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!

The Asthma and Allergy Foundation of America (AAFA) calls May the National Asthma & Allergy Awareness month because this is the peak season for problems. So it seemed fitting to write about asthma and increase awareness.

Asthma is major health concern in America. Did you know (according to the AAFA)

10 people a day die from asthma
Asthma affects 24 million Americans
3 million children (younger than 18) have asthma

Asthma is chronic disease that causes the airways in the lungs to be inflamed. The inflammation causes the airways to become narrow. Those narrow airways spell trouble whenever the demands on the lungs are increased. Those demands, or “triggers,” make it difficult to breathe when a person has asthma.

Common Asthma triggers

Exercise
Viruses/sickness
Cigarette smoke (both first and secondhand)
Pets
Allergens
Cold air/weather
Molds and dust

If you don’t have asthma, it can be hard to understand what having an attack feels like. Imagine running a mile and only being allowed to breathe through a straw. Pretty quick you would feel terrible. Your head would hurt and you’d feel dizzy (from not getting enough oxygen to your brain). You’d be seriously winded, extremely tired, and your chest would be hurting. Even when someone with asthma is not having an attack, it is common to still be symptomatic.

Asthma Signs and Symptoms

Cough (especially worse at night and first thing in the morning)
Cough with exercise
Wheezing
Shortness of breath
Chest tightness

What Causes Asthma?

The short answer is we don’t exactly know. The longer answer is that science has shown a number of different contributing factors.

There’s a lot of different science to show that early and frequent exposure to certain common allergens and infections decreases the risk of developing asthma. For example, having a pet early in life can decrease the risk of developing asthma, but later the pet can act as a trigger. Coming from a large family or living on a farm is also protective against asthma. Early use of antibiotics in life is also linked to asthma (yet another reason to judiciously use antibiotics). Viruses can both decrease and increase the risk. For example, early exposure to respiratory syncytial virus (RSV) increases the risk.
There is a strong genetic component to developing asthma. There are many specific genes that have been linked to development of asthma. Families that are “atopic,” that is, those with eczema, allergies, and asthma, are also at increased risk. So while one condition (e.g., eczema) doesn’t lead to the other (e.g., asthma), having one, increases the risk of developing another. This phenomenon is often referred to as the “atopic march.”

Ashtma Treatment

There is no cure for asthma. You may have heard of kids “outgrowing asthma.” While not exactly true, the concept is that the lungs continue to grow and develop in the first 6-8 years of life. Many kids, who had trouble when they were toddlers, will get better as their lungs mature. Treatment generally consists of using medications (commonly inhalers) to modify symptoms and avoiding triggers. Inhalers are divided into 2 groups:

Controller inhalers. These medications are used daily to prevent the asthma attack. Generally, these are inhaled steroids.
Rescue inhalers. These medications are used on an as needed basis to deal with symptoms when the asthma has flared.

You will work with your child’s pediatrician to help determine the severity of your child’s asthma. The severity will determine what and how often you’ll be giving your child medication. (As an aside, prep yourself. The medications can be really expensive and unfortunately, there aren’t a lot of generic drugs available).

If you managed to read the entire article, here’s the comical reward for your efforts. Whenever I write an article, I often double check facts (especially if I quote a statistic). I discovered this interesting historical note about asthma. In the 1930s-1950s, asthma was considered one of the “holy seven” psychosomatic illnesses. Asthma was considered psychological and was consequently often treated with psychoanalysis and other talking cures. The “wheeze” (which is really from a constricted/tight airway) was thought to be a suppressed cry of a child for its mother. The treatment of depression was especially important for people with asthma. Isn’t that a riot? If your doctor prescribes Prozac to your child who is having an asthma attack, your doc may be a little too old school. Throw that little historical nugget out at your next dinner party.

Tag: asthma attack

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