Children need extra help to control asthma symptoms

July 1, 2012

Asthma medications for children must match a child's ability to understand and control treatment of symptoms.

Asthma affects one in 12 people in the United States and was once considered a condition of hyperactive airways.

"Now we think of it more as a chronic inflammation, and this has changed our understanding of the appropriate treatment," says Michael Sherman, MD, senior vice president and chief medical officer for Harvard Pilgrim Health Care. "We now recognize the critical importance of taking ongoing maintenance medications, such as inhaled corticosteroids to suppress airway inflammation."

Low daily doses of an inhaled corticosteroid (ICS) suppress airway inflammation and reduce the risk of exacerbations, according to Mark Abramowicz, MD, editor of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs.

GROWING CONCERNS

Asthma is one of the most common chronic diseases of childhood. About 1 in 10 children (10%) and 1 in 12 adults (8%) had asthma in 2009.

"For children with mild intermittent asthma, an inhaled short-acting beta-2 agonist (SABA) should be used as needed," says Dr. Abramowicz. "For mild, moderate or severe persistent asthma, ICSs are the preferred long-term treatment for control of symptoms. ICSs do not, however, alter the underlying severity or progression of the disease."

Medications prescribed for children must match their ability to understand and control the device used to deliver the medication.

"In young children, a SABA or an ICS may best be delivered through a metered-dose inhaler with a valved holding chamber and face mask or mouthpiece, or through a nebulizer," says Dr. Abramowicz. "Dry powder inhalers are not suitable for use in young children, who cannot reliably inhale rapidly or deeply enough to use them effectively."