According to 2005 data from the Centers for Disease Control, 9% of U.S. children suffer from asthma. That's more than six million children who have trouble breathing, some of them often.
Quick-relief medications include:
- Short-acting beta2 antagonists (SABA) - The most common is albuterol, but levalbuterol and pirbuterol also fall into this category. These medicines relax the smooth muscle in the lungs. This lets air flow in and out more easily. SABA drugs are the drug of choice for relief of acute symptoms. They can also be used before exercise to prevent exercise-induced bronchospasm. They are inhaled into the lungs. Pirbuterol is only available in an inhaler. Albuterol and levalbuterol also can be given through a nebulizer machine (which creates a mist that is inhaled. The effects of these drugs wear off in four to six hours. Common side effects include a rapid heart rate, tremor, and headache.
- Anticholinergics - Ipratropium bromide is another medicine that can relax the smooth muscle in the lung. It often is given in an emergency room along with a SABA when someone has a severe asthma attack. It is sometimes used instead of a SABA in patients who have too many side effects with a SABA. It is also available either as an inhaler or as a solution for use with a nebulizer machine.
- Corticosteroids - When the above medications are not helping an asthma attack, doctors usually prescribe steroids. They are usually given by mouth, but may also be given in a vein to very ill patients. Steroids are usually given for 3 to 5 days, but may be prescribed for a longer period of time in patients with particularly bad asthma.
Controller medicines include:
- Corticosteroids - Yes, this was in the last category! But corticosteroids also play a role in preventing asthma attacks. Inhaled corticosteroids help by reducing inflammation and irritation in the lungs, and are the first choice for prevention. They usually are given using an inhaler. Some patients with hard-to-control asthma need to take higher doses by mouth, either as a pill or a liquid, for long periods of time. This is rare.
At the recommended low doses, there are very few side effects. But you should rinse your mouth after using them, to prevent irritation and fungal infection. At higher doses, or when taken as a pill, there can be risks of cataracts, thinning bones, or poor growth.
Cromolyn sodium and necrodomil also help reduce inflammation and irritation in the lungs. They are not quite as effective as corticosteroids. They can also be used before exercise.
- Leukotriene modifiers - These fight inflammation in a different way. They include montelukast, zafirlukast, and zileuton. They often are given along with inhaled steroids to people with difficult-to-control asthma. Alone, they can help prevent exercise-induced asthma flare-ups. They also can prevent allergy symptoms.
- Long-acting Beta2-antagonists - These relax the muscular lining of the lungs. They work for up to 12 hours. They are used in combination with inhaled steroids for the treatment of moderate or severe persistent asthma. These drugs should never be used alone, or as treatment for acute symptoms, because of the small possibility that they can actually increase the risk of a severe asthma attack. When combined with inhaled steroids, they can be very helpful.
- Methylxanthines - Theophylline (taken by mouth) used to be a mainstay of asthma treatment, but is now rarely used. Taking too much can be dangerous. Anyone taking it needs regular blood tests.
- Immunomodulators - Omalizumab is an antibody treatment given as a shot. It can help patients with asthma caused by allergies. There is a very small possibility of a severe allergic reaction. So this drug is only given when there are staff and medications on hand to treat this kind of reaction.
- Antihistamines - Many people with both allergies and asthma will benefit from taking antihistamines. These include diphenhydramine, cetirizine, and loratadine. They help the stuffy nose and scratchy eyes caused by allergies. They also may help prevent wheezing.
When giving your child medications for asthma, make sure you:
- Have a written Asthma Action Plan that clearly spells out which medications you should give, how much, and how often.
- Follow the instructions exactly! Giving too much or too little can make the medications dangerous, or useless.
- Give the medications correctly. This is especially true of inhalers; you should always give those with an aerochamber. If you don't have an aerochamber, or you're not sure how to use the one you have, call your doctor.
- Call your doctor with any questions or concerns you have about the medications (especially if you are thinking of stopping them).
- Bring your child to the doctor regularly, not just when he or she is sick. Talk to the doctor about the best schedule of visits for your child.