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.
“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.
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.
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 described below. 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 offered asthma treatment based on their symptoms.
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.
2. Preventer and reliever
Your GP will consider prescribing a preventer inhaler to use every day, even when your child seems well, if your child is having asthma symptoms or needing to use their reliever inhaler three times a week or more, or their symptoms are waking them up at night. This will soothe and prevent the inflammation in their sensitive 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), usually Montelukast. 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.
It’s important to review this treatment change in four to eight weeks to make sure it’s right for your child.
“There have been reports of children taking Montelukast having side effects such as nightmares, sleepwalking, anxiety, depression or irritability,” says Dr Andy Whittamore. “If you notice any of these changes in your child, talk to your GP as soon as possible.”
4. Long-acting bronchodilator
If the LTRA add-on therapy isn’t helping, your GP can consider stopping it and starting a long-acting bronchodilator 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 bronchodilator every day, their GP may consider trying them on the MART regime. This is where a combination inhaler can be used as both a preventer and reliever inhaler and there’s usually no need to use a separate reliever inhaler.
Referral to asthma specialist for more support
If their asthma 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.
“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 or message them via WhatsApp on 07378 606 728 (Monday-Friday, 9am-5pm).
Last updated September 2019
Next review due September 2022