Connect with others who understand.

sign up log in
About MyAsthmaTeam

Treatments for Moderate to Severe Childhood Asthma

Posted on January 03, 2022
Medically reviewed by
Deborah Pedersen, M.D.
Article written by
Kristopher Bunting, M.D.

  • Various types of medications are available to treat moderate to severe asthma in children.
  • Medications are used both for long-term control of asthma (such as steroids) and for treating acute asthma attacks (like quick-relief bronchodilators).
  • Medications will likely need to be adjusted over time to achieve adequate asthma control.

Although childhood asthma is one of the most common chronic illnesses in children, treatment options do exist that can help your child live a healthier life. Proper asthma treatments are essential to control asthma symptoms and prevent asthma attacks, emergency room visits, and hospital stays.

What Is Moderate to Severe Asthma?

Asthma occurs when a person’s airways and lungs experience inflammation, typically due to exposure to specific triggers. The severity of asthma is classified based on how frequently symptoms occur and how much they limit physical activity. Additionally, lung function testing can assess severity. Lung function can be tested in a doctor’s office through spirometry or at home with a peak flow meter. The latter measures peak expiratory flow (PEF) rate, the amount and speed at which air exits the lungs with forceful exhalation.

Symptoms of asthma include:

  • Shortness of breath
  • Difficulty breathing
  • Frequent or chronic cough
  • Wheezing when exhaling (a whistling noise)
  • Tightness or congestion in the chest

In moderate persistent asthma and severe persistent asthma, asthma symptoms occur every day and often at night. They can cause reduced lung function and limit a person’s physical activity. Asthma symptoms can interfere with your child’s school day. There are some ways to prepare your child to return to the classroom after an asthma diagnosis.

People with moderate to severe asthma may require quick-relief medicine every day until their asthma is under control. The goal of persistent asthma treatment is to limit daytime symptom activity to less than two days a week and nighttime symptoms to less than two days a month. Additionally, symptoms should not interfere with daily activities, and PEF should be at least 80 percent of the child’s previously established “personal best.”

Asthma Treatments

The two main treatments for asthma are inhaled corticosteroids, which control symptoms long-term, and quick-relief inhaled bronchodilators, used to treat acute asthma attacks. Additional treatments may be added to inhaled corticosteroid treatment for more severe asthma, including:

  • Long-acting bronchodilators
  • Leukotriene modifiers
  • Theophylline
  • Biologics
  • Allergy treatments
  • Oral steroids

Asthma medications can be administered in several different ways, including inhalers and nebulizers, as well as pills, syrups, and injections.

Corticosteroids

Controller medication or maintenance therapy for asthma is intended to prevent symptoms and reduce the need for quick-relief medications. Inhaled corticosteroids fight inflammation and reduce mucus in the lungs. Depending on asthma severity, corticosteroids may be given at a low dose or a high dose. Types of corticosteroids include Asmanex (mometasone), Flovent (fluticasone), and Pulmicort (budesonide). To work properly, inhaled corticosteroids must be taken every day as prescribed.

Corticosteroids can also be combined with long-acting beta-agonists — bronchodilators that are similar to rescue inhalers but work for a longer period of time. These combination medications are typically used when steroids alone cannot control symptoms. Using these two medications in combination can sometimes decrease the amount of inhaled corticosteroid needed to control asthma symptoms. Examples include Advair Diskus (fluticasone/salmeterol), Breo Ellipta (fluticasone/vilanterol), and Symbicort (budesonide/formoterol).

Oral corticosteroids, available in pill form or as a syrup for very young children, also have a role in asthma treatment. A short course of oral steroids may be given at the start of treatment to help bring asthma symptoms under control. Oral steroids may also be used to treat severe asthma episodes. Daily oral steroid treatment should be avoided due to side effects from chronic steroid use, but may be needed in rare cases for severe asthma that is difficult to control.

Bronchodilators

Bronchodilators treat asthma by opening up the airways in the lungs. There are several different types of bronchodilators used to treat asthma. Short-acting beta-agonists, such as Proventil (albuterol), are used as quick-relief medicines to treat acute asthma symptoms. They may also be used before exercise to prevent asthma symptoms.

Albuterol is a rescue medication, intended for use only as needed. Frequently needing to use albuterol can be an indication that a person’s asthma is not well controlled.

Long-acting beta-agonists can be used as an add-on medication to inhaled steroids for long-term control of asthma. There are several combination inhalers that combine a corticosteroid with a long-acting beta-agonist.

Are you a parent or caregiver for a child with asthma?
Click
here to share your experience in the comments below.

Leukotriene Modifiers

Leukotriene modifiers are drugs that block the action of leukotrienes — inflammatory molecules that are involved in causing asthma symptoms. These drugs, such as Singulair (montelukast), come in pill form and are taken every day for long-term asthma control.

Theophylline

Theophylline is another drug that may be added to steroid therapy for long-term asthma control. Theophylline has both anti-inflammatory and bronchodilator effects that can improve asthma symptoms. It comes in a pill that is taken daily. People taking this drug need to undergo regular blood tests to make sure that levels of the medicine stay within an effective range.

Biologics

Biologics are human-made from biological molecules, such as antibodies. They can be used along with inhaled corticosteroids to help treat moderate to severe asthma. Most biologics are given as injections, either at home or in the doctor’s office. Biologic medications often require special approval from insurance companies due to their high cost. Different biologic medications are useful in different people. Examples include Xolair (omalizumab), Fasenra (benralizumab), and Dupixent (dupilumab).

Allergy Treatments

Allergic asthma is the most common type of childhood asthma. Children with allergies may require additional oral or nasal allergy medications. They also may need allergy immunotherapy (known as “allergy shots”) to treat specific allergies.

Lifestyle and Environmental Changes

Medications can help keep asthma symptoms under control, but it is important to identify and eliminate asthma triggers and allergens as well.

Common asthma triggers include:

  • Tobacco smoke
  • Dust mites
  • Pet hair or dander
  • Air pollution
  • Cleaning products and disinfectants
  • Pests or vermin, such as cockroaches, mice, and rats

Asthma can also be triggered by exercise, stress, breathing cold air, or viral infections. Other triggers may include exposure to allergens such as foods, pollen, and dust. It may be necessary to change certain habits to avoid asthma triggers.

Take the poll: What's the most frustrating lifestyle change your child experiences due to asthma?

Talk To Your Doctor About Treatment Options

Moderate to severe asthma can be difficult to treat. Your child’s doctor may need to add one or more long-term medications to achieve and maintain adequate asthma control.

Patience may be needed to endure ineffective treatments until an effective combination of therapies is found. Work closely with your child’s doctor to help find what works. Report symptoms and side effects to your child’s health care team, and make sure that medications are administered properly before changing treatment.

It may take time to get severe asthma under control, but there are many treatment options to try, so don’t lose hope.

Talk With Others Who Understand

MyAsthmaTeam is the social network for people with asthma and their loved ones. On MyAsthmaTeam, more than 7,000 members come together to ask questions, give advice, and share their stories with others who understand life with asthma.

Are you a parent or caregiver for a child with asthma? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Deborah Pedersen, M.D. has specialized in allergy and asthma care as well as pediatrics for over 16 years. Review provided by VeriMed Healthcare Network. Learn more about her here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

Related articles

If your child has asthma, it’s a good idea to discuss with their doctor when and how to use...

Talking To Your Child’s Doctor About Asthma Treatment

If your child has asthma, it’s a good idea to discuss with their doctor when and how to use...
Asthma is a chronic lung condition. Asthma cannot be cured, but it can be managed. There are two...

Treatments for Asthma

Asthma is a chronic lung condition. Asthma cannot be cured, but it can be managed. There are two...
Treatment options for eosinophilic asthma are often aimed at reducing inflammation and lowering...

Treatments for Eosinophilic Asthma

Treatment options for eosinophilic asthma are often aimed at reducing inflammation and lowering...

Recent articles

If you’re living with asthma, you’re already aware of the impact that the condition can have on...

Asthma Awareness: How To Get Involved

If you’re living with asthma, you’re already aware of the impact that the condition can have on...
Asthma affects more than 5 million children in the United States, and it can cause symptoms such...

Take the Poll: What’s the Most Frustrating Lifestyle Change Your Child Experiences Due to Asthma?

Asthma affects more than 5 million children in the United States, and it can cause symptoms such...
It’s important to prepare ahead of time for your child with asthma to start a new school...

Getting Back to School While Living With Childhood Asthma

It’s important to prepare ahead of time for your child with asthma to start a new school...
Asthma is a lung disease that causes chronic inflammation in the airways, difficulty breathing,...

Spondylitis and Asthma: Is There a Connection?

Asthma is a lung disease that causes chronic inflammation in the airways, difficulty breathing,...
Asthma is known to have several comorbidities, or co-occurring conditions. Recent research...

IBD and Asthma: What’s the Connection With Crohn’s and Colitis?

Asthma is known to have several comorbidities, or co-occurring conditions. Recent research...
You can never ask too many questions on MyAsthmaTeam. Other members are here to support you, help...

Share and Receive on MyAsthmaTeam

You can never ask too many questions on MyAsthmaTeam. Other members are here to support you, help...
MyAsthmaTeam My asthma Team

Thank you for signing up.

close