Asthma treatment and asthma action plans

Asthma flare-ups or attacks: treatment for children aged 0-6 years

Here’s what to do if your child has an asthma flare-up or asthma attack:

Remain calm and sit your child down.
Give your child 2-6 puffs of reliever medicine from the inhaler (usually the blue one) through the spacer. Your child should take 4 normal breaths after each puff before getting the next puff.
Wait 4 minutes.

If there’s little or no improvement in symptoms or symptoms get worse, immediately call 000 for an ambulance. Say that your child is having an asthma attack. Follow steps 1-3 until the ambulance arrives.

If your child’s symptoms improve after treatment, watch your child throughout the day. If symptoms happen again, start treatment again.

If your child has had an asthma attack or is having flare-ups that need treatment more than once every 3 hours, take your child to the GP as soon as possible.

Asthma flare-ups or attacks: treatment for children aged 6 years or older

Here’s what to do if your child has an asthma flare-up or asthma attack:

Remain calm and sit your child down.
Give your child 6-12 puffs of reliever medicine from the inhaler through the spacer. Your child should take 4 normal breaths after each puff before getting the next puff.
Wait 4 minutes.

If your child’s symptoms improve after treatment, watch your child throughout the day. If symptoms happen again, start treatment again.

If your child has had an asthma attack or is having flare-ups that need treatment more than once every 3 hours, take your child to the GP as soon as possible.

The symptoms of severe asthma and allergies are very similar. If your child has diagnosed anaphylaxis and is showing signs of severe asthma, use their adrenalin injector at the same time as starting inhaler treatment.

Asthma treatment: your child’s asthma action plan

Every child with asthma should have an individualised asthma action plan, regardless of how mild or severe their symptoms usually are.

The aim of all asthma action plans is to prevent asthma flare-ups and attacks so that your child can lead a healthy, balanced life. An asthma action plan also aims to minimise the severity and length of any attacks that do happen.

Your child’s asthma action plan will cover the:

steps to take if your child has a flare-up or attack
medicines your child needs and information about how to take them
triggers for your child’s asthma and how to avoid them.

You and your child will work with your child’s doctor to develop the asthma action plan.

It’s important to give a copy of the asthma action plan to anyone who’s caring for your child. This includes family, carers, babysitters, sports coaches and your child’s school.

It’s a good idea for your child to see their doctor or nurse regularly to monitor their asthma symptoms and treatment and to review the asthma action plan. If you’re not sure about any aspects of your child’s asthma action plan, check with your child’s doctor or nurse.

Your child’s asthma action plan: categories of asthma

The treatment in your child’s asthma action plan will depend on the kind of asthma that your child has.

Infrequent intermittent asthma
Children with infrequent intermittent asthma usually need treatment only for asthma flare-ups or attacks. They might not need to take any asthma medicines in between flare-ups or attacks, unless the flare-ups or attacks are severe.

Frequent intermittent asthma
Some children with frequent intermittent asthma might need to take preventer medicine every day to reduce the frequency and severity of their flare-ups or attacks.

Persistent asthma
Children with persistent asthma need to take preventer medicine every day to treat asthma symptoms that disrupt sleep, exercise or daily activities. Some children might need to take multiple asthma medicines.

Your child’s asthma action plan: asthma medicines

Your child’s asthma action plan will include asthma medicines. Asthma medicines can be divided into:

relievers, which treat asthma symptoms
preventers/controllers, which prevent asthma symptoms.

Some children take more than one of these types of medicines. Your doctor will tell you the most appropriate medicines for your child.

Relievers
Short-acting beta-2 agonists like salbutamol (Ventolin, Asmol) are most often used to treat asthma symptoms. These drugs help to relax the narrowed airway passages and make it easier for air to get through.

If your child is having a severe asthma attack, your child might be given corticosteroids (prednisolone) to reduce inflammation and swelling in their airway passages.

Preventers
Drugs to prevent asthma symptoms are very important. They can reduce inflammation in the airway passages, relax the airway muscles for prolonged periods of time, or target the underlying factors that cause inflammation and allergies.

Asthma preventers include:

inhaled corticosteroids like fluticasone (Flixotide), ciclesonide (Alvesco), beclomethasone (Qvar) and budesonide (Pulmicort)
corticosteroid tablets or mixtures (prednisolone), which children take by mouth
montelukast (Singulair), which is a tablet that can be taken alone or with inhaled corticosteroids
combination inhalers, which combine inhaled corticosteroid and long-acting beta-2 agonists like fluticasone and salmeterol (Seretide), budesonide and formoterol (Symbicort), and flucticasone and vilanterol (Breo Ellipta)
biologics like omalizumab and mepolizumab (Xolair and Nucala), which are given by injection every 2-4 weeks and are used for severe asthma not controlled by other preventers.

Safety and side effects of asthma medicines
Asthma medicines are generally very safe, especially those that are inhaled. But if you think your child is experiencing side effects from medicines, discuss this with your doctor.

Children who use corticosteroids inhalers might get oral thrush. There’s also a chance that children can damage their tooth enamel if they use an inhaler and don’t look after their teeth properly. Your child can avoid these side effects by rinsing out their mouth after using their corticosteroid inhaler. Also make sure your child’s teeth are cleaned twice a day with toothpaste – but allow 30-60 minutes after using an inhaler before brushing.

If your child uses an inhaler, learning how to use it is very important. You and your child’s health professionals might need to explain several times and show your child how to do it.

Your child’s asthma action plan: avoiding asthma triggers

Your child’s asthma action plan should cover avoiding the things that trigger asthma attacks.

For example, your child should avoid things that might irritate their airways, like cigarette smoke and air pollution.

If your child is allergic to certain animals, it’s a good idea for your child to avoid touching these animals. If your family pet is the problem, you could think about keeping the animal outside or not letting the animal sleep on your child’s bed or in your child’s bedroom.

If your child is affected by goose down or feathers, they might be better off with non-allergenic bedding.

If your child is allergic to house dust mites, you can reduce dust in your home and your child’s bedroom by:

regularly wet-dusting surfaces and vacuuming floors
minimising soft toys and clutter in your child’s bedroom
replacing curtains and carpets with blinds and hard flooring
washing sheets and pillowcases every week in water 60°C or hotter
using anti-dust covers on your child’s mattress and pillow
washing blankets, doonas and dust mite covers every 2 months in hot water.

It’s OK to look at how you can balance prevention measures with the need to limit big changes to your home and lifestyle. You might not need to make big changes if your child has only mild symptoms.

Living with asthma

Most children with asthma lead lives that have a healthy balance of physical and other activities.

If your child is diagnosed with asthma, keep encouraging your child to do sport and exercise. Your child might benefit from taking reliever medicine just before exercise to prevent a wheeze or a cough.

If your child has frequent attacks or if symptoms stop your child from playing sport, sleeping at night or feeling healthy, it’s likely that your child is being undertreated or not taking their medicine properly. Talk to your doctor about this.

Children with asthma might not be able to judge the severity of their symptoms well. For example, they often say they feel fine even if their asthma is poorly controlled. Keep an eye on your child’s symptoms and visit your doctor if you have any concerns.