Asthma treatment in children under age 5

The treatment goals for young children with asthma are to:

• Treat inflammation in the airways, most often with daily medicine, to prevent asthma attacks. This also is called long-term treatment.
• Use quick-relief medicine to treat asthma attacks.
• Stay away from or lessen the effect of asthma triggers.
• Help children stay as active as usual.

Your child's healthcare professional adjusts your child's long-term treatment over time. At first, the amount of medicine may be raised, also called stepped up. This is done until the asthma is under control for a time. Then the amount of medicine is lowered, also called stepped down. This common treatment plan is called the stepwise approach. The goal is to find the right balance of medicine. It involves taking the least amount of daily medicine possible to keep asthma under control. It also means needing as few quick-relief treatments for asthma attacks as possible.

If your child needs to use quick-relief medicine too often, the long-term treatment likely will be stepped up. Or another medicine may be added.

Medicine gets stepped up or down depending on the response to treatment and each child's overall growth and development. It also depends on seasonal changes or changes in activity levels.

Long-term control medicines

Long-term control medicines usually are taken daily to prevent asthma symptoms. You also might hear them called maintenance medicines. Types of long-term control medicines include the following:

• Inhaled corticosteroids. These medicines are breathed in to treat the airway inflammation that leads to asthma symptoms. They're the most effective and important type of long-term control medicine for children. Inhaled corticosteroids for infants and preschool children include budesonide (Pulmicort Flexhaler, Pulmicort Respules), fluticasone (Flovent HFA) and beclomethasone (Qvar Redihaler).

• Leukotriene modifiers. These medicines taken by mouth block the effects of immune system chemicals that lead to asthma symptoms. A leukotriene modifier may be added to a treatment plan if an inhaled corticosteroid alone does not control asthma well enough. The medicine montelukast (Singulair) is approved in a chewable tablet form for children ages 2 to 6. It's approved in a granular form that can be added to pureed food for children as young as 1.

  Rarely, montelukast has 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.

• Long-acting beta agonist. This type of medicine is breathed in to relax muscles in the airways that carry air to the lungs. A long-acting beta agonist is not used by itself due to a risk of serious asthma attacks. Instead, it can be added to an inhaled corticosteroid treatment if the steroid alone doesn't help enough. A common long-acting beta agonist approved for children 4 years and older is salmeterol (Serevent).
• Long-acting beta agonist and an inhaled corticosteroid. These two medicines can be combined to treat small children with serious, persistent asthma. For example, salmeterol plus fluticasone (Advair Diskus) is approved for children 4 years and older.
• Cromolyn. This medicine is breathed in to ease inflammation in the lungs. It can be used by itself or as an add-on treatment with inhaled corticosteroids. There is not as much research as to how well it works compared with the other long-term control medicines for young children.
• Oral corticosteroids. These medicines taken by mouth help ease lung inflammation. They're used only when asthma can't be controlled with other treatments.

Quick-relief rescue medicines

These medicines can relieve asthma symptoms right away, and the effects last 4 to 6 hours. Quick-relief medicines for asthma include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA).

For children with mild, occasional asthma symptoms, this type of medicine may be the only treatment that is needed.

For young children who have ongoing asthma and use long-term control medicines, quick-relief medicine is used to treat asthma attacks. It also may be used to prevent asthma symptoms triggered by exercise.

Overuse of quick-relief medicines usually means that a healthcare professional needs to change the long-term control treatment plan.

Medicine delivery devices

Most asthma medicines are given with a device called a metered dose inhaler. A correctly timed deep breath is needed to get medicines into the lungs. Attachments for metered dose inhalers and other devices can make it easier for children under age 5 to get the right amount of medicine. These devices include:

• Valved holding chamber with face mask. This can be attached to a metered dose inhaler. The chamber helps a child breathe in the medicine. The mask lets the child take six breaths to get the same amount of medicine the child would get by breathing in a single large puff of medicine.
• Nebulizer. This device turns medicines into a fine mist. Your child breathes the mist in through a face mask. Young children often need to use a nebulizer because it's hard or not possible for them to use other inhaler devices.