So Part 2 deals with treatment options for Asthma. The hallmark of Asthma is the reversibility of symptoms when correct treatment is given . These symptoms can be either intermittent or persistent.
Intermittent: If symptoms happen two or less times a week, if it does not interfere in daily activities and if it causes less than two night awakenings in a month.
Persistent: The symptoms occur more regularly than above. Persistent asthma can be mild, moderate or severe depending on the degree and frequency of symptoms.
The medications used for Asthma belong to two categories :
1) Relievers : For immediate relief in case of an asthma attack .
2) Preventers : For Persistent Asthma to control and reduce frequency of symptoms.
Reliever medications :Bronchodilators — Short-acting bronchodilators relieve asthma symptoms rapidly by relaxing the muscles around narrowed airways. In India, Salbutamol (Ventolin, Asthalin) ) is the most commonly used short-acting bronchodilator.
When a child experiences wheeze, shortness of breath , persistent dry cough or chest tightness , this medication can be given via either a spacer ( with or without mask ) or a nebuliser.
Metered-dose inhaler versus nebulizer — Medications can be delivered with a nebulizer or through a metered-dose inhaler with an attached spacer (valved holding device) device and a mask.
●Nebulizers use compressed air to change a medication from liquid form to a fine spray that can be inhaled through a mask or mouthpiece. When a facemask is used, it should be placed snugly over the face; moving the mask just 1 centimeter away from the face reduces the dose of an inhaled medication by up to 50 percent. They can be useful in children who are unable to hold the spacer device ( smaller kids and kids with disabilities)
●Metered-dose inhalers dispense liquid or fine powder medications ( aerosols) , which mix with the air that is breathed into the lungs. The spacer and face mask help to ensure that the greatest amount of medication is delivered to the lungs .It is preferable to have the child use the inhaler when he or she is awake and not crying.
Inhalers are potable, cheaper, as effective as nebulizer and easier to maintain. Nebulizer can vary in their effectiveness and should be serviced regularly .
Watch everything about using and managing MDI( Metered Dose inhalers) with spacers here :
Side effects of Bronchodilators :— Some children feel shaky, have an increased heart rate, or become hyperactive after using a short-acting bronchodilator. The side effects often decrease over time.
Oral Bronchodilator syrups: It is a common practice to be prescribed bronchodilators in the form of syrups. Though they tend to be effective in relieving symptoms, they are slower in action and have more side effects. During my practice in the UK, these syrups were not available for the above reasons and we almost always managed all asthma cases with inhalers.
Preventers or Controller medications:
Children with persistent asthma need to take medication on a daily basis to keep their asthma under control, even if there are no symptoms of active asthma on a given day. Their function to decrease inflammation (or swelling) of the small airways over time.
The doses and types of controller medications prescribed to children with asthma depend on a child’s asthma severity and level of symptom control.
A.)Inhaled Steroids: (common brand name: Budecort)— Inhaled steroids work by reducing inflammation, including swelling and sensitivity of the airways. These medications are the preferred treatment for persistent asthma. Regular treatment with an inhaled steroid medication can reduce the frequency of symptoms (and the need for inhaled bronchodilators), improve quality of life, and decrease the risk of a serious asthma attack.
Side effects of steroids: — Unlike steroids that are taken by mouth, very little of the inhaled drug is absorbed through the airways into the bloodstream, and there are few side effects. The most common side effect is oral thrush .This can usually be prevented by taking inhaler with a spacer with or without a face mask (which helps to deliver medication to the lungs rather than the mouth).
B.)Leukotriene modifiers (Montelukast ) — These are less effective than inhaled steroids but can be either used in milder asthma or in combination with steroids.
C.)Other controllers : Long acting bronchodilators in combination with steroids ( Common brand name: (Seroflo) These medications are used when the symptoms are not adequately controlled by the above controller medications.
I have not mentioned the doses for the medications as Asthma is a condition which needs to be managed under proper medical guidance and follow up. The purpose of this write-up is to enable you to understand why your doctors prescribes the above medications.
Emergency management Plan for Asthma Attacks : After discussion with your paediatrician , ideally, every child should have an Asthma emergency management plan. Here is an example how a plan looks like :
Control of Triggers : Apart from medications, equally important is trying to identify triggers for your child’s asthma and try to eliminate them as far as possible:
Possible things that can help are: preventing exposure to cigarette smoke, wet mopping and vacuum cleaning to remove dust, removing carpets, not letting pets sleep in same room as the child.
In Summary : Asthma is a chronic condition which needs close supervision by the treating doctor and parents. It can be effectively managed if you have a good knowledge of the triggers that precipitate the attacks so that you can initiate timely and effective treatment .
1.) Uptodate.com: Patient education: Asthma treatment in children (Beyond the Basics)
2.) Patient.info: Paediatrics : Asthma
3.) http://www.cochrane.org: Spacers vs nebulisers for delivery of beta-agonist relievers in the treatment of an asthma attack