If the child has persistent asthma (more than one episode a month) or severe attacks of asthma (requiring admission to hospital) the aim of management should be to prevent these acute attacks. These children should be referred to an asthma clinic for chronic maintenance management if possible. The aim of treatment is to allow the child to have a good quality of life, i.e. play sport, attend school normally and sleep well. Treatment requires the use of both anti-inflammatory and bronchodilator drugs.
The treatment of persistent asthma:
- In mild persistent asthma (with repeated mild episodes of cough and wheezing which occur once or twice a week) a low daily dose of inhaled corticosteroid (‘prevention’ therapy e.g. beclomethasone 100–200 μg) should be given in addition to the short acting bronchodilator. Inhaled steroids are very effective and safer than oral steroids. Inhaled steroids should be used with a spacer. Rinse out the mouth after inhaling the steroid to avoid excessive absorption.
- Moderate persistent asthma requires higher doses of daily inhaled steroids (e.g. beclomethasone 200–400 μg).
- In severe persistent asthma, oral steroids may be needed. These patients should be management by an asthma clinic at a regional or tertiary health centre.
- Short acting inhaled bronchodilators are needed in all patients with asthma and should be used when necessary. Use a spacer whenever possible.
Exercise-induced asthma can be prevented by inhaling a short acting bronchodilator 10 minutes before starting the exercise.
In severe or repeated attacks of asthma, daily treatment is needed to give the child as normal a quality of life as possible.
A long acting bronchodilator (beta 2 agonist) such as salmeterol, or sustained release oral theophylline, or a leukotriene antagonist may be added as a steroid sparing agent.