Updated 02 August 2017

How do you treat asthma in children?

In almost all cases with a bronchodilator and inhaled corticosteroids.

Children usually use the same medication as adults. The amount and type of medication will depend on the severity of the asthma. The approach to treatment in children (as in adults) is to "Hit Early, Hit Hard - Then Step Down".

In mild cases (intermittent asthma, with less than two acute asthma attacks per week), only a bronchodilator may be necessary, while more severe cases (persistent asthma, more than two attacks per week) could benefit from daily inhaled corticosteroid medication to help prevent attacks by reducing the chronic inflammatory reaction in the airways.

In infants, management of asthma presents unique problems. But it is always better to treat a child as if he has asthma than not to treat. If a parent is unsure whether the infant's wheezing is because of asthma, or whether he is suffering an acute attack, it is better to give a bronchodilator than to withhold treatment if he has been diagnosed with asthma.

Because an infant’s airways are so small, the smallest amount of mucus or tissue swelling can cause significant airway narrowing. Infants also have proportionately less smooth muscle around their airways resulting in less support for the airway, but also less spasm of the airway. As a result, infants also respond less well to bronchodilators, which open up the airways and provide older asthmatics with quick relief. But there is no reason why a child's asthma cannot be managed and controlled to such an extent that he can live a normal life.

Parents often panic because they do not know whether their infant or toddler is really inhaling deep enough to get all the medication to his lungs. For infants and children, a spacer with a valve to ensure that no air escapes from the spacer, can be of great value.

A child often inhales in shallow and short breaths when using an inhaler, exhaling more than inhaling. As soon as your child can understand, you can teach your child to relax before using his inhaler, and inhale long and slowly from the spacer, keeping his mouth on the spacer while exhaling slowly through his nose, and then inhaling again. After four to five inhalations, chances are good that he inhaled all the medication he needs.


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Professor Keertan Dheda has received of several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others.Read his full biography at the University of Cape Town Lung Institute

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