Treating asthma in children ages 5 to 11

Asthma in children is one of the most common causes of missed school days. The airway condition can disrupt sleep, play and other activities.

Asthma can't be cured. But you and your child can lessen the symptoms. The key is to follow an asthma action plan. This is a written plan you make with your child's healthcare team. It helps you track symptoms and adjust treatment as needed.

Asthma treatment in children:

• Improves day-to-day breathing.
• Reduces flare-ups of asthma symptoms.
• Helps lessen other problems caused by asthma.

With proper treatment, even serious asthma can be kept under control.

Common asthma symptoms in children ages 5 to 11 include:

• Coughing, especially at night.
• A high-pitched whistling sound made while breathing out, called wheezing.
• Trouble breathing.
• Chest pain, tightness or discomfort.
• Staying away from or losing interest in sports or physical activities.

Some children have few day-to-day symptoms, but they have serious asthma attacks now and then. Other children have mild symptoms or symptoms that get worse at certain times.

You may notice that your child's asthma symptoms get worse:

• At night or in the early morning.
• With activity.
• When your child has a cold.
• With triggers such as cigarette smoke or seasonal allergies.
• During strong emotional reactions, such as crying or laughing.

Severe asthma attacks can be life-threatening. These need to be treated right away in the emergency room. Symptoms of an asthma emergency in children ages 5 to 11 include:

• Serious trouble breathing.
• Lasting coughing or wheezing.
• No improvement after using quick-relief "rescue" medicine through an inhaler, such as albuterol (ProAir HFA, Ventolin HFA, others).
• Not being able to speak without gasping for air.
• Breathing in so hard that the stomach area is sucked under the ribs.
• Nostrils flaring.
• Peak flow meter readings in the red zone. A peak flow meter is a hand-held device that can measure how much air your child can quickly breathe out. Being in the red zone means that the airway has become very narrow.

For children 5 years of age and older, healthcare professionals can find and track asthma with the same tests used for adults. These include spirometry and peak flow meters. They measure how much air your child can quickly force out of the lungs. That provides a sign of how well the lungs are working.

If your child's usual breathing seems regular, other tests might be done to find out if your child has asthma. Breathing might be measured before and after exercising. Breathing may also be measured after breathing in cold air or a medicine called methacholine. These kinds of tests are known as bronchoprovocation challenges.

Other tests that your child's healthcare professional may recommend include a chest X-ray and allergy testing.

Your child's healthcare professional may give your child a hand-held device called a peak flow meter. The peak flow meter measures how well the lungs are working.

Low peak flow meter readings are a sign that the asthma is becoming worse. You and your child may notice low readings before you even notice symptoms. This helps you know when to adjust treatment to prevent a flare-up of asthma symptoms.

If your child's asthma symptoms are very bad, your family doctor or pediatrician may recommend seeing an asthma specialist.

Treatment aims to find the right type and amount, of medicine needed to control your child's asthma. This helps prevent side effects.

You'll keep a record of how well your child's current medicines seem to control symptoms. Based on this record, your child's healthcare professional may "step up" treatment to a higher dose or add another type of medicine. If your child's asthma is well controlled, the healthcare professional may "step down" treatment by reducing your child's medicines. This is known as the stepwise approach to asthma treatment.

These also are known as maintenance medicines. They are usually taken every day on a long-term basis to control lasting asthma. These medicines may be used seasonally if your child's asthma symptoms become worse during certain times of the year.

Types of long-term control medicines include:

• Inhaled corticosteroids. These medicines are breathed in to treat the airway inflammation that leads to asthma symptoms. They are the most common long-term control medicines for asthma. They include fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), beclomethasone (Qvar RediHaler), ciclesonide (Alvesco, Omnaris) and mometasone (Asmanex HFA).

• Leukotriene modifiers. These medicines taken by mouth block the effects of immune system chemicals that lead to asthma symptoms. They include montelukast (Singulair) and zafirlukast (Accolate). They can be used alone or along with inhaled corticosteroids.

  Rarely, montelukast and zafirlukast have been linked to mental reactions. These include agitation, aggression, hallucinations, depression and suicidal thinking. Get medical help right away if your child has any unusual reactions.

• Combination inhalers.These contain two types of medicines that are breathed in: an inhaled corticosteroid plus a medicine that relaxes muscles in the airways, called a long-acting beta agonist (LABA). Combination inhalers include the combinations fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort), fluticasone-vilanterol (Breo Ellipta) and mometasone-formoterol (Dulera). In some situations, long-acting beta agonists have been linked to serious asthma attacks.

  LABA medicines should be given only to children when they are combined with a corticosteroid in a combination inhaler. This lowers the risk of a serious asthma attack.

• Biologics. These shots of medicine target parts of the immune system to help control moderate to severe asthma. They include omalizumab (Xolair), dupilumab (Dupixent) and mepolizumab (Nucala). The shots are given every 2 to 4 weeks, depending on the biologic used. Children age 6 and older may benefit from having this type of medicine added to their treatment plans.

These medicines also are called short-acting bronchodilators. They relieve asthma symptoms right away and last 4 to 6 hours. Albuterol is the most commonly used quick-relief medicine for asthma. Levalbuterol (Xopenex) is another.

Although these medicines work quickly, they can't keep your child's symptoms from coming back. If the symptoms are frequent or serious, a long-term control medicine such as an inhaled corticosteroid is needed.

Your child's asthma is not under control if your child often needs to use a quick-relief inhaler. Relying on a quick-relief inhaler to control symptoms puts your child at risk of a serious asthma attack. It's also a sign that your child's healthcare professional needs to think about making treatment changes. Track the use of quick-relief medicines. Then share the information with your child's healthcare team at every visit.

Asthma attacks are treated with rescue medicines and with corticosteroids taken by mouth or by shot.

Most asthma medicines are given with a device that lets a child breathe the medicine directly into the lungs. Your child's medicine may be delivered with one of these devices:

• Metered dose inhaler. These small hand-held devices are a common delivery method for asthma medicine. To make sure your child gets the correct dose, a hollow tube called a spacer can be attached to the inhaler.
• Dry powder inhalers. For some asthma medicines, your child may have one of these devices. A dry powder inhaler requires a deep, rapid breath in to get the full dose of medicine.
• Nebulizer.This device turns medicine into a fine mist. Your child breathes the mist in through a face mask. Nebulizers can deliver larger doses of medicines into the lungs than inhalers can. Young children often need to use a nebulizer. That's because it's hard or not possible for them to use other inhaler devices.

Allergy shots may help if your child has allergic asthma that can't be easily controlled by avoiding asthma triggers. These shots are given over time to stop or reduce allergy attacks that cause asthma symptoms to flare. The shots also are known as immunotherapy.

First, your child receives skin tests to find out which allergy-causing substances, also called allergens, may trigger asthma symptoms. During these tests, the skin is exposed to possible allergens. Then your child is closely watched for symptoms of an allergic reaction.

Once the allergens that trigger your child's asthma are found, your child gets a series of shots. These injections contain small amounts of those allergens. Your child likely will need allergy shots once a week for a few months. Then the shots are needed once a month for 3 to 5 years. Your child's allergic reactions and asthma symptoms should get better over time.

The biologic treatment omalizumab can help allergic asthma that isn't well controlled with inhaled corticosteroids.

Managing your child's asthma may seem overwhelming at first. But the follow steps can help make it easier for you.

A key part of managing your child's asthma is to learn what steps to take on a daily, weekly, monthly and yearly basis. It's also important to understand the purpose of each part of tracking symptoms and adjusting treatment. You, your child and caregivers need to:

• Understand the different types of medicines for asthma and how they work.
• Learn to recognize and record symptoms of asthma that becomes worse.
• Know what to do when your child's asthma gets worse.

A written asthma action plan is an important tool. It lets you know how well treatment is working based on your child's symptoms. With your child's healthcare team, make a written asthma plan that outlines the steps needed to manage your child's asthma. You and your child's caregivers should have a copy of the plan. That includes babysitters, teachers and coaches.

The plan can help you and your child:

• Track how often your child has asthma flare-ups, also called exacerbations.
• Judge how well medicines control symptoms.
• Note any medicine side effects, such as shaking, irritable behavior or trouble sleeping.
• Check how well your child's lungs work with a peak flow meter.
• Measure how much your child's symptoms affect daily activities such as play, sleep and sports.
• Adjust medicines when symptoms get worse.
• Know when to see a healthcare professional or get emergency care.

Many asthma plans use a stoplight system of green, yellow and red zones that relate to worsening symptoms. This system can help you quickly figure out how controlled your child's asthma is and spot symptoms of an asthma attack. Some asthma plans use a symptoms questionnaire called the Asthma Control Test. This measures how controlled your child's asthma has been over the past month.

It's important to help your child stay away from triggers that set off asthma symptoms. These triggers vary from child to child. Work with your child's healthcare team to find out what things cause your child's asthma symptoms to flare.

Common asthma triggers include:

• Colds or other respiratory infections.
• Allergens such as dust mites or pollen.
• Pet dander.
• Exercise.
• Cold weather.
• Mold and dampness.
• Cockroach exposure.
• Cigarette smoke and other irritants in the air.
• Severe heartburn due to gastroesophageal reflux disease (GERD).

Follow and update your child's asthma action plan. That's the key to keeping asthma under control. Carefully track your child's asthma symptoms. And make medicine changes as soon as they're needed. If you act quickly, your child is less likely to have a serious attack. Your child also likely won't need as much medicine to control symptoms.

With careful asthma management, your child is likely to have fewer flare-ups and more time for school, play and the rest of daily life.