Asthma treatment in children under age 5

The treatment goals for young children with asthma are to:

• Treat inflammation in the airways, usually with daily medication, to prevent asthma attacks
• Use short-acting drugs to treat asthma attacks
• Avoid or minimize the effect of asthma triggers
• Maintain normal activity levels

Your doctor will use a stepwise approach for treating your child's asthma. The goal is overall management with a minimum number of asthma attacks that require short-term treatment.

This means that initially the type or dosage of treatment may be increased until the asthma is stable. When it is stable for a period of time, your doctor may then step down the treatment, so that your child takes the minimum drug treatment needed to remain stable. If your doctor determines at some point that your child is using a short-acting drug too often, then the long-term treatment will be stepped up to a higher dose or additional medication.

This stepwise approach may result in changes up or down over time, depending on each child's response to treatment and overall growth and development, as well as on seasonal changes or changes in activity levels.

Medications for long-term control

Long-term control, or maintenance, medications are usually taken daily. Types of long-term control medications include the following:

• Inhaled corticosteroids are the most commonly used long-term asthma control drugs for children under age 5, as well as the preferred treatment according to the National Asthma Education and Prevention guidelines. Easily administered inhaled corticosteroids available to infants and preschool children include budesonide (Pulmicort Flexhaler, Pulmicort Respules), fluticasone (Flovent HFA) and beclomethasone (Qvar Redihaler).
• Leukotriene modifiers may be added to a treatment plan when an inhaled corticosteroid treatment alone does not result in stable asthma management. The drug montelukast (Singulair) is approved in a chewable tablet form for children age 2 to 6 and in a granular form that can be added to pureed food for children as young as 1.
• Long-acting beta agonist is an inhaled drug that can be added to a corticosteroid treatment regimen. The drug salmeterol is a long-acting beta agonist combined with an inhaled corticosteroid as a single-dose inhaled medication (Advair HFA).
• Cromolyn is an inhaled drug that blocks inflammatory events and may be used as an add-on treatment with inhaled corticosteroids. There is less evidence of the effectiveness of this treatment than for the other long-term control drugs appropriate for young children.
• Oral corticosteroids are used only when asthma management cannot be controlled with other treatments.

Short-acting medications

These medications — called short-acting bronchodilators — provide immediate relief of asthma symptoms, and effects last four to six hours. Short-acting bronchodilators for asthma include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA).

For children with mild, intermittent asthma symptoms, the short-acting medication may be the only treatment needed.

For young children who have persistent asthma and use long-term control drugs, the short-acting drug is used as a quick-relief, or rescue, medication to treat asthma attacks. It may also be used to prevent asthma symptoms triggered by exercise.

Overuse of short-acting medications usually indicates that the long-term control treatment plan needs to be revised.

Medication delivery devices

Most asthma medications are given with a device called a metered dose inhaler that requires a correctly timed deep breath to get medications to the lungs. Attachments for metered dose inhalers and other devices can make it easier for children under age 5 to get an appropriate dose. These devices include:

• Valved holding chamber with mask. A valved holding chamber with a face mask can be attached to a metered dose inhaler. The chamber allows a child to inhale the medication and doesn't allow exhaling into the device. The mask enables your child to take six normal breaths to get the same dosage as inhaling a single large puff of medication.
• Nebulizer. A nebulizer turns medications into a fine mist your child breathes in through a face mask. Young children often need to use a nebulizer because it's difficult or impossible for them to use other inhaler devices.