Asthma: treatment and prevention

• Asthma emergency action plan
• Clinical categories of asthma
• Asthma medications
• Relievers
• Preventers
• Controllers
• Prevention
• Understanding asthma management

Asthma emergency action plan

If your child has asthma you need an emergency action plan, regardless of how mild or severe the symptoms usually are.

Here’s what to do in an asthma emergency:

1. Remain calm and sit your child down.
2. Give your child four separate puffs of his reliever medication (usually the one with the blue writing or label) through the spacer. Put in one puff at a time, and ask your child to take four deep breaths with each puff, before you give the next puff. Do this for a total of four puffs (16 breaths by your child).
3. Wait four minutes. If there’s little or no improvement, repeat step 2 above.
4. If there’s still little or no improvement after four minutes, call an ambulance and state that your child is having an asthma attack. While waiting for the ambulance to arrive, give your child the reliever medication again through the spacer as described above. Wait four minutes and do it again. Repeat this until the ambulance arrives.

Clinical categories of asthma

Children with asthma can be grouped into one of three clinical categories. Treatment depends on which category your child is in.

Episodic asthma
Symptoms occur several times a year, usually in association with a cold or viral infection. If your child has episodic asthma, she might wheeze or cough for a few days, and should respond rapidly to treatment. In between attacks, she’s in good health and enjoys an unrestricted lifestyle with no asthma symptoms. She usually onlyneeds treatment for acute asthma attacks, and doesn’t need to take any asthma medications in between attacks. Most children with asthma fall into this group.

Persistent asthma
Children with persistent asthma have several acute attacks each year, usually more frequently than those with episodic asthma. Children with persistent asthma might also have symptoms in between attacks.

If your child has persistent asthma, he might have an intermittent cough, or a wheeze triggered by exercise. He’ll usually be given medication on a daily basis to prevent acute attacks.

Chronic asthma
This is the smallest group of children with asthma. If your child has chronic asthma, her symptoms are ongoing, and she needs to take several medications a day.

Asthma medications

Asthma medications come in different forms, and combinations of medicines are often necessary. Medication can include:

• Medications that can be inhaled as a mist from a hand-held inhaler, such as a metered dose inhaler or puffer, best breathed through a plastic chamber called a spacer device. Occasionally medications are inhaled from a nebuliser driven by a pump. The inhaler with a spacer device is just as effective and much more convenient.
• Dry powders that can be inhaled from a hand-held inhaler (spinhaler or rotahaler).
• Liquids, tablets or sprinkles that can be swallowed.

Asthma medications can be divided into the following categories:

• Relievers, which are used to treat and relieve the symptoms of asthma.
• Preventers, which are used to prevent acute attacks from occurring.
• Controllers, which are used where asthma remains uncontrolled despite the use of relievers and preventers.

Some children take one, two or even three of these classes of medication. Your doctor will tell you the most appropriate medications for your child to take.

New and more powerful drugs for the treatment of asthma are introduced from time to time. These are especially useful for children with severe asthma who are under the care of a specialist.

Relievers

Beta-2 agonists such as salbutamol (Ventolin, Asmol) and terbutaline (Bricanyl) are the most commonly used drugs for the treatment of acute symptoms of asthma. These drugs relax the narrowed breathing tubes and make it easier for air to get through.

Prednisolone (a steroid) is often given early during an acute attack to minimise the acute inflammation. This reduces the swelling of the lining of the air passages.

Preventers

Drugs used to prevent asthma are very important. They act either to reduce the effects of inflammation (which is the main underlying cause of the disease), or to minimise the effects of some of the cells in the airways that contribute to the inflammatory response.

Preventative medications need to be taken regularly every day. The drugs used for prevention include the following:

• Inhaled steroids such as beclomethasone (Qvar), budesonide (Pulmicort), fluticasone (Flixotide) and ciclesonide (Alvesco), which can be inhaled and used to prevent attacks.
• Steroid tablets or mixtures (prednisolone), which can be given by mouth to prevent attacks.
• Sodium cromoglycate (Intal), which is an alternative to corticosteroids. This is inhaled on a regular basis, irrespective of whether your child has symptoms or not.
• Montelukast (Singulair) is another alternative to corticosteroids. This is a tablet that needs to be taken every day.

Controllers

If your child’s asthma isn’t controlled by using preventers, and he’s more than five years old, your doctor will consider prescribing symptom controllers.

These drugs are a long-acting version of beta-2 agonists, so they act like salbutamol, but for longer. Examples include Serevant and Formeterol. These drugs must only be used in combination with a preventer. This is made easier by the availability of combination inhalers, such as Seretide (contains Flixotide and Serevant) and Symbicort (contains Pulmicort and Formeterol).

Prevention

The mainstay of asthma prevention is the appropriate use of preventative asthma medications.

You should also think about factors that might trigger attacks of asthma. Try to avoid cigarette smoke and exposure to animals that cause allergy symptoms, including household pets. Your child might be better off with non-allergenic bedding if she’s affected by goosedown or feathers. In some cases, you might need to remove your carpets to minimise dust and decrease your child’s exposure to the common house dust mite.

Prevention measures should be balanced with the need to limit big changes to the living conditions of your child and family. Big changes mightn’t be needed if your child only has mild symptoms.

Understanding asthma management

You and your child need to understand the causes and management of asthma.

Asthma management plans
Every child with asthma should have an asthma management plan. This involves you and your child:

• knowing what triggers asthma symptoms
• understanding how to take the asthma medication – how much, how often and how to use the inhaler correctly
• knowing what to do if your child’s symptoms get worse, and what to do in an emergency if your child doesn’t respond to the drugs that are usually taken.

Note that learning how to use an inhaler is very important and might need to be explained and demonstrated several times before your child can do it properly.

It’s a good idea for your child to see her doctor or nurse regularly to monitor her asthma symptoms and treatment. If you’re not sure about any aspects of your child’s management plan, you can check with your child’s health professional.

Medications
Asthma medicines are generally very safe, especially those that are inhaled. Children usually get into trouble because they don’t take enough asthma medication, rather than because they take too much. If you think your child is experiencing side effects from medications, discuss this with your doctor.

Getting on with life
Most children with asthma can lead perfectly normal lives. Keep encouraging your child to participate in sport and exercise. Your child might benefit from taking her asthma medication just before exercise to prevent a wheeze or a cough from happening.

If your child has frequent attacks, or if symptoms prevent him from playing sport, sleeping at night, or feeling healthy, it’s likely that he’s being undertreated. Talk to your doctor about this so the treatment can be changed as needed.

It’s important to let your child’s school know about your child’s asthma.

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