generally used on and as needed basis. When your child is having trouble with coughing, wheezing or difficulty breathing you can begin to use them every four to six hours (except for the syrup form which is only used three times a day) or follow your treatment plan.
If your child only has coughing or wheezing after physical activities, then he may have exercise induced asthma. For this problem, it is best to use a bronchodilator 20-30 minutes before activities that make him wheeze. Also, avoid intense activities done in cold, dry air (swimming is a good sport for children with exercise induced symptoms).
Let your pediatrician know if you are using a bronchodilator regularly, such as more than once every one to two weeks, so that a preventative medication can be started.
Commonly used short term bronchodilators include:
- Proventil HFA - a CFC free metered dose inhaler
- Albuterol (Ventolin, Proventil) - MDI and nebulizer soln
- Levalbuterol (Xopenex) - nebulizer soln
- Bitolterol (Tornalate) - MDI and nebulizer soln
- Pirbuterol (Maxair) - metered dose inhaler
- Terbutaline (Breathaire)
- Albuterol rotahaler (Ventolin rotocaps) - a dry powder inhaler
- Ipratropium (Atrovent) - MDI and nebulizer soln
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Anti - Inflammatory Treatments
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| These are medicines that are used to help prevent your child from having an asthma attack. To be effective, they must be used every day, even when your child is not having any problems. These medicines will not help relieve any of the symptoms of an acute attack, such as coughing, wheezing or difficulty breathing.
This type of medication is also commonly referred to as a:
- preventative medication
- long term preventative medication
- daily controller
- controllers
One preventative medication is Intal (or Cromolyn), which should be used 3-4 times each day. It is available as a nebulizer solution (usual dose is 2ml or one ampule 3-4 times a day) or as an inhaler (usual dose is 2 puffs 3-4 times a day). Intal is a mast cell stabilizer and is usually considered to be less potent than steroid medications.
Other preventative medicines are the steroid inhalers, which include Flovent, Azmacort, Vanceril DS, Aerobid, and Pulmicort. In general, the usual starting dose for these steroid inhalers is 2 puffs twice a day. Always use a spacer with your steroid MDI and be sure to rinse your child's mouth out with water after using it (to prevent thrush). Also, if you are also going to use a bronchodilator medicine, you should use it first and then use your steroid inhaler.
While there are some concerns about high doses of inhaled steroids affecting children's growth, having uncontrolled or poorly controlled asthma can also lead to many side effects, including poor growth, hospitalizations and even death. Your Pediatrician will monitor your child's growth closely while he is on a steroid inhaler. In general, if needed, it is much safer to use a steroid inhaler than to have uncontrolled or poorly controlled asthma.
Serevent (or Salmeterol) is another preventive medication and it is a long acting form of the bronchodilators. It is available as a MDI (usual dose is 2 puffs twice a day) or as a Diskus (usual dose is 1 inhalation twice a day). Unlike the other bronchodilators, Serevent is for prevention only and not for an acute attack.
Advair is a new medicatin that combines Flovent and Sevevent is a single dry powder inhaler. It is available in three strengths.
Singulair is a newer anti-inflammatory medication that is available as a tablet and chewable pill that is taken once a day. Your Pediatrician may use this medication alone or in addition to one of the above medicines. Accolate is a similar medication.
Commonly used preventative medications include:
- Flovent 44, 110, 220 - steroid MDI
- Flovent 50, 100, 250 - steroid dry powder inhaler
- Pulmicort - steroid dry powder inhaler
- Pulmicort Respules - steroid solution available for use with a nebulizer
- Aerobid - steroid MDI
- Azmacort - steroid MDI
- Vanceril, Vanceril DS - steroid MDI
- Serevent - long acting bronchodilator available as a MDI
- Serevent Diskus - long acting bronchodilator available as a dry powder inhaler
- Singulair - leukotriene antagonist 4mg (chewable), 5mg (chewable) and a 10mg pill
- Accolate - leukotriene antagonist - 20mg tablets
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