Different treatment pathways are recommended depending on if your child is under five years old or aged five to 16. But in both cases the goal is always to make sure their asthma is as well managed as it can be, using the lowest doses of asthma medicine possible.
“It can sometimes take time to find the right treatment for your child, so it’s important to keep in touch with your child’s GP or asthma nurse and go back to review any new medicines your child’s been given,” says Dr Andy Whittamore, Asthma UK’s in-house GP.
Before changing your child’s medicines or increasing the dose your GP will need to talk to you about
- how regularly your child is taking their preventer medicine
- your child’s inhaler technique
- any triggers your child may come into contact with, such as cigarette smoke – which will make managing their asthma a lot harder – or pets
- anything else going on, such as hay fever, or damp in the house.
“It may be that with the right support in finding a good routine, understanding their triggers, and getting their inhaler technique right, your child will be able to manage their asthma symptoms without needing to be prescribed higher doses,” says Dr Andy.
Children under five can’t do the usual tests to diagnose asthma. If your child only has asthma symptoms occasionally, your GP may suggest a ‘watch and wait’ approach.
They may prescribe a reliever inhaler for your child to take just when they get symptoms.
But if your child is having asthma symptoms three times a week or more, or is waking up at night with symptoms, your GP may want to try some asthma medicines for about eight weeks to see if they help. This is known as a ‘trial of treatment’.
The trial will usually consist of the first three steps on the pathway. After eight weeks of trying the asthma medicines your GP will ask you to bring your child back in to see how the medicines worked. If they did, then it means your child is more likely to have asthma.
But if your child’s suspected asthma is still not controlled using these asthma medicines your GP may refer your child to an asthma specialist for more support.
Your child will be given medicines for their asthma based on the latest treatment guidelines.
When your child’s asthma medicines are working well you can expect to notice your child
- isn’t getting daytime symptoms
- isn’t waking up at night because of their asthma
- doesn’t need their blue reliever inhaler
- isn’t having asthma attacks
- can get on with daily life (including school or exercise) without asthma symptoms getting in the way.
1. Reliever only
If your child gets asthma symptoms very rarely, and if their lung function is normal, your GP may sometimes consider treatment with just a reliever inhaler.
But it’s important to take your child back to your GP if they are getting asthma symptoms or need to use their reliever three or more times a week because they may need a preventer medicine too.
“There are very few children who will be given a reliever inhaler without a preventer too. Most children with asthma benefit from a regular preventer inhaler taken every day to prevent symptoms coming on,” says Dr Andy.
2. Preventer and reliever
Most children with asthma also need a preventer inhaler to take every day as prescribed. Your child's preventer inhaler keeps them well with their asthma over time by preventing the inflammation in their airways. Preventer inhalers are often brown.
3. Add-on therapies
“Your GP may suggest your child tries either a long-acting bronchodilator, or an LTRA preventer tablet, in addition to their usual inhaled corticosteroid preventer,” says Dr Andy.
“Guidelines vary on which one your child should try first, and both can make a difference. If one doesn’t seem to make a difference to your child they can try another one.”
Preventer and reliever and LTRA tablet
If your child’s asthma isn’t well controlled with their daily preventer medicine your GP may consider a Leukotriene Receptor Antagonist (LTRA), usually Montelukast, as an add-on therapy.
This means your child will be taking their daily preventer inhaler, and an LTRA tablet, and have the reliever inhaler to help with on-the-spot symptoms if they come on.
“There have been reports of children taking Montelukast having side effects such as nightmares, sleepwalking, anxiety, depression or irritability,” says Dr Andy. “If you notice any of these changes in your child, talk to your child's GP as soon as possible.”
Even if the medicine is suiting your child, it’s important to review this treatment change in four to eight weeks.
Your child's GP may consider a long-acting bronchodilator as an add-on therapy for your child to use alongside their preventer inhaler.
This can be prescribed as a combination inhaler, so the long-acting bronchodilator medicine is in the same device as their daily preventer medicine.
If your child's asthma is still uncontrolled even though they're using a preventer inhaler and a long-acting bronchodilator every day, your GP may consider trying them on the MART regime.
MART inhalers include a steroid preventer medicine and a certain type of long-acting bronchodilator medicine which can also be used as your child's emergency reliever. Not all combination inhalers can be used as a reliever so check with your child's GP.
4.Referral to asthma specialist for more support
If your child has tried an LTRA preventer tablet, and a long-acting bronchodilator alongside their usual asthma medicines, but their symptoms haven’t improved, they may be referred to a paediatric consultant specialising in asthma care.
Special tests may be used, for example FeNO, to help work out the best treatment option for your child.
“At different times of your child’s life, or even at different times of the year, your child’s GP or asthma nurse may prescribe more, or less, treatment depending on your child’s symptoms,” says Dr Andy.
“This is why it’s so useful to take your child to their asthma review, so you and your GP can see how their asthma’s been and can change medicines if needed.”
You don’t have to wait for your child’s next review before booking in to see your GP or asthma nurse.
Book an appointment if
- you notice your child’s asthma symptoms are getting worse (for example, they’re using their blue reliever inhaler more often than usual or they’re waking up at night with symptoms). Your GP or asthma nurse may increase your child’s medicines.
- you’re worried about side effects you’ve noticed, particularly changes to your child’s mood or sleep patterns. These can be side effects of Montelukast.
- your child hasn’t had any asthma symptoms for at least three months. Your GP or asthma nurse may consider reducing their medicines.
Sometimes your GP may recommend reducing your child’s medicines dose or how often they take it.
Before they do, though, it’s important for you both to consider:
- what symptoms your child’s getting and how often they’re getting them
- the side effects of the treatment
- how long they’ve been taking the current dose
- the benefits of their current dose
- your wishes – and your GP may be able to take into account your child’s wishes, too.
Your child is more likely to be able to cut down on the medicine they’re taking if their asthma has been well managed and they’ve had no symptoms for at least three months. For example, they may be prescribed just a reliever inhaler for when symptoms come on.
You’ll still need keep an eye on things and take your child back to your GP if you notice your child:
- needs their reliever inhaler three or more times a week
- is coughing or wheezing or waking in the night
- has a lower than usual peak flow score or their score is up and down.
Your GP may need to increase your child’s medicines again to stop their airways being so sensitive and inflamed and causing asthma symptoms.
“Make sure your GP makes a note of any changes to the medicines your child needs to take on their asthma action plan,” says Dr Andy.
To talk to our friendly asthma nurse specialists about your child’s asthma, call the Asthma UK Helpline on 0300 222 5800 (Mon-Fri, 9am-5pm) or message them via WhatsApp on 07378 606 728.
Last updated November 2019
Next review due September 2022