Pediatric Asthma Protocols

Pediatric Asthma Protocols
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What is Asthma?

Imagine if you felt like you had an elephant sitting on your chest? This is the sensation children have along with breathing difficulty when they have asthma. With asthma, the bronchial tubes spasm (get narrow) and the mucus membranes swell. Some attacks are brought on by allergies and others are triggered from environmental irritants. According to the American Academy of Pediatrics, “asthma is the most common lasting disorder in childhood currently affecting around 6.2 million Americans under 18 years of age.” Early diagnosis and pediatric asthma protocols are of utmost importance - some children have asthma as infants and toddlers. If a child shows any type of breathing problems, it’s time to see a doctor immediately.

Symptoms and Diagnosis of Pediatric Asthma

Although asthma symptoms can be the same for children and adults, make note of any of these symptoms your child may have and report these to your doctor.

  • Coughing
  • Wheezing
  • Difficulty breathing
  • Recurring upper respiratory infections and/or pneumonia

Children show signs in different ways. An infant may have problems breathing while taking a bottle during feeding. Toddlers may cough and become out of breath while trying to run during play. For many children, asthma attacks will become more noticeable if they have a cold or other respiratory infection.

Doctors can sometimes diagnose a child with asthma from listening to the chest, although diagnosing young children is difficult. Older children can do simple breathing tests such as spirometry or peak flow measurements, which help give doctors specific criteria to work with. The Mayo Clinic states there is a newer test available that measures nitric oxide levels in a child’s breath. They claim that higher levels of nitric oxide can mean that a child’s lungs are not working to capacity and the asthma is not under control.

How Can Doctors Treat Asthma in Children?

Doctors like to use the “step” program when using medications to treat a child’s asthma. They treat the symptoms with medications at a dose that produces symptomatic relief with the least amount of side effects. Sometimes this medication needs to “step up” to a higher dose or an additional one is added. When the asthma symptoms are well controlled, the doctor may take a “step down” by reducing doses.

Maintenance medications are used daily to prevent bronchial spasms and keep asthma under control. These are considered long-term protocol, however, some children only need to use these medications seasonally. Treating asthma is an individual approach.

Inhaled corticosteroids are anti-inflammatory drugs that are commonly used in children, as well as adults. Such products as budesonide (Pulmicort), fluticasone (Flovent), triamcinolone (Azmacort), and beclomethasone (Qvar) are well known drugs and used with children. These medications can be dispensed in nebulizers (fine mist that is inhaled) or the canisters can be inhaled through spacers (plastic hollow tube that holds the medication) for a better inhalation.

Montelukast (Singulair) and zafirlukast (Accolate) are sometimes added to the inhaled corticosteroid as leukotriene modifiers (leukotrienes in the body can cause inflammation) to help bring down asthma symptoms due to allergies and irritants.

Cromolyn is another anti-inflammatory drug that needs to be taken several times a day along with the inhaled steroid.

Theophylline is a pill that opens up the airways and relaxes the muscles to make breathing easier. This drug needs to be taken several times a day. This is an older therapy for asthma and not prescribed as much today.

Rescue medications, also called short-acting bronchodilators, will provide immediate breathing relief for people with asthma. These will keep the asthma symptoms under control for 4-6 hours. Albuterol is the most common drug, although newer levalbuterol (Xopenex) and pirbuterol (Maxair) are also used with children. Rescue inhalers work wonders, but the asthma will come back unless the child is using the maintenance medications above for daily control. If the child is using rescue inhalers too often, then the asthma is not under control and this warrants a visit to the doctor.

If the child has been diagnosed with allergies, which is causing asthma, allergy-desensitization shots (immunotherapy) can be given usually once a week. The child is given a series of injections containing small amounts of the allergen for months and even years in hopes of ridding of the allergy which may be causing the asthma symptoms.

Pediatric asthma protocols have helped many children and working with your doctor to set goal plans is the best route to success. Prognosis is good for young children who follow asthma protocols as many become asymptomatic by the time they reach adulthood. On the other hand, children who get asthma onset during their teen years may carry this persistent disorder with them through life.


“Asthma in Children Under 5” (Mayo Clinic)

“Treatment of Childhood Asthma” (American Academy of Pediatrics)

Diseases of the Human Body - 4th Edition by Carol D. Tamparo & Marcia A. Lewis [F.A. Davis Company, 2005] pps.246-247

Photo credit: Flickr CC by Viralbus