Treatments
It is important to get control of your child's asthma as soon as it is diagnosed. This will help prevent symptoms and will help your child lead a full and active life. The following treatments are the main forms of asthma management: A pressurised metered dose inhaler with a volumatic spacer( Plus a face mask) is the preferred delivery system.
In most cases regular asthma treatment is done in a step-like way. The first step in treatment will be to use a "reliever" medicine that is used whenever the child needs it. Depending on the severity of your child's asthma, how well they respond to reliever medicines and how often they need to use them, the next step of treatment is to begin regular "preventer" medicine.
Concerns about steroids
Relievers (Bronchodilators)
Relievers are medicines that children can take immediately when asthma symptoms appear. They quickly relax the muscles surrounding the narrowed airways. Relievers are also called bronchodilators. This allows the airways to open wider making it easier to breathe again. However, relievers do not reduce the swelling in the airways.
- Relievers are essential in treating asthma attacks.
- If taken before exercise they can reduce the chances of your child getting wheezy.
- Relievers usually come in blue inhalers.
- Salbutamol and terbutaline are two examples of relievers. Ipratropium bromide is a different type of reliever medicine. It is most commonly used in children under one.
Not all relievers work well for all children under one year old. Your doctor will probably try different relievers to find one that works best for your child.
Are there any side effects from relievers?
Relievers are an effective medicine and have few side effects if taken as prescribed. They can make your child excitable and may increase the heart rate, but this is usually when relievers are given in high doses or is your child shows a sensitivity to their particular inhaler. The side effects generally subside with time.
Preventers (Controllers)
Preventers are commonly referred to as the "brown inhaler". Preventers may be recommended if your child needs to use a reliever more than twice a week on a regular basis. Preventers help calm down the swelling in the airways and stop them from being so sensitive. This means the airways are less likely to react badly when they are exposed to an asthma trigger. Preventers:
- Reduce the risk of a severe asthma attack
- Reduce asthma symptoms - improve quality of life.
- The protective effect of a preventer builds up over a period of time so they need to be taken every day, usually morning and evening, even if your child is feeling well. When your child first starts using them it may take up to 14 days before you notice any improvement in asthma symptoms and several months before they reach their optimum effect.
A top tip is to leave your preventer inhaler by your toothbrush, as it is an easy way to remember to take it twice as day as prescribed and to brush your teethand rinse your mouth after taking your preventer inhaler.
The first choice of preventer is an inhaled steroid. There are several kinds of inhaled steroids but they all work in the same way; beclomethasone, budesonide and fluticasone are all examples.
Combination Inhalers
For some children a doctor may prescribe a combination inhaler that combines an inhaled steroid with a long-acting bronchodilator.
These inhalers contain both an inhaled preventer (reduces inflammation) and a long acting reliever (keeps airways open) and are taken on a daily basis. Examples of combination inhalers are Seretide and Symbicort.
If an inhaled steroid alone does not control symptoms, an alternative preventer is a leukotriene modifier antagonist or 'LTRA', leukotriene receptor antagonist. An LTRA can be used as an alternative to inhaled steroids or when inhaled steroids cannot be used. LTRA medicines block the action of naturally occurring chemicals in the lungs called leukotrienes, which are known to cause narrowing of the airways and inflammation in the lungs which can lead to asthma symptoms. These medicines are available as tablets, chewable tablets (in some cases flavoured), and as granules which may be given with food for children as young as six months. This ensures that the child gets all of the medication in a way that is easy to take.
Concerns about steroids
Some parents worry about giving their child steroids to treat their asthma. Here are some points to remember:
- The steroids used to treat asthma are called corticosteroids.
- Corticosteroids are similar to those produced naturally in our bodies.
- They are completely different from the anabolic steroids used illegally by body builders and athletes.
- Most children use inhaled steroids which go straight into the airways, so very little is absorbed into the rest of the body.
- Your doctor will prescribe the lowest possible dose of inhaled steroids to get your child's asthma under control.
- Low doses of inhaled steroids do not commonly cause serious side effects or affect growth.
When are steroid tablets used in asthma?
A short course of steroid tablets (usually 3-5 days) is sometimes needed to treat an acute severe asthma attack. They are very effective at bringing severe asthma symptoms under control quickly.
Steroid tablets can lower the body's resistance to chickenpox. If your child has had a course of steroid tablets in the last month and is in contact with chickenpox, go and see your doctor. Talk to your doctor or practice nurse about any concerns you have about the side effects of your asthma treatment.
