How is asthma treated in children?

Doctors use the latest guidelines to prescribe treatment for your child's asthma.

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

Your child’s GP or asthma nurse will prescribe your child treatment based on the latest national guidelines for asthma care. They’re updated every two years by the medical experts from the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) and state the aim of treatment is to manage your child’s asthma so that: 

  • They get no daytime symptoms
  • They get no night-time waking due to asthma
  • They have no need for rescue medicines (their blue reliever inhaler)
  • They have no asthma attacks
  • Asthma doesn’t limit their daily life (including school or exercise) 

When asthma symptoms happen, the tubes that carry air in and out of your child’s lungs are sensitive and inflamed. Taking the right medicines in the right way will reduce that inflammation and sensitivity so your child is less likely to get symptoms.

When your child starts treatment

When your child’s GP or asthma nurse is working out which medicines are best to treat your child’s asthma or suspected asthma, they will use an approach recommended in the BTS/SIGN guidelines. 

Making sure your child is always on the right treatment

The idea is that asthma treatment is like a staircase, and your child can move up or down a step depending on their symptoms. The goal is always to make sure their asthma is as well managed as it can be using the lowest doses possible. So at different times of your child’s life, or even at different times of the year, their GP or asthma nurse can move them up or down a step.

Stepping up

Stepping up means increasing your child’s medicines dose or changing the type of medicine they’re taking or increasing how often they take it.

Before moving your child up a level, their GP or asthma nurse will check to make sure they’ve been

If you need help getting into a good routine with your child’s medicines, getting their inhaler technique just right, or working out what your child’s triggers are, it may be that your GP or asthma nurse will help you with this rather than stepping your child up.

Stepping down

Stepping down means reducing your child’s medicines dose or changing the type of medicine they’re taking or decreasing how often they take it.

Before moving your child down a level, their GP or asthma nurse will consider:

  • what symptoms they’re 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 most likely to be moved down a step if their asthma has been well managed and they’ve had no symptoms for at least three months. 

If your child is moved down a step, you will be asked to keep an eye on their symptoms. If you notice that any symptoms come back (for instance, they’re using their reliever inhaler more often than usual; their coughing, wheezing or feeling breathless; they’re waking up at night; their peak flow drops or becomes more variable) make an appointment straight away to see their GP or asthma nurse. They may need to move back up a level so the medicines can stop their airways being so sensitive and inflamed and causing symptoms.

Your child’s treatment can be changed at an asthma review

Even if your child’s symptoms are well managed, it’s important to book in an asthma review for your child at least once every six months. This is so your GP or asthma nurse can see how they’re doing and move them up or down the levels of treatment if necessary.

Your child’s treatment can be changed at any time

You don’t have to wait for your child’s next review before booking in to see their GP or asthma nurse. For instance:

  • if you notice your child’s asthma symptoms are getting worse (for instance, they’re using their blue reliever inhaler more often than usual; they’re coughing, wheezing or feeling breathless; they’re waking up at night; their peak flow drops or becomes more variable) book an extra appointment. Their GP or asthma nurse may increase (step up) your child’s medicines dose.
  • if your child hasn’t had any asthma symptoms for at least three months, book an extra appointment. Their GP or asthma nurse may consider reducing (stepping down) their medicines.

The different levels of asthma treatment (for children age under five)

Level one

  • symptoms are usually mild and occur on average less than twice a week
  • treatment is usually a short-acting reliever inhaler to open the airways quickly for on-the-spot relief when symptoms occur
  • If your child is using their reliever inhaler three times a week or more, or has had an asthma attack in the last two years, speak to their GP or asthma nurse to see whether their treatment needs changing.  

Level two

  • symptoms should be rare, if any at all  
  • treatment is usually a daily preventer inhaler to reduce the sensitivity and inflammation in the airways so symptoms are less likely, and your child’s airways are less likely to react to any triggers  or, if the preventer inhaler cannot be used, your child will probably be prescribed leukotriene receptor antagonists (these are sometimes called LTRAs or preventer tablets)
  • your child will also be given a short-acting reliever inhaler for when symptoms occur 
  • if your child is using their reliever inhaler three times a week or more, speak to their GP or asthma nurse to see whether their treatment needs changing. 

Level three

  • treatment is usually a daily preventer inhaler and sometimes leukotriene receptor antagonists as well
  • your child will also be given a short-acting reliever inhaler for when symptoms occur
  • if your child is using their reliever inhaler three times a week or more, speak to their GP or asthma nurse to see whether their treatment needs changing. 
  • if your child is younger than two, or symptoms are persistent, your GP or asthma nurse will probably refer you to a paediatric consultant and team who specialise in asthma care

Level four

  • treatment is usually a daily preventer inhaler and leukotriene receptor antagonists as well
  • your child will also be given a short-acting reliever inhaler for when symptoms occur
  • care is usually provided by a paediatric consultant and team who specialise in asthma care

The different levels of asthma treatment (for children age five to 12)

Level one

  • symptoms are usually mild and occur on average less than twice a week
  • treatment is usually a short-acting reliever inhaler to open the airways quickly for on-the-spot relief when symptoms occur
  • if your child is using their reliever inhaler three times a week or more, speak to their asthma nurse or GP to see whether their treatment needs changing. 

Level two

  • treatment is usually a daily preventer inhaler to reduce the sensitivity and inflammation in the airways so symptoms are less likely, and your child’s airways are less likely to react to any triggers  
  • your child will also be given a short-acting reliever inhaler for when symptoms occur
  • if your child is using their reliever inhaler three times a week or more, speak to their GP or asthma nurse to see whether their treatment needs changing.  

Level three

  • treatment is usually a daily preventer inhaler
  • your child will also probably be prescribed a long-acting reliever inhaler (this can be prescribed as a separate inhaler or as a combination inhaler in the same device as the daily preventer inhaler)
  • your child will also be given a short-acting reliever inhaler for when symptoms occur
  • add-on therapies and a slightly higher dose of steroids may be prescribed as needed
  • if your child is using their reliever inhaler three times a week or more, speak to their GP or asthma nurse to see whether their treatment needs changing. 

Level four

  • treatment is usually higher doses of a daily preventer inhaler
  • your child will also probably be prescribed a long-acting reliever (this can be prescribed as a separate inhaler or as a combination inhaler in the same device as the daily preventer inhaler
  • your child will be given a short-acting reliever inhaler for when symptoms occur
  • add-on therapies and a much higher dose of steroids may be prescribed as needed
  • if your child is using their reliever inhaler three times a week or more, speak to their GP or asthma nurse to see whether their treatment needs changing. 

Level five

  • symptoms are usually more serious and/or more frequent
  • care is usually provided by a paediatric consultant and team who specialise in asthma care
  • treatment is usually higher doses of a daily preventer inhaler
  • your child will also probably be prescribed a long-acting reliever (this can be prescribed as a separate inhaler or as a combination inhaler in the same device as the daily preventer inhaler
  • your child will also be given a short-acting reliever inhaler for when symptoms occur
  • after more tests, add-on therapies and long term steroid tablets will be prescribed as needed

 Last updated October 2016