This time of year, I am seeing tons of kids with complaints of coughing. Not surprisingly, I am prescribing a lot more inhaled medications to help with those coughs. The trick is knowing when and what to use. Now all coughs do not need inhalers. Furthermore, inhalers are not just prescribed for kids with asthma (although that is the typical reason).
Why would you use an inhaler if you don’t have asthma?
Sometimes after getting a bad respiratory bug/virus, the airways in the lungs will get inflamed. This is sometimes referred to as a “post viral reactive airway disease.” When the airways are inflamed and irritated you get coughing. Inhaled steroids are used to help decrease that inflammation (which indirectly gets rid of the cough). Not all coughs need an inhaler. When your pediatrician listens to your child’s lungs he/she will determine if it sounds like your child has airway inflammation (which often manifests with wheezing).
What is an inhaled steroid?
Inhaled steroids (more correctly, inhaled corticosteroids) are medicines that delivered in an aerosolized from (through an inhaler or nebulizer machine) and go directly to the lungs. Inhaled steroids reduce swelling in the airways. There are a number of inhaled steroids, here are ones commonly used in pediatrics (of note, while I included the generic name of each med, to my knowledge there aren’t any generic inhaled corticosteroids that come in an inhaler-which just means they are expensive medications Examples are:
- Fluticasone (tradename Flovent)
- Budesonide (tradename Pulmicort)
- Beclomethasone dipropionate (tradename QVAR)
- Mometasone (Asmanex)
- Ciclesonide (Alvesco)
It’s also worth mentioning that there are a number of inhaled corticosteroids that are in combination with long acting bronchodilators. These meds are considered a step up in terms of strength (so used in kids who have more severe asthma or breathing issues). They include medications like Advair, Dulera, and Symbicort.
Inhaled corticosteroids in general are considered “preventative” or “controller” medications. While they are absolutely used when a kid is sick, they are also designed to help with chronic airway inflammation, thereby preventing/controlling asthma symptoms before they are out of control.
How is albuterol different?
Albuterol is NOT an inhaled corticosteroid. Instead, it is a bronchodilator. Which means it relaxes the smooth muscles that go around the airways. When the muscles are tight and constricted, the airways get smaller making it harder to breath. Albuterol is also made by a number of different drug manufacturers. Common names are Ventolin, Proair, and Proventil. Xopenex is related to albuterol chemically (it just has one little change that helps some kids who are prone to problems with albuterol).
When do I use which medication?
- Inhaled corticosteroids – Use everyday. They prevent symptoms.
- Bronchodilators (e.g., albuterol) – Use as needed. They are rescue inhalers, so it is used as the need arises (e.g., trouble breathing, coughing attack, wheezing).
Does my child need a spacer?
The short answer is yes. Spacers are little plastic tubes that act as a holding chamber for the inhaled medications. The medicine stays in the tube until the child inhales a good breath and takes the medication into his/her lungs. Nearly all inhaled medications should be used with a spacer. There are a few exceptions where the spacer is built into the inhaler (e.g. Aerospan or Pulmicort flexhaler) or the inhaler comes in a form that was designed to eliminate the need for a spacer (e.g. Advairs diskus). Otherwise, the studies show that a good percentage of the medication when used without the spacer, ends up in the mouth, predominately on the tongue, instead of the lungs where it was intended to go. Spacers increase the actual percentage of the medication going to the lungs.
If your child needs an inhaler, make sure you understand what kind of inhaler it is and how to use it. Good luck!