Kids and Asthma: The Best Medicine

Childhood asthma has been diagnosed in some 6.2 million children and is “the most common chronic disorder in children,” according to the American Lung Association.

Still, millions more may be infected with “hidden asthma.” Many cases go undiagnosed because “wheezing” is commonly considered the main symptom of the disease. Meanwhile, coughing is often overlooked, but “any child who has frequent coughing or respiratory infections should be evaluated for asthma”, says the American Lung Association.

Once diagnosed, parents should be aware that although the underlying inflammation is always present, asthmatic attacks are often triggered by environmental factors. Second-hand smoke is considered the main factor that not only triggers attacks, but also worsens the inflammatory condition itself.

It is important for parents to monitor exactly when an attack takes place, and what could have triggered it. This knowledge can help the child and the parents effectively control the symptoms and prevent future episodes.

Triggers parents should be vigilant for include respiratory infections, colds, pollen, mold, animal dander, feathers, dust, certain foods, sudden temperature change, cigarette smoke, and even excitement, exercise, or stress.

There is no cure for asthma, but there are various types of medications available that can help manage asthma and prevent or diminish the number of attacks. When lifestyle adjustments are coupled with appropriate treatments, most children can lead normal and active lives.

In a recent article for the Journal of the American Academy of Asthma, Allergy and Immunology, Dr. Stanley Szefler said, “initial treatment should be based on assessment of asthma severity, but subsequent treatment based on level of control.” It is not uncommon that a particular type of medication will work well at first, but eventually needs to be switched for another.

Because asthma is a condition that is triggered by a wide array of environmental factors, a number of different medications exist to address each one. Every case of childhood asthma is unique and the combination of treatment options should be developed with each child’s characteristics in mind.

For example, children with exercise-induced asthma respond best to “mast cell stabilizers.” These are a class of drugs that can be inhaled and prevent the substance responsible for irritation and inflammation from being released into the lungs.

Intal and Tilade are used for this purpose, and have very few side effects. Compared to the side effects associated with the oral steroids, the bad taste and dry throat sometimes experienced with these drugs is relatively insignificant.

The most frequently used types of asthma drugs used are anti-inflammatory medications. Although these do not treat the symptoms of an asthma attack, they are effective at preventing episodes and reducing their frequency.

Anti-inflammatory medications reduce mucus production and swelling of the airways, making the lungs less sensitive and less reactive to common asthma triggers. Some of the inhaled corticosteroids currently available include Advair, Aerobid, Azmacort, Flovent, Pulmicort, and Qvar.

The main benefit of these medications is that they have very few side effects, especially when used at low doses. High doses of the drug sometimes cause a type of yeast infection in the mouth, which is easily treatable.

According to the American Academy of Asthma, Allergy and Immunology, a new study shows that inhaled corticosteroids may be the most effective form of treatment. Corticosteroids reduce the frequency of asthma attacks and improved lung function, which in turn reduces the need for beta-agonist bronchodilators to treat the symptoms during the episode.

Some of the inhaled medications, including Advair, contain additional compounds aside from corticosteroids. Recently, some of these drugs have been ordered by theFDA to contain a “black box warning” because in rare cases they can actually worsen the asthma attacks and cause asthma-related death. Although the list of possible side effects is extensive and most are not considered serious, the benefits experienced with these drugs more often than not outweigh the risks in severe cases of childhood asthma.

Oral and intravenous medications exist to control severe cases of asthma, but are also paired with more severe side effects. Some of these medications include Medrol, Methylpred, Solu-Medrol, Deltasone, Prelone, Pediapred, and Orapred.

The side effects associated with oral and intravenous medications occur after months or years of use, and ideally are used on a short-term basis. This avoids long term side effects such as acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes, and slowing of growth.

Although controlling asthma is a priority for all parents who have asthmatic children, treating the symptoms when an attack occurs is equally important. Inhaled or oral steroids do not provide relief during these episodes, and therefore a bronchodilator is often prescribed. This is a class of drugs that relieves an asthma attack by dilating the airways and relaxing the bronchial smooth muscle.

Another class of drugs that relaxes the smooth muscles in the airways is the leukotriene modifiers. These are sold under the names Accolate and Singulair, and block a natural chemical in the body called leukotriene. These chemicals cause tightening of the airway muscles and production of mucus and fluid.

By using these drugs, the chemicals cannot carry out their normal function and thus help reduce asthma symptoms. The side effects of these drugs are also relatively mild and include headache and nausea. They also can interfere with other drugs. To prevent serious complications, parents should always make sure to disclose any other medication (whether over-the-counter or prescribed) a child is taking.

Clear communication with your pediatrician is the key to helping you and your child decide what the best course of action is, and help your child breathe easier. health writer Christine Buske contributed to this report.

Click here to check out Dr. Manny's book The Check List (Harper Collins, 2007), from which this article was excerpted.

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.

Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny's work, visit