Asthma management

The treatment goals for adolescents include the following:

• Treat inflammation in the airways, usually with daily medication, to prevent asthma attacks
• Use short-acting drugs to treat asthma attacks
• Avoid or minimize the effect of asthma triggers
• Maintain normal activity levels
• Include the adolescent in creating and managing a treatment plan

Your doctor will use a stepwise approach for treating your child's asthma. The goal is overall management with a minimum number of asthma attacks that require short-term treatment. This means that initially the type or dosage of treatment may be increased until the asthma is stable.

When your child's asthma is stable for a period of time, your doctor may then step down the treatment — this ensures your child takes the minimum drug treatment needed to remain stable. If your doctor determines at some point that your child is using a short-acting drug too often, the long-term treatment will be stepped up to a higher dose or additional medication.

This stepwise approach may result in changes up or down over time, depending on your child's response to treatment and overall growth and development, as well as on seasonal changes, changes in activity levels or other factors.

Medications for long-term control

Long-term control, or maintenance, medications are usually taken daily. Discuss with your doctor risks associated with treatment options and learn signs of adverse reactions.

Types of maintenance medication include the following:

• Inhaled corticosteroids are the most common maintenance medications for asthma, as well as the preferred treatment according to the National Asthma Education and Prevention guidelines. These anti-inflammatory drugs include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler, Pulmicort Respules), flunisolide, ciclesonide (Alvesco), beclomethasone (Qvar Redihaler) and mometasone (Asmanex).

• Long-acting beta agonists (LABAs) may be added to inhaled corticosteroid treatment when a corticosteroid alone does not result in stable asthma management. Long-acting beta agonists have been linked to severe or life-threatening asthma attacks.

  According to current Food and Drug Administration recommendations, LABA medication is given to an adolescent only when the drug is administered in combination with a corticosteroid. These include the combinations fluticasone-salmeterol (Advair Diskus, Advair HFA), budesonide-formoterol (Symbicort) and mometasone-formoterol (Dulera).

• Leukotriene modifiers may be used as an alternative to corticosteroids for mild asthma or added to a treatment plan when an inhaled corticosteroid treatment alone doesn't result in stable asthma management. These include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR).

  In rare cases, these medications have been linked to psychological reactions such as aggression, anxiousness, hallucinations, depression, irritability and suicidal thinking. Seek medical advice right away if your child has any unusual psychological reaction.

• Theophylline is a daily pill that opens the airways (bronchodilator). Theophylline (Theochron) may be used as an alternative for long-term control of mild asthma or added to a corticosteroid treatment.
• Oral corticosteroids are used only when asthma cannot be controlled with other treatments.

Short-acting medications

These medications — called short-acting bronchodilators — provide immediate relief of asthma symptoms, and effects last four to six hours. Short-acting bronchodilators for asthma include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA).

For adolescents with mild, intermittent asthma symptoms, the short-acting medication may be the only treatment needed.

For adolescents who have persistent asthma and use maintenance drugs, the short-acting drug is used as a quick-relief, or rescue, medication to treat asthma attacks. It may also be used to prevent asthma symptoms triggered by exercise.

Immunotherapy for allergy-induced asthma

Your doctor may recommend allergy shots (immunotherapy) if an allergy induces asthma attacks and if the allergen cannot be avoided. This treatment may be particularly useful for an allergy to pets, dust mites or pollens.

The purpose of allergy shots is to build up a tolerance by gradually increasing exposure to an allergen. Shots are administered once or twice a week in increasing doses, usually for three to six months. A maintenance dose is administered every two to four weeks for a period of three to five years.

Biological therapy for asthma

A new class of drugs, called biologics, may help target certain cellular substances that promote inflammation during asthma attacks. Your doctor may recommend biological therapy if your child experiences severe asthma that is poorly controlled with other medications. These drugs include benralizumab (Fasenra), dupilumab (Dupixent), and reslizumab (Cinqair).

Medication delivery devices

Most asthma medications are given with a device that allows a child to breathe medication directly into the lungs. Talk to your doctor about the proper use of a device, the delivery options for your child's medication and the appropriate device for your child's needs. Inhalation devices include:

• Metered dose inhaler. Small hand-held devices, metered dose inhalers are a common delivery method for asthma medication. This device propels the medication in a puff that needs to be inhaled in a single breath.

  An attachment called a spacer can improve medication delivery. A valved holding chamber is a similar attachment, but allows several regular breaths and doesn't allow accidental exhaling into the device.

• Dry powder inhaler. This hand-held device doesn't propel the medication. A deep, rapid inhalation activates the release of the drug and is necessary to get a full dose.
• Nebulizer. A nebulizer turns medications into a fine mist your child breathes in through a face mask. A nebulizer is a good option for a child who finds it difficult to use other inhalers.