children s health issues
Asthma in Children
Treatment of Asthma in Children
For acute attacks, bronchodilators and sometimes corticosteroids For chronic asthma, inhaled corticosteroids (sometimes combined with bronchodilators) and possibly leukotriene modifiers and/or cromolyn Treatment is given to resolve sudden (acute) attacks and sometimes to prevent attacks. Children who have mild, very infrequent attacks usually take drugs only during an attack. Children who have more frequent or severe attacks also need to take drugs even when they are not having attacks. Different drugs are used depending on the frequency and severity of the attacks. Children with infrequent attacks that are not very severe usually take a low dose of an inhaled corticosteroid or a leukotriene modifier (montelukastorzafirlukast) every day to help prevent attacks. These drugs reduce inflammation by blocking the release of the chemical substances that inflame the airways. Treatment of an acute asthma attack consists of Opening the airways (bronchodilation) Stopping inflammation A variety of inhaled drugs open the airways (bronchodilators—see Treating Asthma Attacks ). Typical examples are Children and adolescents should use a metered-dose inhaler with a spacer or valve-holding chamber ( see Figure: How to Use a Metered-Dose Inhaler ). The spacer optimizes delivery of the drug to the lungs and minimizes the chance of side effects. Shake the inhaler after removing the cap. Exhale fully for 1 or 2 seconds. Put the inhaler in your mouth or 1 to 2 inches from it and start to breathe in slowly, like sipping hot soup. While starting to breathe in, press the top of the inhaler. Breathe in slowly until your lungs are full. (This should take about 5 or 6 seconds.) Hold your breath for 10 seconds (or as long as you can). Breathe out and, if a second dose is required, repeat the procedure after 1 minute. If you find it difficult to coordinate breathing using this method, a spacer can be used. Infants and very young children sometimes can use an inhaler and spacer if an infant-sized mask is attached. Children who cannot use inhalers may receive inhaled drugs at home through a mask connected to a nebulizer (a small device that creates a mist of the drug by using compressed air). Inhalers and nebulizers are equally effective at delivering the drugs, but most parents find the inhaler and spacer much more convenient and easier to use. Albuterolalso can be taken by mouth, but this route is less effective and may have more side effects than inhalation and usually is used only in infants who do not have a nebulizer and are too young to use an inhaler. Children with moderately severe attacks also may be given corticosteroids by mouth or injection. Children with very severe attacks are treated in the hospital with bronchodilators given in a nebulizer or an inhaler at least every 20 minutes initially. Sometimes doctors use injections ofepinephrineorterbutaline(bronchodilators) in children with very severe attacks if inhaled drugs are not effective rapidly enough. Doctors usually give corticosteroids by vein to children having a severe attack. Treatment of chronic asthma consists of Taking inhaled corticosteroids daily and possibly other drugs that control inflammation Using an inhaler before exercise ), a long-acting bronchodilator (always mixed with an inhaled corticosteroid in a combination inhaler), or cromolyn. Drugs are increased or decreased over time to achieve optimal control of the child’s asthma symptoms and to prevent severe attacks. If these drugs do not prevent severe attacks, children may need to take corticosteroids by mouth. Children over age 5 and adolescents with asthma can be treated similarly to adults (see Treating Asthma Attacks ). Children who have attacks during exercise usually inhale a dose of bronchodilator just before exercising. Children whose asthma is triggered byaspirinor other nonsteroidal anti-inflammatory drugs (NSAIDs) must avoid using these drugs. This reaction, however, is very uncommon in children. Because asthma is a long-term disorder with a variety of treatments, doctors work with parents and children to make sure they understand the disorder as well as possible. Adolescents and mature younger children should participate in developing their own asthma management plans and establishing their own goals for therapy to improve adherence to treatment. Parents and children should learn how to determine the severity of an attack, when to use drugs and a peak flow meter, when to call the doctor, and when to go to the hospital. Parents and doctors should inform school nurses, child care providers, and others of the child's disorder and the drugs being used. Some children may be permitted to use inhalers in school as needed, and others must be supervised by the school nurse. 