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Treatment Options for Persistent Asthma

written by: AngelicaMD • edited by: Diana Cooper • updated: 3/28/2011

Asthmatic children and adolescents may experience symptoms that occur more than a few times in a week with nighttime attacks and flare-ups. The frequency and severity of symptoms may vary depending on consistency of treatments. Learn more about persistent asthma treatment to prevent complications.

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    Symptoms of Persistent Asthma

    Asthma is the leading cause of chronic illness in children, affecting 10 to 12 percent of them in the United States. Inflammation of the bronchial tubes (the airways) and production of lots of sticky mucus in the airways result in frequent coughing, wheezing and shortness of breath. They may also feel fatigue, anxiety and difficulty in sleeping at night. Affected children usually develop these symptoms by the age of 5 and may be unrecognized as symptoms of asthma until later, when the child easily becomes tired or experiences them at night and after exercise. Sometimes the symptoms are attributed to colds, flu or allergies, but when they occur more often than two times a week with flare-ups at night, they may be suffering from persistent asthma.

    Diagnosis of persistent asthma is made according to the frequency and severity of symptoms and confirmed by pulmonary (lung) function tests.

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    Treatment for Persistent Asthma

    Asthma is a chronic disease that is characterized by frequent exacerbations of symptoms that may be triggered by allergens, exercise and other events. As such, the goals of treatment are to provide long lasting maintenance medications and symptomatic relief for exacerbations or asthma attacks.

    Persistent asthma treatment may therefore be classified into two categories: long term control and symptomatic or quick-relief treatment.

    Long term control or maintenance medications are important to prevent permanent lung damage and dysfunction, to improve the quality of health and life of the patient and to prevent serious asthma attacks. Since the mechanism by which asthma symptoms develop involves chronic inflammation of the airways and mucus production, these are prevented by giving anti-inflammatory drugs that reduce swelling and mucus secretion in the airways. These drugs last for several hours (up to twelve) and include:

    • inhaled corticosteroids like budesonide and beclomethasone
    • inhaled cromolyn or nedocromil
    • long-acting bronchodilators like theophylline, beta-agonists and anticholinergics
    • leukotriene antagonists
    • omalizumab - for older children with moderate-to-severe asthma triggered by seasonal allergens despite inhaled corticosteroids and oral steroids

    Inhaled medicines may be given through nebulizers for kids younger than 3 years old and by metered-dose inhalers for children who can be trained to use them. The drugs may also be used in combinations to ensure adequate control of symptoms.

    Symptomatic and quick relief may be given for acute exacerbations like shortness of breath or wheezing in the form of short-acting bronchodilators like albuterol. These act within minutes after inhalation and lasts for 2 to 4 hours. If the child uses this drug more than twice a week he might need long-term control therapy. When the asthma attack is severe one can be given oral corticosteroids like prednisone, although this may take a longer time to work and must not be taken for more than two weeks. Inhaled ipratropium is another medication that may be given for serious or worsening asthmatic attacks.

    Treatment of persistent asthma should follow a stepwise approach as advised by a physician. Parents, caregivers and patients must be educated on the proper ways to avoid asthma triggers, to maintain proper medication and to anticipate attacks. Symptoms of asthma may vary in different individuals and the severity may also fluctuate within an individual. Therefore, therapy may vary according to the progression of symptoms. Constant evaluation and follow-up with their physicians may be necessary to monitor effectiveness of therapy and prevent chronic lung disease.

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    References

    UMMC, “Asthma in children and adolescents – Treatment”, http://www.umm.edu/patiented/articles/what_general_guidelines_treating_asthma_000005_7.htm

    WebMD, “Treatment of Asthma”, http://firstaid.webmd.com/asthma-in-children-treatment