Picking the Right Asthma Medication for Children

You thought it was just a persistent chest cold. Kids get colds, right? And some times they just hang on and on and on… but now the pediatrician is sitting here telling you that your child doesn’t have a cold that won’t quit. He has asthma.

Take a deep breath and consider – this is something that your child has trouble doing. And it’s not just him. Over the past twenty years or so, the rates of asthma in children have risen so quickly that many health experts refer to it as an epidemic. The bad news is that your child has a chronic condition that will require long-term treatment and will affect almost every other area of his life. The good news is that asthma is among the most researched health conditions in the world today, and there are new avenues of treatment opening up all the time.

Just twenty years ago, most people – medical professionals included – thought of asthma as something like a sleeping dog. It just lay there until something woke it up – and then it got dangerous. Treatment generally consisted of avoiding triggers – don’t wake the dog up! – and hitting it with a bronchodilator when it did wake up. Doctors now understand far more about the mechanics of asthma. These days, treatment for asthma is a multi-pronged approach. In most cases, the doctor will still prescribe a bronchodilator – sometimes called a ‘rescue inhaler’ – for treatment of those acute ‘I-can’t-catch-my-breath’ moments.

He’s also likely to prescribe a ‘maintenance’ medication to help control the inflammation that triggers asthma attacks. These ‘maintenance’ meds come in two basic flavors – inhaled corticosteroids (ICS) and leukotriene receptor antagonists. Essentially, ICS are anti-inflammatory. They act directly on the bronchioles and bronchial passages to reduce inflammation and keep the air passages open. Leukotriene receptor antagonists block the production of leukotrienes, substances in the lungs that cause narrowing and swelling of the airways. The National Asthma Education and Prevention Program lists corticosteroids as the treatment of choice, with leukotriene antagonists as one of several alternative therapies.

The truth is, however, that different children react differently. Some do far better using ICS daily, while others have better results from the leukotriene inhibitors. Until recently, the problem has been that deciding which child should get which medication was a matter of trial and error. Many parents simply accepted the medication that the doctor gave them and never thought to go back and say ‘This isn’t doing the trick’. All that may change in the near future, thanks to a study from the Childhood Asthma Research and Education Network. It found that there are ways to predict which children will do better on one type of medication or other.
Researchers found that children who had low lung function and high inflammation did especially well on inhaled corticosteroids. Younger children who had had asthma for a shorter period of time showed better results with the leukotriene receptor antagonist. For children that fit neither category, they suggest a trial with each medication to see which works best for each individual child.