Asthma treatment

If your child's asthma symptoms are severe, your family doctor or pediatrician may refer your child to see an asthma specialist.

The doctor will want your child to take just the right amount and type of medication needed to control his or her asthma. This will help prevent side effects.

Based on your record of how well your child's current medications seem to control signs and symptoms, your child's doctor may "step up" treatment to a higher dose or add another type of medication. If your child's asthma is well controlled, the doctor may "step down" treatment by reducing your child's medications. This is known as the stepwise approach to asthma treatment.

Long-term control medications

Known as maintenance medications, these are generally taken every day on a long-term basis to control persistent asthma. These medications may be used seasonally if your child's asthma symptoms become worse during certain times of the year.

Types of long-term control medications include:

• Inhaled corticosteroids. These are the most common long-term control medications for asthma. These anti-inflammatory drugs include fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), beclomethasone (Qvar RediHaler), ciclesonide (Alvesco, Omnaris) and mometasone (Asmanex HFA).

• Leukotriene modifiers. These include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). They can be used alone or as an addition to treatment with inhaled corticosteroids.

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

• Combination inhalers. These medications contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include the combinations fluticasone-salmeterol (Advair HFA), budesonide-formoterol (Symbicort), fluticasone-vilanterol (Breo, Ellipta) and mometasone-formoterol (Dulera). In some situations, long-acting beta agonists have been linked to severe asthma attacks.

  LABA medications should only be given to children when they are combined with a corticosteroid in a combination inhaler. This reduces the risk of a severe asthma attack.

• Theophylline. This is a daily medication that opens the airways (bronchodilator). Theophylline (Theo-24, Elixophyllin) is not used as often now as in past years.
• Biologics. Nucala, an injectable medication, is given to children every four weeks to help control severe asthma. Children age 6 and older may benefit from the addition of this therapy to their current treatment plan.

Quick-relief 'rescue' medications

These medications — called short-acting bronchodilators — provide immediate relief of asthma symptoms and last four to six hours. Albuterol (ProAir HFA, Ventolin HFA, others) is the most commonly used short-acting bronchodilator for asthma. Levalbuterol (Xopenex) is another.

Although these 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 such as an inhaled corticosteroid.

Your child's asthma is not under control if he or she often needs to use a quick-relief inhaler. Relying on a quick-relief inhaler to control symptoms puts your child at risk of a severe asthma attack and is a sign that your child needs to see the doctor about making treatment changes. Track the use of quick-relief medications, and share the information with your child's doctor at every visit.

Asthma attacks are treated with rescue medications, and oral or injectable corticosteroids.

Medication delivery devices

Most asthma medications are given with a device that allows a child to breathe medication directly into the lungs. Your child's medication may be delivered with one of these devices:

• Metered dose inhaler. Small hand-held devices, metered dose inhalers are a common delivery method for asthma medication. To make sure your child gets the correct dose, he or she may also need a hollow tube (spacer) that attaches to the inhaler.
• Dry powder inhalers. For certain asthma medications, your child may have a dry powder inhaler. This device requires a deep, rapid inhalation to get the full dose of medication.
• Nebulizer. A nebulizer turns medications into a fine mist your child breathes in through a face mask. Nebulizers can deliver larger doses of medications into the lungs than inhalers can. Young children often need to use a nebulizer because it's difficult or impossible for them to use other inhaler devices.

Immunotherapy or injectable medication for allergy-induced asthma

Allergy-desensitization shots (immunotherapy) may help if your child has allergic asthma that can't be easily controlled by avoiding asthma triggers. Your child will begin with skin tests to determine which allergy-causing substances (allergens) may trigger asthma symptoms.

Once your child's asthma triggers are identified, he or she will get a series of injections containing small doses of those allergens. Your son or daughter 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 and asthma symptoms should gradually diminish.

Omalizumab (Xolair) is an injectable treatment that can help allergic asthma that isn't well controlled with inhaled corticosteroids.