Asthma drugs: What every parent should know

by Gary A. Emmett, M.D.

My last blog was about Stefon, a teenager who did not really understand when he was in trouble with his asthma or how asthma medicines could help him. This blog is about those medications – and how to use them.

First, some basics. There are two kinds of asthma medicines: Rescue medicines (in the U.S. primarily albuterol and sometimes levalbuterol) and preventive medicines (inhaled corticosteroids such as fluticasone and many others). Stefon, who wheezed with every cold he caught, skipped preventive medicines and relied on his rescue medicine much too frequently. As a result, he ended up in the hospital several times. He would have probably stayed out of the hospital if he had used his medications the smart way: Preventive medicines everyday, rescue medicine only on rare occasions.

What is your child or teen doing? Often, my patients with asthma do not even know the names of their medicine (the "blue pump" or similar is a common answer I get when trying to figure out what medicine my patient is taking).  Help them figure out if they're using the right medication as directed. If you're not sure, ask your health professional for an "Asthma Action Plan" which will list the medicine your child needs to use in detail – including which to take when, how often and at what dose.

What's the big deal about preventive asthma medications? Modern asthma care tries to prevent the inflammation (irritation) of the lungs that causes muscle spasm around the airways, swelling of the airway walls and mucous production in the lungs. These problems set the body up for wheezing when an asthma-prone person is exposed to irritants (pollen, dust, animal dander and especially cigarette smoke) or an infection (viral illnesses like colds and flu that make many people wheeze). If you keep inflammation under control with preventive medications, then asthma attacks may be prevented or at least be less severe.

Preventive asthma medications include inhaled corticosteroids such as fluticasone (Flovent) and budesonide (Pulmicort). (Others include Asmanex, Azmacort, Dulera, Foradil and Qvar). If your child or teen's asthma is harder to control, your doctor may recommend a corticosteroid plus a long-acting albuterol-like drug, such as fluticasone/salmeterol (Advair) or budesonide/fomoterol (Symbicort). Another preventive asthma medicationis Montelukast (Singulair), a pill taken at night that also helps nasal stuffiness. Some doctors prescribe theophylline products, which are old-fashioned but do work, such as Slo-Bid, Theochron , Theo-Dur, Theo-24, Uniphil. Preventive medicine usually has to be taken once or twice daily, every day, to work well.  One exception: Some people only wheeze in one season, such as spring or autumn, and only have to take preventive medicine starting a week or so before the seasons change.

Where do rescue medicines fit in to your child's asthma plan? This kind of medicine relaxes the muscles around the airways in the chest and also decreases swelling in the walls of these air passageways.  Rescue medicines can short-circuit an asthma attack, but aren't meant to be used every day. If your child uses rescue medication more than once a week, it's a sign that he or she may not be using the correct preventive medicine or isn't using the preventive medicine as directed. The rescue medicine albuterol (Ventolin, Proventil, ProAir) comes either in an inhaler or in a nebulizer.

Giving asthma medications to children can be challenging. If a child is too young to use an inhaler, your doctor may recommend a nebulizer —  a breathing machine that converts asthma medicine into a mist that is easily inhaled into the lungs. Another option is adding a "spacer" to a child or teen's inhaler. This is a long tube attached to the inhaler that makes it easier for kids (and adults) to take asthma drugs into their lungs while leaving less in the mouth and throat. Tests show that spacers can work as well as nebulizers, but I've found that many patients' parents disagree. Talk with your child's doctor about what's best for him or her.

If you have more questions about asthma medications, I recommend the KidsHealth Web site from the Nemours Foundation, which has a variety of articles on asthma, written for kids, teens and parents.

Gary A. Emmett, M.D., Thomas Jefferson University Hospital, Jefferson Medical College.