Moderate to Severe Childhood Asthma: 6 Ways To Manage It | MyAsthmaTeam

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Moderate to Severe Childhood Asthma: 6 Ways To Manage It

Medically reviewed by Deborah Pedersen, M.D.
Updated on January 2, 2024

Although childhood asthma is one of the most common chronic (ongoing) illnesses in children, various treatment options 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 experiences airway inflammation, typically caused by exposure to specific triggers. Asthma severity is classified based on how frequently symptoms occur and how much they limit physical activity.

Additionally, lung function testing can be used to 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 rate, the amount and speed at which air exits the lungs with forceful exhalation.

Symptoms of asthma include:

In moderate persistent asthma and severe persistent 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 also interfere with your child’s school day and affect their mental health.

Asthma Treatments

There are two main treatments for managing asthma — inhaled corticosteroids, which control symptoms long term, and quick-relief inhaled bronchodilators, used to treat acute (sudden) 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 ways, including inhalers and nebulizers, as well as pills, syrups, and injections.

1. Corticosteroids Fight Inflammation

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 mometasone (Asmanex), fluticasone (Flovent), and budesonide (Pulmicort Flexhaler). 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 time. These combination medications are typically used when steroids alone can’t control symptoms. Using these two medications together can sometimes decrease the amount of inhaled corticosteroid needed to control asthma symptoms. Examples include fluticasone/salmeterol (Advair Diskus), fluticasone/vilanterol (Breo Ellipta), and budesonide/formoterol (Symbicort).

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’s difficult to control.

2. Bronchodilators Open Up the Airways

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

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

Long-acting beta-agonists can be used as add-on medications to inhaled steroids for long-term control of asthma. Several combination inhalers combine a corticosteroid with a long-acting beta-agonist.

3. Leukotriene Modifiers Help Control Asthma

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

4. Biologics Are Prescribed in Severe Cases of Asthma

Biologics are human-made from biological molecules, such as antibodies. They can be used 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. Examples include omalizumab (Xolair), benralizumab (Fasenra), and dupilumab (Dupixent).

5. Some Form of Allergy Treatment May Be Needed

Allergic asthma is the most common type of childhood asthma. Children with allergies may require additional oral and/or nasal allergy medications. They also may need allergy immunotherapy in the form of “allergy shots” to treat specific allergies.

6. Lifestyle and Environmental Changes Can Control Asthma Symptoms

Medications can help keep asthma symptoms under control, but it’s also important to identify and eliminate asthma triggers and allergens.

Common asthma triggers and irritants 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 risk factors include exposure to allergens such as foods, pollen, and other environmental allergens, such as dust. It may be necessary to change certain habits to avoid asthma triggers.

Which Asthma Classification May Require Lifestyle Changes To Control It?

Your specific asthma classification won’t necessarily dictate which lifestyle changes you should pursue, but your symptoms and triggers are likely to guide this approach. Talk to your pulmonologist or other health care provider to evaluate which lifestyle adjustments may help you experience fewer asthma symptoms and flare-ups.

Discuss Treatment Options With Your Child’s Doctor

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

You may need to be patient and try various treatments until an effective combination of therapies is found. Work closely with your child’s doctor to 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 11,000 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 of a child with asthma? What approaches have you used to manage their symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Updated on January 2, 2024
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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.

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