How is asthma treated in children?

If your child’s been diagnosed with asthma or has suspected asthma, you’ll be reassured to know there’s a range of effective treatments available.

Your child will be given asthma medicines for their asthma based on the latest asthma treatment guidelines.

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.

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 might be exposed to 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.

Taking the right medicines as prescribed, and in the right way, will reduce the inflammation and sensitivity in your child's airways so your child is less likely to get symptoms. 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.

Different treatment pathways are recommended depending on if your child is under five years old or aged 5-16. 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.

Treating ‘suspected asthma’ in children under five

Children under five can’t do the usual tests to diagnose asthma. If your child only has symptoms very rarely the GP may suggest a ‘watch and wait’ approach. They may prescribe a reliever inhaler for your child to take just when they get symptoms. 

‘Trial of treatment’

But if your child is having symptoms three times a week or more, or is waking up at night with symptoms, the 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’.

Your child will be prescribed a low dose of preventer medicine in a preventer inhaler. Or, if your child is unable to use a preventer inhaler, they’ll be offered a Leukotriene Receptor Antagonist (LTRA) instead, usually Montelukast.

After eight weeks of trying the asthma medicines:

  • they’ll ask you to bring your child back in to see how the medicines worked
  • if the medicines didn’t help symptoms, even though your child was taking them regularly and in the right way, your GP will consider other diagnoses that might be more likely
  • if the medicines did seem to work, your GP will suggest you stop the treatment for a time to see if symptoms come back.
  • if symptoms do come back it means it’s very likely your child has suspected asthma. Your child can continue on asthma medicines until they are old enough to do asthma tests.

Leukotriene Receptor Antagonists (LTRAs) as well as preventer inhaler

If your child is taking their preventer inhaler as prescribed and in the right way but their asthma still isn’t well controlled the GP will consider a Leukotriene Receptor Antagonist (LTRA) to take as well. The most common type is Montelukast. It comes in tablet form but is also available as a chewy tablet or as soluble granules. Your child will need to take it alongside their usual preventer inhaler.

This means your child will be taking their daily preventer inhaler, and an LTRA tablet, and have the reliever inhaler to help with symptoms if they occur.

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.

How children aged 5 to 16 are treated for asthma

Your child will be offered asthma treatment based on their symptoms. 

1. Reliever only

If your child gets symptoms very rarely, and if their lung function is normal, the GP can consider treatment with just a reliever inhaler. But it’s important to take your child back to the GP if they need to use their reliever three or more times a week – they may need a preventer medicine too.

2. Preventer and reliever

If your child is having symptoms three times a week or more, or symptoms are waking them up at night, their GP will consider prescribing a preventer inhaler to use every day, even when your child seems well. This will prevent the inflammation in their airways so they’re less likely to react to their asthma triggers.

3. Preventer and reliever and LTRA tablet

If your child’s asthma isn’t well controlled with the daily preventer medicine your GP will consider a Leukotriene Receptor Antagonist (LTRA). This means your child will be taking their daily preventer inhaler, and an LTRA tablet, and have the reliever inhaler to help with symptoms if they occur. It’s important to review this treatment change in four to eight weeks to make sure it’s right for your child.

4. Long-acting reliever inhaler

If the LTRA add-on therapy isn’t helping, the GP can consider stopping it and starting a long acting reliever inhaler (LABA) instead to use alongside their preventer inhaler. This can be prescribed as a combination inhaler in the same device as the daily preventer inhaler.

5. MART regime

If your child’s asthma is still uncontrolled even though they’re using a preventer inhaler and their long-acting reliever inhaler every day, and they’re over 12, their GP might consider trying them on the MART regime. This is where a specific preventer inhaler can be used as both a preventer and reliever inhaler.

6. Referral to asthma specialist for more support

If symptoms are more serious and/or more frequent your child may be referred to a paediatric consultant specialising in asthma care. After more tests, add-on therapies, for example theophylline, and long-term steroid tablets will be prescribed as needed.

Reviewing your child’s medicines

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. 

This is why it’s so useful to take your child to their asthma review, so you and their GP can see how their asthma’s been and change medicines if needed.

You don’t have to wait for your child’s next review before booking in to see their 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). Their GP or asthma nurse may increase your child’s medicines.
  • your child hasn’t had any asthma symptoms for at least three months. Their GP or asthma nurse may consider reducing their medicines.

Reducing your child's asthma medicine

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 they 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 their 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.

The GP may need to increase their medicines again to stop their airways being so sensitive and inflamed and causing symptoms.

Make sure your GP makes a note of any changes to the medicines your child needs to take on their asthma action plan.

 

Last updated January 2018

Next review due July 2019