Treatment Options for Childhood Asthma

Asthma Medications

Asthma medications are categorized by their actions which are targeted at the two main physiologic effects of asthma: hyperresponsiveness and inflammation. There are two separate phases of asthma management:

  • Management of acute exacerbations of asthma ("asthma attacks")
  • Long-term asthma management or maintenance therapy

Management of Acute Exacerbations of Asthma

Quick-relief medications, known as "reliever" or "rescue" medications, are used for the management of acute exacerbations or asthma attacks. These medications include:

  • Inhaled Bronchodilators

    • bronchodilators are medications that cause the smooth muscles of the airways to relax and, thereby, open up the airways to make breathing easier.
    • inhaled bronchodilators know as short-acting Beta-adrenergic agonists are often used to provide quick relief for acute asthma attacks because they can:
      • improve airflow to the lungs
      • improve control of asthma symptoms
      • reduce the likelihood of emergency visits and hospitalization from acute asthma attacks
    • examples of short-acting Beta-adrenergic agnonists include:
      • albuterol (Proventil; AccuNeb; Ventonil)
      • levalbuterol (Xopenex).
    • inhaled short-acting Beta-adrenergic bronchodilators share the following characteristics:
      • rapid onset of action: act within 5 minutes
      • maximum effect is observed in about 30 minutes
      • effective for up to 4 hours with a single inhalation dose
      • most common side-effects are heart palpitations and tremor

  • Anticholinergic bronchodilators

    • ipratropium bromide (Atrovent)is a short-acting inhaled anticholinergic bronchodilator that works within 15 minutes to relieve bronchospasm and its effect lasts for up to 6 hours.
    • studies have shown that the addition of ipratropium bromide to an inhaled short-acting Beta-adrenergic agonist is more effective than the short-acting Beta-adrenergic agonists alone for the treatment of acute asthma attacks in children.

  • Systemic Corticosteroids

    • corticosteroids are powerful antiinflammatory medications that are used for the treatment of a wide range of conditions where inflammation plays a major role in the disase process.
    • corticosteroids may be administered either systemically (orally; intramuscular injection; intravenous injection) or by inhalation.
    • systemic corticosteroids are effective for the treatment of acute asthma attacks in children
    • examples of systemic corticosteroids include:

      • methylprednisolone (Medrol)
      • prednisolone (Delta-Cortef)
      • prednisone (Deltasone; Liquid Pred; Orasone)

Oxygen may need to be administered during an acute attack for some children.

Long-Term Asthma Management

The following medications, known as "controller" or "maintenance" medications, are used for the long-term management of asthma:

  • Inhaled Bronchodilators

    • bronchodilators are medications that cause the smooth muscles of the airways to relax and, thereby, open up the airways to make breathing easier.
    • inhaled bronchodilators know as long-acting Beta-adrenergic agonists are often used for the long-term management of asthma symptoms.
    • examples of long-acting Beta adrenergic agonists include:
      • salmeterol (Serevent)
      • formoterol (Foradil)
      • fluticasone/salmeterol (Advair) - an inhaled medication that contains both an inhaled corticosteroid (fluticasone) and a long-acting Beta adrenergic agonist (salmeterol)
    • inhaled long-acting Beta-adrenergic bronchodilators share the following characteristics:
      • onset of action - about 30 minutes
      • maximum effect is observed in about 2 hours
      • effective for up to 8-12 hours with a single inhalation dose
      • most common side-effects are heart palpitations and tremor

  • Inhaled Corticosteroids

    • corticosteroids are powerful antiinflammatory medications that are used for the treatment of a wide range of conditions where inflammation plays a major role in the disase process.
    • corticosteroids may be administered either systemically (orally; intramuscular injection; intravenous injection) or by inhalation.
    • inhaled corticosteroids are a standard part of maintenance therapy for the long-term management of childhood asthma.
    • studies have shown that inhaled corticosteroids can lead to improvements in both asthma symptoms and lung function in children with mild to moderate asthma.
    • inhaled corticosteroids can also help prevent acute asthma attacks and can also reduce the use of other asthma medications.
    • examples of inhaled corticosteroids include:
      • budesonide (Pulmicort)
      • fluticasone (Flovent)
      • beclomethasone CFC (Beclovent; Vanceril)
      • flunisolide (AeroBid)
      • triamcinolone acetonide (Azmacort)

  • Leukotriene Receptor Antagonists

    • medications known as leukotriene receptor antagonists have been shown to improve control of asthma symptoms in children.
    • usually used in combination with other standard asthma medications
    • examples of leukotriene receptor antagonists include:
      • montelukast (Singulair)
      • zafirlukast (Accolate)

  • Nedocromil

    • nedocromil (Tilade) is an inhaled asthma medication that has been shown to improve asthma symptoms and lung function in children with asthma.
    • nedocromil is not as effective, however, as inhaled corticosteroids for the long-term management of childhood asthma.

  • Cromolyn Sodium

    • cromolyn sodium (Intal) is an inhaled asthma medication that is less effective than inhaled corticosteroids and is, therefore, not considered as a first-line treatment for childhood asthma

  • Methylxanthines (theophylline)

    • in general, theophylline is not recommended as a first-line treatment for childhood asthma because of its potential to cause serious side-effects including irregular heart beats (arrhythmias) and seizures.