At Hassenfeld Children’s Hospital at Pelisyonkis Langone, pulmonologists, doctors who specialize in breathing problems in children, develop a personalized medication plan for each child, depending on the severity of his or her asthma symptoms.
A mainstay of treatment for children with mild to moderate asthma symptoms, inhaled corticosteroids reduce inflammation in the airways and prevent asthma symptoms, such as wheezing and difficulty breathing.
Corticosteroids such as beclomethasone and fluticasone come in a metered dose inhaler, a small canister that provides a measured amount of the corticosteroid. The inhaler is attached to a special delivery system, called a spacer, which collects the medication in a chamber before your child inhales it using an attached mouthpiece.
The spacer helps to deliver the correct amount of medication into the airways rather than the mouth and throat. Side effects, such as irritation of the throat, are usually avoided when corticosteroids are delivered with a spacer device.
Your child may use inhaled corticosteroids daily for several weeks or months, depending on how well the medicine controls symptoms. Inhaled corticosteroids are also used to treat children who have cough-variant asthma, in which coughing is the only symptom.
Long-Acting Beta Agonists
Doctors may prescribe inhaled long-acting beta agonists, such as salmeterol and formoterol, which relax muscles inside the airways for up to 18 hours. Doctors often prescribe an inhaler combining one of these medications with a corticosteroid for children whose severe asthma symptoms have not been controlled with an inhaled corticosteroid alone or for children with severe exercise-induced asthma.
Leukotriene inhibitors, such as montelukast, block the activity of leukotrienes—one of the chief substances in the body that cause inflamed and narrowed airways in people with asthma triggered by allergies. Asthma symptoms not well controlled by an inhaled corticosteroid may respond to this medication, taken daily by mouth as a chewable tablet.
Symptoms sometimes flare up when a child is exposed to viruses, cigarette smoke, or other triggers, even when asthma is well controlled by medication. Rescue medications can provide fast-acting, short-term relief of symptoms that come on suddenly.
The most commonly used rescue medications are short-acting beta agonists, such as albuterol, which can be delivered to the airways in less than 30 seconds with a metered dose inhaler. Our doctors prescribe rescue inhalers for all children with asthma and offer instruction on how and when to use them.
Using rescue inhalers more than once a week may be a sign that your child’s asthma is not under control. Side effects of rescue medications may include jitteriness and a rapid heartbeat.
Children with severe asthma symptoms may be treated briefly with a corticosteroid, such as prednisone, taken by mouth. Doctors carefully monitor children taking steroids in pill form, because they have the potential to cause serious side effects, such as slowed growth or osteoporosis, a weakening of the bones.
For children ages 12 and older whose asthma symptoms persist despite treatment with other medications, our doctors may prescribe an injectable medication called omalizumab. This medication is administered in the doctor’s office with an injection under the skin every two weeks.
Omalizumab blocks an antibody—immunoglobulin E, also known as IgE—that’s produced in higher amounts in people with asthma triggered by allergies. Your child’s doctor may perform a blood test to measure your child’s level of IgE to determine the best dosage.
Anaphylaxis is a rare, though possibly life-threatening, side effect of omalizumab. It is often signaled by hives, difficulty breathing, a rapid pulse, dizziness, nausea, or fainting.
If your child receives a prescription for omalizumab, you will also receive an EpiPen®. This is a device for giving an injection of epinephrine in the event of a severe allergic reaction to the medication. Epinephrine reverses the allergic reaction by narrowing blood vessels and opening airways.
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