If your child has persistent asthma, the best control medicine is an inhaled corticosteroid.
If your child is five years old, or older, and has been diagnosed with mild persistent, moderate persistent, or severe persistent asthma, talk with your doctor about the kind of controller medication your child is on. The revised 2002 NAEPP (National Asthma Education and Prevention Program) guidelines recommend inhaled corticosteroids, a controller medication, over other controller medications such as cromolyn, nedocromil, theophylline or leukotriene receptor antagonists. Inhaled corticosteroids improve asthma control more than the other controller medications.
Inhaled corticosteroids are safe and, over the long run, will not inhibit your child’s growth.
Some parents worry that long-term use of inhaled corticosteroid medications for children with persistent asthma may delay or inhibit growth or decrease bone density. The revised 2002 NAEPP (National Asthma Education and Prevention Program) guidelines indicate that long-term use of inhaled corticosteroids produces no clinically important, long-term, irreversible changes in growth or bone density.
Salmetrol and formoterol “long-acting inhaled beta-agonists“ work better than leukotriene receptor antagonists or theophylline as add-on medications to inhaled corticosteroids for children age five and older.
If your child is age five or older and has moderate persistent asthma, ask your doctor what kind of medicine may have been prescribed in addition to inhaled corticosteroids. To improve asthma control, the 2002 NAEPP(NATIONAL ASTHMA EDUCATION AND PREVENTION PROGRAM) guidelines recommend adding a long-acting inhaled beta-agonist – such as salmeterol or formoterol“ rather than leukotriene receptor antagonists or theophylline to low to medium doses of inhaled steroids. Adding an inhaled beta-agonist also works better than doubling the dose of inhaled corticosteroids.
Keep a written asthma plan and take regular peak flow readings if your child has moderate persistent or severe persistent asthma.
Will adding a written asthma management plan to medical treatment offer better control of your childs asthma than medical treatment by itself? Studies do not yet provide a clear answer. If your doctor has given you a plan be sure to follow it. Is it better to manage asthma based on symptoms or on peak flow readings? Studies show that either way works.
Question #1: Do inhaled steroids work better for asthma control than other medications in children, and are they safe to use in children?
Answer: The consistent use of inhaled steroids improves asthma control more than other controller medications such as cromolyn, nedocromil, theophylline or leukotriene receptor antagonists. Furthermore, there are no clinically important, long-term, irreversible changes in growth, bone density, eye or adrenal gland changes with their continued use in children.
The recommendations from the 1997 EPR II have been changed to state that inhaled corticosteroids are the preferred treatment for children with mild, persistent asthma.
Question #2: Do patients with moderate persistent asthma, who are already on inhaled steroids, do better with the addition of a second medication?
Answer: The addition of a long-acting inhaled beta-agonist, such as salmeterol or formoterol, improves asthma control more than the addition of leukotriene receptor antagonists, theophylline or even doubling the dose of inhaled steroids. The EPR II recommendations have been changed for children over the age of 5 and adults, indicating that the preferred treatment for moderate persistent asthma is the addition of a long-acting inhaled beta-agonist to low to medium doses of inhaled steroids.
Studies of these combinations of medications are not as plentiful for children younger than age 5, so the Panel recommends two preferred options for moderate, persistent asthma in children less than 5 years old: low dose inhaled steroids plus a long-acting inhaled beta-agonist, or medium dose inhaled steroids alone.
Question #3: Does the addition of antibiotics to standard asthma care improve the care of asthma attacks?
Answer: Antibiotic therapy does not improve the treatment of acute asthma attacks when given routinely or when the suspicion of bacterial infection is low. The current recommendations from the 1997 EPR II document are unchanged. Antibiotics should only be used for the treatment of conditions that accompany an acute asthma attack when those conditions are likely to be caused by a bacterial infection.
Question #4: Is a written asthma management plan better than medical management alone, and are written asthma management plans based on peak flow better than those based on symptoms?
Answer: The studies that have been done on these questions are not strong enough to provide a clear answer. There is some suggestion that written asthma action plans are superior in adults with asthma. This does not imply, however, that they are not so for children. It is just that there is not adequate information in children to tell if they are more effective.
There are few good studies on the issue of peak flow-based management plans compared to symptom-based plans. Studies that have been done indicate that the two methods are at least equally effective, and individual patient characteristics may be important in deciding which method to use.
The NAEPP recommendations are unchanged from the earlier EPR II: written plans as a part of an overall effort to educate patients in self-management are recommended, and peak flow monitoring should be considered in patients with moderate or severe asthma.
Question #5: In patients with mild or moderate persistent asthma, does early treatment with control therapy prevent the progression of asthma?
Answer: Current studies do not provide evidence that the early treatment of asthma can prevent progression of the disease. Large studies in children ages 5 to 12 years do not show that lung function declines progressively, although symptoms, and disease, are better controlled with inhaled steroids.
When inhaled steroid therapy is discontinued, symptoms return. This suggests that inhaled steroids provide superior control in this age group, but do not affect the underlying disease. In contrast, studies in 3- to 5-year-old children and adults do suggest that changes in lung function can occur, rapidly in some adults. However, studies on whether early treatment can prevent these declines have not been done.
The bottom line: take inhaled corticosteroids on a consistent basis if you have persistent asthma (regardless of age), keep a written asthma plan and take regular peak flow readings if you have moderate or severe asthma.
