Childhood Asthma

Did you know that asthma is the most common chronic pulmonary condition in children? Poorly managed and undiagnosed asthma in young children can lead to visits to the emergency room, hospital stays, missed workdays for parents and suffering that many young children can’t express.
What is asthma?
Asthma Symptoms
Diagnosis
Treatment

What is asthma?

Asthma is a common chronic (long term) inflammatory illness of the lungs and airways. It causes respiratory symptoms, limitation of activity, and attacks that sometimes require urgent health care and may be fatal. During an asthma attack the airways get more irritated than normal, swell up, fill with mucus and get smaller in reaction to certain triggers.

Different kids have different triggers, a few examples are pollen, dust mites, pets, smoke, pollution and exercise. During an asthma attack, a child may experience trouble in breathing, wheezing, chest tightness or coughing. Asthma can be mild, moderate or severe and sometimes, life-threatening. While there is no cure for the disease, asthma can be controlled with proper medication and education, allowing children to live a free and active life.1

1Global Initiative for Asthma - GINA. 2020. Faqs - Global Initiative For Asthma - GINA. [online] Available at: <https://ginasthma.org/about-us/faqs/> [Accessed 15 October 2020].

Asthma Symptoms

Not all children have the same asthma symptoms. A child may even have different symptoms from one episode to another. Signs and symptoms of asthma in children include:2

2WebMD. 2020. Childhood Asthma. [online] Available at: <https://www.webmd.com/asthma/children-asthma> [Accessed 15 October 2020].

A cough that doesn’t go away (which may be the only symptom) Coughing spells that happen often, especially during play or exercise, at night, in cold air, or while laughing or crying. A cough that gets worse after a viral infection Seesaw motions in their chest (retractions)
Less energy during play, and stopping to catch breath during activities Avoiding sports or social activities Trouble sleeping because of coughing or breathing problems Shortness of breath
Chest tightness or pain Wheezing, a whistling sound when breathing in or out Tight neck and chest muscles

Diagnosis

A diagnosis of asthma is based on:

  • Child’s medical history: information such as what signs and symptoms of asthma they have had
  • Family medical history: has anyone they are related to had asthma or related conditions such as occur with those who are atopic
  • Physical examination and testing

There is no specific test that can tell if a child has asthma, however there are tests that can help in the diagnosis when the results are considered along with the medical and family history and physical exam. Diagnosing kids presents unique challenges, especially when they are very young. Children who are preschool age or younger may not be able to complete the airflow test, which requires blowing very hard into a tube and infants and toddlers can’t describe how they feel.

This makes it especially important for parents, other family members and caregivers to know the symptoms of asthma in kids and to be alert for symptoms and talk to a doctor.3

3Saglani S, Menzie-Gow AN. Approaches to Asthma Diagnosis in Children and Adults. Front Pediatr. 2019;7:148. Published 2019 Apr 17. doi:10.3389/fped.2019.00148

Treatment

Asthma medications are divided into 2 groups:

1. Quick-Relief Medications:
Quick-relief medications are for short-term use and should be taken only during an asthma attack. They open up narrowed airways and help relieve the feeling of tightness in the chest, wheezing, and breathlessness. These medications are taken only on an as-needed basis.4

2. Controller Medications:
Asthma is characterized by a chronic inflammation of the airways, when it becomes more narrow, making it hard for air to move in and out. It happens because there is a tightening of the muscles surrounding the these airways, causing swelling and extra mucus, which all add to the narrowing, which is called obstruction.5

Controller medications are used on a daily basis to treat this inflammation, thus controlling asthma and reducing the number of days or nights that your child has symptoms, as well as the risk of asthma attacks.

Most common controller medications include:6

  • Inhaled steroids
  • Leukotriene receptor antagonists
  • Oral steroids (prescribed only for severe asthma)

Inhaled corticosteroids are the preferred controller medication for all ages. When used in the recommended doses, they are safe for most children. However, the child’s doctor may recommend another type of controller medication based on the specific needs of the child.7

4Everettclinic.com. 2020. Pediatric Asthma | The Everett Clinic. [online] Available at: <https://www.everettclinic.com/medical-departments/pediatrics/pediatric-asthma> [Accessed 15 October 2020].
5Chop.edu. 2020. Asthma | Children’s Hospital Of Philadelphia. [online] Available at: <https://www.chop.edu/conditions-diseases/asthma> [Accessed 15 October 2020].
6Mayo Clinic. 2020. Treating Asthma In Children Ages 5 To 11. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/childhood-asthma/in-depth/asthma-in-children/art-20044383> [Accessed 15 October 2020].

Myths vs Facts

Asthma is one of the most common chronic childhood conditions, but there are still many myths
and misunderstandings about it. Read on for the most common myths and why they need busting.

1. Children with asthma shouldn’t exercise. MYTH

As long as their asthma is controlled, there is no reason children with asthma can’t be physically active.7
Did you know, there are a whole host of sports stars that suffer from asthma or asthma-related conditions? In fact, it has recently been reported that the condition is more common amongst elite athletes (especially those competing in endurance activities) - around 21 to 25% of top performers suffer from asthma, compared to 9 to 10% within the general population.

2. Asthma is treatable. FACT

What we most want is for children with asthma to lead healthy, normal lives. And here’s the thing: this is possible. We can work to avoid and manage triggers and there is medication that helps prevent and relieve symptoms.

3. Inhaled corticosteroids are the same as anabolic steroids. MYTH

One common misconception is that inhaled corticosteroids are the same as anabolic steroids that athletes use to help build muscle and increase strength and stamina. Corticosteroids do not do either of these things, they are hormones produced naturally by the body. When warranted, the doctor will prescribe a much smaller amount of corticosteroid to help reduce the inflammation in the lungs and keep asthma under control.8

4. Asthma medication is needed only when a child feels sick. MYTH

Asthma is a chronic inflammatory disease of the airways, therefore, no inflammation goes away just because the symptoms went away. Some medications, called controllers, need to be taken daily to control the inflammation present in the lungs of asthmatic people. If your child needs daily controller asthma medication, but does not always take it, asthma symptoms can worsen and may cause a serious asthma attack. That’s why you should always keep track and take care of your childs treatment.

5. Inhaled steroids used to treat asthma will stunt my child’s growth. MYTH

If used properly, inhaled steroids do not affect your child s growth. Inhaled steroids acts local, directly to on the lungs. Many parents are concerned about the side effects that a daily controller treatment with inhaled corticosteroids may have. Ironically, the available evidence suggests that perhaps the greater harm to children with asthma arises from the avoidance of the use of inhaled corticosteroids when they are needed. Avoidance of inhaled corticosteroid therapy has been observed to lead to a poorer growth as result of poorer asthma control.9

A poorer asthma control evolves to a persistent asthma, which may lead to a reduced growth in lung function, and some are at risk of accelerated decline in lung function in early adult life.10

6. Nebulization cannot be used in infants and young children. MYTH

Nebulization is an effective method to deliver medicines to the lungs and airways in infants and young children. In young children, inhaling through a nebulizer can be easier than other devices. Also, smaller doses of medicine are required compared with oral medicines, thereby reducing the risk of side effects.11

7. There is more than one type of asthma. FACT

Allergic (extrinsic) Asthma is triggered by an allergic reaction to an inhaled substance such as dust, pollen, mold, chemicals, animals, etc. 90 percent of asthma cases are caused by extrinsic asthma. Non-allergic (intrinsic) Asthma is triggered by factors not related to allergies such as exercise, anxiety, depression, cold air or dry air, etc. The symptoms of both are the same: coughing, wheezing, shortness of breath, rapid breathing, and chest tightness.12

8. My child will never lead a normal life because of his/her asthma. MYTH

Even though there is no cure for asthma, it can be controlled. Children with well-controlled asthma are able to participate in most activities without limitations and live an active and normal life.13

7Asthma UK. 2020. Help Your Child Stay Active | Asthma UK. [online] Available at: https://www.asthma.org.uk/advice/child/life/exercise/ [Accessed 15 October 2020]

8What Are the Differences Between Inhaled and Oral Corticosteroids?. Verywell Health. https://www.verywellhealth.com/the-difference-between-inhaled-oral-corticosteroids-200612#. Published 2020. Accessed November 4, 2020.

9Pedersen S. Do inhaled corticosteroids inhibit growth in children?. Am J Respir Crit Care Med. 2001;164(4):521-535. doi:10.1164/ajrccm.164.4.2101050
10McGeachie MJ, Yates KP, Zhou X, et al. Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma. N Engl J Med. 2016;374(19):1842-1852. doi:10.1056/NEJMoa1513737.

11Healthline. 2020. Nebulizers For Babies: How They Work. [online] Available at: <https://www.healthline.com/health/nebulizer-for-baby> [Accessed 15 October 2020].

12Medicalnewstoday.com. 2020. Intrinsic And Extrinsic Asthma: Causes, Symptoms, And Treatment. [online] Available at: <https://www.medicalnewstoday.com/articles/325536> [Accessed 15 October 2020].

13Who.int. 2020. Asthma. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/asthma> [Accessed 15 October 2020].

Daily Care

Asthma is a chronic inflamatory disease that is episodic, meaning that symptoms can come and go. The good news is that you can find support to help you manage your child’s asthma and create asthma-friendly environments so he/she can live an active and healthy life.
Have an Action Plan
Asthma-Proof Your Home
Safety at daycare/nursery or school
Guide to use a Jet Nebulizer

1. Have an Action Plan

An asthma action plan has all the information you need in one place so you can look after your child’s asthma well. The goal is to reduce or prevent asthma attacks and emergency department visits. It only takes a few easy steps to get started:

  1. Download a child asthma action plan here (Download button for PDF).
  2. Book an appointment with your child’s doctor.
  3. At the appointment talk through the plan with your child’s doctor and fill it in together.
  4. Ask your child’s doctor for a copy so you can always have it in hands.
  5. Share your child’s action plan with friends, family, teachers and caregivers.

2. Asthma-Proof Your Home

An asthma trigger is anything that irritates the airways that causes or worsens asthma symptoms, even leading to an asthma attack by the increase of inflammation in the airways. These triggers are a part of everyday life. By identifying and eliminating triggers, you are taking an important step toward managing your child’s asthma. But avoiding asthma triggers is not always easy. If your child’s airways are already inflamed, they will be more sensitive to these airborne allergens and irritants and will respond to smaller amounts of them.

To help you learn more about your child’s asthma triggers, download the Asthma Triggers: What to Know and What to Do (Download for PDF).

3. Safety at daycare/nursery or school

Young children spend a significant part of their time at daycare/school. That is why it is so important that asthma symptoms are well managed while they are there. Use our school checklist of preventive measures to help reduce the risk of asthma-related sickness at school.

  1. Schedule an asthma check-up with your child’s doctor.
  2. Ensure your child’s asthma prescriptions have enough refills available and have not expired.
  3. Meet with your child’s daycare nurse and teachers, discuss specific triggers and typical symptoms, give them a copy of your child’s asthma action plan and make sure the daycare or school has your emergency contact details.
  4. Go over good hygiene habits, encourage them to wash their hands regularly, avoid touching their eyes, nose or mouth, and avoid sharing their inhaler with others.
  5. Ask the doctor whether your child should get the annual flu shot before daycare or school starts.

4. Guide to use a Jet Nebulizer

Before using a nebulizer with your child, remember to read all the instructions. You can also download a Parent’s Guide to Jet Nebulizing we’ve prepared with tips from parents like you on how they made nebulizing easier. You can also share this guide with your family members, teachers, day care providers or babysitters, making sure they are comfortable with using a jet nebulizer is important. If you have any questions about how to use a nebulizer, contact your child’s doctor or the manufacturer.

Tips for kids

Managing asthma in children under 5 years old can be difficult. Sometimes your child may be frustrated, angry or sad because they need to cut their usual activities to avoid the triggers. Treatment with nebulizers can also bring difficulties, babies and young children may be frightened by the appearance and noise of the device, but there are tricks that can make the whole process more pleasant for them. Here are some tips that can help you keep asthma under control so your children can feel better and live a more healthy and active life.
How can I treat my child’s asthma at home?
What can I do to help my child’s asthma?
What can I do to help my child sleep better?
What to pack when travelling.

How can I treat my child’s asthma at home?

1. Making nebulization a special experience:
- Make the mask special by decorating it with cheerful makeup or stickers, and give the nebulizer a fun name.
- Role Play: pretend with your child that he or she is a firefighter, astronaut, pilot, or alien once the mask goes on and play along during treatment.
2. Make your child more involved in the treatment process:
- If possible, involve them in the choosing process. There are several kid-friendly models of nebulizers.
- Let your child be “in charge” of nebulizing by putting on the mask or turning the machine on and off.
3. Make treatment part of the routine:
- Use the nebulizer at the same time each day so that your child knows what to expect.
- Try nebulizing as part of the morning routine between eating breakfast and brushing your child’s teeth.

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What can I do to help my child’s asthma?

- Monitor your child during activity and have rescue medication handy.
- Make sure your child knows the signs of an asthma attack and how to respond.
- If your child is in daycare or school or day care, make sure the nurse, teachers and coaches know about your child’s asthma, can recognize signs of an asthma attack, and can respond when needed.
- Make sure your child has a good warm up period of about 5 to 10 minutes of stretching and light activity before starting any vigorous activity. Cooling down is just as important and so is keeping your child well hydrated.
- Taking these steps will help your child to breathe easier and reduce the chances of having severe symptoms and asthma attacks.

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What can I do to help my child sleep better?

- Keep a clean bedroom environment.
- Make sure to change sheets regularly, wash bedding in hot water, and wipe down shelves, ledges or nearby furniture to minimize dust. Don’t let your child sleep in the same room with pets.
- Choose allergy-free linens. Make sure pillows have a cover and look for allergy-free materials.
- Sleep on a slight incline. Elevating the head 4-6 inches by adding blocks under the bed post can help with Gastroesophageal reflux disease (GERD) symptoms. Sleeping on an incline can reduce acid regurgitation.
- Use a humidifier. Keep the air moist in your child’s room with a humidifier.

If your child suffers from asthma symptoms at night regularly, call your child’s doctor to discuss adjusting their treatment plan. Sometimes oral medications used to manage asthma may also cause sleep disturbances. Be sure to discuss with your child’s doctor if your child experiences bouts of insomnia while taking an asthma medication.

Include fruits and vegetables in your child’s daily meals.Vegetables are loaded with vitamins and minerals that can help support healthy lung function. Broccoli, spinach, and squash are among the most nutrient-dense veggies because they are packed with vitamins and minerals like Vitamins C and E and bioflavonoids. Just like vegetables, fruits have the vitamins and minerals necessary for healthy lung function. Kiwi fruit is especially helpful when it comes to asthma because of its high levels of Vitamin C and apples, which contain a bioflavonoid called quercetin, can help reduce inflammation.

Keep your child hydrated.
Dehydration can lead to water retention and inflammation, both of which can aggravate asthma symptoms. Getting enough water helps the body run smoother and the lungs work better. Choosing water instead of juice or soda can also help kids avoid too much sugar.

Travelling with your kids.
Having asthma shouldn’t stop kids from enjoying a family vacation and sleepovers. With careful planning, they can get all the benefits of time away from home. Before you travel, make sure that your child’s asthma is well controlled. If it’s been getting worse, check in with the doctor. Your child might need a change in medicines or a visit with the doctor before going away.

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What to pack when travelling

Medicines:
Keep quick-relief medicine (also called rescue or fast-acting medicine) and long-term control medicine (also called controller, preventer or maintenance medicine) handy, not buried in the car trunk. If you’re flying, take them in your carry-on luggage.
That way, you’ll have them if needed during the flight or if your checked bags go astray. Time zone changes can be tricky. While traveling, try to have your child take medicines at the usual home time. Upon arrival in another time zone, adjust the dosage times to the local clock.
Nebulizer:
If your child uses one, you might want to get a portable version. Many of these can be plugged into a car’s accessory power outlet (or the cigarette lighter in older vehicles). If you’re traveling abroad, make sure you have the adapter you need to use it.
Peak flow meter:
if your child uses one.

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FAQ

Asthma is a common chronic disease associated to inflammation of the airways, which become narrower and extra-sensitive to irritants. Asthma symptoms include cough, wheezing, shortness of breath, and chest tightness, and may vary over time in frequency and intensity.1

The causes of asthma are not fully understood. Asthma is probably usually caused by a mixture of hereditary factors and environmental factors, but how these factors work together is still largely unknown. Allergens from house dust mites and pets are the most common causes, but many other allergens, such as pollen and moulds, can cause asthma. However, some patients with asthma have no confirmed allergies.2

Asthma tends to run in families, which means that the child more likely to develop asthma if someone in the family already has it. Children with eczema or food allergy are more likely than other children to develop asthma. Allergy to pollen, house dust mites or pets also increases the chance of developing asthma. Exposure to tobacco smoke, air pollution or other irritants can also cause asthma symptoms in those with an underlying tendency to asthma. The risk factors for childhood asthma include:3
  • Allergies or eczema
  • Family history of asthma
  • Low birth weight
  • Exposure to second-hand smoke before or after birth
  • Frequent respiratory infections
  • Gastroesophageal Reflux Disease (GERD)

Most children who experience breathing difficulties at a young age will never completely grow out of it, but more than 50 percent of children will see a decrease of asthma and allergy symptoms as they grow older. For children who have asthma attacks due to allergens, allergy shots or allergy medications may help reduce the number of acute breathing attacks.4

Children who have allergies to elements of the environment such as pollen, animals, mould, dust and food are more likely to have asthma. Asthma is more likely to develop in children who were born prematurely.4

No. Asthma medications are not addictive, and your child will not become “immune” to the beneficial effects by using them regularly. Asthma is different in every patient, and symptoms can change over time. The doctor will determine which asthma medication is best. At recommended doses, asthma medications are safe when used properly.5

Asthma can start at any age, although about half of all people with asthma have had their first symptoms by the age of 10, and many children with asthma have had their first asthma attack before the age of 6.4

If your kid has asthma and is allergic, you should not have a pet. If your child has asthma but no signs of allergy, plus not obvious symptoms from pets, it is probably all right to keep a pet in the family, but bear in mind that it will contribute to the amount of dust in the house.4

Asthma triggers are factors that can cause or worsen asthma symptoms, and even lead to an asthma attack by increasing the inflammation in the airways. The following triggers can cause asthma symptoms and/or start an asthma attack:6
  • infections, usually those caused by a virus (e.g. colds or flu)
  • exercise, especially in cold weather
  • emotions, such as excitement, fear or anger
  • chest pressure
  • laughing
  • food additives, such as tartrazine (an artificial food colouring), or food allergens, such as peanuts (sensitised or allergic individuals can have a very severe allergic reaction)
  • certain medications -some children may be allergic to some drugs (e.g. aspirin)
  • allergens:
Once your child is sensitised or allergic, both indoor and outdoor allergens, even small amounts, can cause asthma symptoms and attacks, as well as other allergic symptoms such as sneezing or a runny nose. It is therefore important to know whether your child’s asthma is caused or worsened by allergens. Repeated exposure to allergens may also be a cause of long-term (chronic) inflammation in the airways. Proper advice about which allergens and environments your kid should avoid can only be given after talking to the doctor and often after the child have been tested for allergies.

Also, many irritating particles or chemicals in the air can trigger an asthma attack. Examples include tobacco smoke, diesel exhaust, air pollution, perfume or other strong scents, household sprays, sulphur dioxide, grain or flour dust and sawdust.

Sudden weather changes (e.g. cold winds, humidity and storms) can too trigger asthma in some children. Some of these sudden changes can cause the release of allergens, such as pollen, that can make asthma worse in children whose asthma is allergy related. Cold air can also have a direct irritant effect on inflamed airways.

Well controlled asthma in children means all the following:
  • Decreased or no asthma symptoms (cough, wheezing or shortness of breath) on a day to day basis
  • No acute asthma episodes or attacks (including ER visits or hospitalizations)
  • Not requiring oral steroids (prednisone) more than once per year
  • No limitations on activities or school attendance
  • No more than twice a week use of quick acting rescue medicines.

Yes. Remember asthma is a chronic inflammatory disease of the airways, therefore, no inflammation goes away just because the symptoms went away. Some medications, called controllers, need to be taken daily to control the inflammation present in the lungs of asthmatic people. If your child needs daily controller asthma medication, but does not always take it, asthma symptoms can worsen and may cause a serious asthma attack. That’s why you should always keep track and take care of your child’s treatment.7

Many parents are concerned about the side effects that a daily controller treatment with inhaled corticosteroids may have. Ironically, the available evidence suggests that perhaps the greater harm to children with asthma arises from the avoidance of the use of inhaled corticosteroids when they are needed. Avoidance of inhaled corticosteroid therapy has been observed to lead to poorer asthma control, poorer growth (as result of poorer asthma control) increased morbidity and hospitalizations, and more frequent need for courses of treatment with systemic corticosteroids.

Apart from the (fortunately low) risk of dying from asthma, there is also a risk that lung function will deteriorate over the years. These risks make it important to assess whether your child’s asthma is really under control and to learn what treatment your child might need to help prevent permanent lung damage.8

If asthma is not well controlled, it leads to a slower growth, increased morbidity and hospitalizations, and more frequent need for treatment with systemic corticosteroids. Apart from the risk of dying from asthma (fortunately low), there is also a risk that lung function will deteriorate over the years. Daily controller therapy that contains inhaled corticosteroids helps controlling asthma in children and decreases the risk of poor controlled asthma effects.

Asthma symptoms typically come and go. Most common symptoms include trouble in breathing, chest tightness and wheezing or cough. These symptoms normally occur during physical activity and at night/sleep. Other common symptoms of childhood asthma are:1
  • Intermittent or frequent coughing spells
  • Chronic cough
  • Wheezing or whistling upon exhale
  • Shortness of breath
  • Chest tightness or pain
  • Weakness or tiredness
  • Delayed recovery after a respiratory infection

An asthma attack is a sudden worsening of asthma symptoms. In asthmatic children, the airways are inflamed. During an asthma attack, this inflammation gets worse, the muscles around the airways contract, and excessive mucus is produced, limiting the air that flows in and out of the lungs. When asthma is under good control, the airways are clear and air flows easily in and out.
Other indications that your child is suffering from an asthma attack:
  • Cannot complete a sentence without catching their breath
  • Widens the nostrils to get air
  • Use the abdominal or stomach muscles to breathe and is struggling to take a deep breath
If asthma is not treated, your child will have repeated attacks of asthma symptoms. Mild attacks can settle down without treatment, but treatment usually helps them to resolve more quickly.

Some causes and triggers are common to all people with asthma, and some are more individual, especially allergens (Read more in “What triggers asthma?”). There are very big differences between people in how readily and how severely they react to different triggers. The severity of the symptoms can differ in the same person at different times, and the effects of treatment can also vary. Asthma does not stay the same, but changes over time, and every child with asthma has good days and bad days (or longer periods). However, if asthma is properly treated, there can also be long periods without symptoms or attacks.6

When asthma is not under control, the airways become inflamed. Inflammation of the airways causes asthma symptoms (wheezing, breathlessness, chest tightness and coughing) by restricting or limiting the airflow to and from the lungs.1
  • The airways become red and swollen, which makes them narrower. This can often take several hours or days to develop and may take just as long to reverse after the asthma attack has passed.
  • Tightening of the muscles that surround the airways (also called bronchoconstriction) makes them even narrower. This tightening can happen very quickly, depending on the type of trigger and underlying inflammation.
  • The airways make more mucus, which can plug up or partly block the airways. The severity of the attacks can range from mild to severe.

If your child has an acute asthma attack, there are several steps you can take to ensure their health and safety. First, remain calm. Staying calm and level-headed will allow you to make the best decisions for your child. Second, have them use their medication according to the doctor’s instructions and help them calm down as much as possible, keeping calm can help keep their airway open. If your child cannot calm his or her breathing even after using medication, you should immediately call your local emergency number or go to the hospital.1

  • Symptoms that are rapidly becoming more severe and do not get better even with the reliever medication
  • Symptoms that do not improve at all, or rapidly return after taking he reliever medication
  • Difficulty talking because of shortness of breath.

The best way to manage your child’s asthma is to treat it preventatively with a controller medication. Regular check-ups with your child’s doctor will help stay on top of breathing problems. Knowing and avoiding your child’s asthma triggers, maintaining a healthy diet and exercise routine for your child, and reducing allergens or pollutants in your child’s environment will also help you managing your child’s asthma.
It is important to ensure your child maintains the doctor’s recommended medication regimen.7

Relievers or airway openers are medicines that provide rapid relief from an asthma attack by quickly opening the narrowed airways (dilating the bronchi). This makes it easier to get air in and out of the lungs. Most airway openers work quickly and can be used to treat an asthma attack. They can also be calledrescue bronchodilators. For children, most common airway openers are short-acting bronchodilators. The most widely used short- and quick-acting airway openers are salbutamol (also known as albuterol) and terbutaline.

People with asthma present chronic inflammation in the airways. Controllers are medicines that treat this chronic inflammation and prevent asthma attacks. The most common controller medicines are inhaled glucocorticosteroids, which reduce airway inflammation. if taken regularly as instructed by the doctor, controller medications help to prevent periods of greater severity of asthma. They may relieve your child of symptoms completely for most of the time as well. If the doctor prescribes an inhaled glucocorticosteroid as treatment, your child must take it regularly, even if there is no wheezing or any other symptoms. Especially because with an uncontrolled inflammation, the airways become swollen, narrower and extra-sensitive. It is good to keep in mind that some degree of inflammation is usually present in the lungs, even when your child is unaware of symptoms, and if asthma is not well controlled, a worsening of the inflammation may occur and lead to an asthma attack.9

Glucocorticosteroids, which are also known as corticosteroids, are anti-inflammatory medicines. They are the most common controller medications used to treat chronic inflammation of the airways and help to prevent asthma attacks. Inhaled glucocorticosteroids are the first treatment option for children under five years old with asthma, due to its high anti-inflammatory effect which ensures reliable asthma symptoms control and lowers the risk of asthma attacks and hospitalizations. The most effective and commonly used are budesonide, beclomethasone and fluticasone.9

In asthma, glucocorticosteroids are usually inhaled so that the medicine goes straight to the lining of the airways affected by inflammation. This also greatly reduces the risk of any possible harmful effects on the rest of the body.
The small amount of medicine that goes into the bloodstream is rapidly removed from the body, so that normally there are none of the side effects that may occur with other types of steroid treatment for asthma.9

Asthma is caused by chronic inflammation of the airways, which makes them become swollen, narrower and extra-sensitive to irritants. Controller medications contain anti-inflammatory medicines, and taken regularly as instructed by the doctor, besides treating current inflammation, they prevent further swelling, reduce the narrowing due to muscle tightening, make airways less sensitive to asthma triggers. Anti-inflammatory controller medications are very effective and can control asthma in most children. The most effective anti-inflammatory medicines are the inhaled glucocorticosteroids, such as budesonide.8

Both corticosteroids and anabolic steroids are sometimes just called steroids. However, corticosteroids are very different from anabolic steroids. Corticosteroids reduce the swelling in the airways that make breathing difficult and decrease the amount of mucus produced in the lungs. Differently, anabolic steroids have an effect like the male hormone testosterone and are used illegally by some athletes to increase muscle mass, strength and endurance. Corticosteroids do not have anything to do with these effects.10

According to medical experts, it is important for patients to continue taking their prescribed asthma medications as usual during the COVID-19 (‘coronavirus disease 2019’) pandemic. This includes ICS-containing medications. Stopping ICS often leads to potentially dangerous worsening of asthma. As such, your child’s physician may recommend nebulizing outside or in an area where air is not recirculated into the home and surfaces are easily cleaned.7

Relievers or airway openers are medicines that provide rapid relief from an asthma attack by quickly opening the narrowed airways (dilating the bronchi). This makes it easier to get air in and out of the lungs. Most airway openers work quickly and can be used to treat an asthma attack. They can also be calledrescue bronchodilators. For children, most common airway openers are short-acting bronchodilators. The most widely used short- and quick-acting airway openers are salbutamol (also known as albuterol) and terbutaline.

Inhaled therapy is considered the essential component to treating asthma. The ability to deliver drugs directly to airways as a major advantage of inhaled treatment. That’s because when medications are taken orally, it will take time to pass through the gastrointestinal tract to the bloodstream before the body uses the active substances where they are needed, while a nebulizer delivers medications very quickly and directly to the respiratory tract.
That is to say nebulizer helps deliver the medication to the necessary target organ; your child’s lungs. Other benefits of using nebulization are:11

Fewer Side Effects
The dosage of medicine needed in nebulizer therapy is lesser as compared to medicines given orally. Thus, nebulizer therapy reduces the risk of side effects compared to oral administration of the same medications.
Easy to Use
Nebulizers require very little effort to use and it is a preferred device for children. Unlike inhalers, which generally require certain breathing/hand coordination, your child only need to breathe normally during nebulizer therapy. This makes it easier also for a caretaker to administer the medication when the patient is unable to do it themselves. Even babies or severely debilitated people can receive medication by nebulizer.
Better compliance
The ease of use of nebulizer will motivate asthmatic kids to comply with their recommended daily administration of drugs. Convenience and ease of use affect patient satisfaction. Patient satisfaction correlated with compliance and better outcomes.
Prevention
Nebulizer treatments can prevent asthma episodes as well as treating an asthma attack. Inhaled steroids are the most important controller treatment to reduce chronic inflammation present on the airways of young children with asthma and prevent asthma attacks. It also works by reducing swelling and mucus production in the airways. Consequently, the airways will become less sensitive and less likely to be exacerbated by triggers.

Cleaning your child nebulizer is recommended after each use to ensure safe and effective medication delivery. Always follow the cleaning instructions provided with the nebulizer and consult the doctor regarding the best cleansing agent for it. To find cleaning instructions for an OMRON nebulizer, please refer to the following links:
- NE-U22 – https://omronhealthcare.com/wp-content/uploads/ne-u22v-instruction-manual.pdf
- NE-U100 – https://www.omronhealthcare-ap.com/Content/uploads/products/88e48ddfa216437184ed9b93d37428bd.pdf
- NE-801C – https://omronhealthcare.com/products/compair-nebulizer-system-nec801/

Mesh caps are maintenance items and do not carry any warranty. Properly maintaining your child’s mesh caps will prolong its life.

  1. After each inhalation treatment, remove the mask adapter from the main unit by pressing both sides of the mask adapter.
  2. Open the medication container and remove the mesh cap.
  3. Discard the medication then re-install the mesh cap.
  4. Fill the medication container with water and close the lid of the medication container. Nebulize the distilled water for 1 to 2 minutes to prevent medication from drying and adhering to the mesh after each use.
  5. Open the lid of the medication container and remove the mesh cap from the medication container.
  6. Wash the mesh cap in mild (neutral) detergent, then rinse off with distilled water. Remove excess water and allow to air dry in a clean place. Some types of medications may remain on the mesh. Make sure to clean the medication from the mesh. Do not wash under running water.

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