Inhaled corticosteroids are topical medications that treat the surface of the lung, but are not absorbed into the child’s system. If an inhaled corticosteroid is swallowed or absorbed, it is quickly excreted and does not act on any other organs or body systems, he explained.
Similar hesitancy occurs with long-acting inhaled beta 2-agonists due to black-box warnings about increased risk for death in some asthma patients. These medications are typically prescribed in combination with inhaled corticosteroids, but the FDA added the warnings after adverse events occurred when the drugs were used as monotherapy.
New delivery devices have since increased safety substantially, according to Johnson. “Combination therapy can be delivered in a single inhalation, avoiding the risk of using only one medication for an extended period,” he added.
Re-evaluate patients regularly
Whatever treatment clinicians choose, they should be sure to carefully and regularly monitor patients with asthma, as it is common to overestimate symptom control. This often happens because patients do not tell their health-care providers about problems they are having, or because clinicians are unclear about how symptoms appear in patients with properly controlled asthma.
“Most children with well-controlled asthma should be able to play sports. Maybe not running, but most other sports,” Edelman said. “The goal of the clinician should be to put a program in place that will allow the child to do that.”
The first rule of thumb, is to avoid asking general questions, like “How’s your asthma?” Johnson advised. Many patients will respond to this question with the answer they believe the clinician wants to hear.
Instead, ask specific questions. In general, children with well-controlled asthma are not kept awake at night coughing, do not miss school regularly and can exercise normally.
If a patient confirms the following events, their asthma is likely not under control and it may be time to re-evaluate treatment:
- Coughing or wheezing two days per week or two nights per month
- Refilling rescue medication more than two times per year
- Emergency treatment or oral corticosteroid use for asthma exacerbations at least two times a year
Another valuable tool is an Asthma Control Test, which is a written form that patients can fill out in the waiting room that enables clinicians to rapidly assess the patient’s asthma, Johnson said.
Also, be sure to create an action plan for all children with asthma, instructing both parents and educators how to respond if the child starts wheezing and detailing preventative strategies. This plan should be given to both the parents and the child’s school, Edelman said, and should be updated annually. The American Lung Association offer this sample action plan.
Debunk asthma myths
In addition to treatment and management, clinicians should be prepared to debunk common and persistent asthma myths.
The first myth is that asthma is a psychological condition. “This isn’t true,” Edelman said. “Children may get very anxious as they get short of breath, and this anxiety may occur before the child starts wheezing. But typically this is caused by the feeling of an attack coming on, not the other way around.”
Another myth is that influenza vaccine can cause asthma exacerbations. It is particularly important to educate parents about the importance of vaccinating children against influenza, particularly those with asthma, because respiratory viruses can cause asthma complications.
The third and final myth is that many people still believe that they need to live with a certain number of asthma symptoms.
“It’s important to understand that, unlike 20 years ago, asthma is something that can be treated successfully today. Children should not be struggling with asthma symptoms when treatments exist to prevent it,” Johnson said.
Kelly Bilodeau is a freelance medical writer.