If your child has chronic asthma symptoms, the most dangerous thing is not the chronic coughing but the chronic state of inflammation inside the lungs. When body tissues are chronically inflamed, they are gradually destroyed in the process. Chronic, uncontrolled asthma slowly destroys lung tissue. This is why chronic asthma must be controlled, not just for the sake of symptom relief but to save the lungs from permanent destruction.

Fortunately, this process of lung destruction by asthma occurs very slowly, and usually it does not happen unless the asthma is untreated for more than a decade. It's not too late to start your child on a control inhaler if she needs it.

Albuterol to the Rescue

There are two main types of medications used to treat asthma. One of them is known as the fast-acting “rescue” medicine. This medicine is called albuterol. It is dispensed in many forms, including a syrup, a liquid to be used with a machine, and an inhaler. Each form has its place in the management of asthma.

The syrup is easy to administer, especially to babies. It does not require additional medical equipment for its administration, and it's only given three times a day. However, this form of albuterol tends to be somewhat less effective, and its side effect of making the heart race is more pronounced. Doctors sometimes prescribe albuterol syrup when they treat a mild wheezing in infants. This is usually used for patients who do not have chronic asthma.

Another common way to administer albuterol is by using an inhaler. This method is by far the most popular. The albuterol is stored inside a small metallic aerosol canister, and the medicine sprays out when one end of the canister is depressed. It works similarly to a hair spray, except the canister is much smaller.

Any child using albuterol from an inhaler must use the inhaler in conjunction with a spacer. A spacer is nothing more than a plastic tube connected to a facemask (Aerochamber is a common commercial brand). The facemask covers the nose and mouth of the child. The inhaler is attached to the spacer from one end, and the mask is placed over the nose and mouth of the child from the other end. When albuterol sprays out from the canister, the air inside the spacer slows down the aerosolized albuterol particles. Without the spacer, the aerosolized particles travel at great speed, and most of the medication gets sprayed to the back of the mouth instead of traveling deep inside the lungs. Using an inhaler without attaching the spacer is quite useless.

Albuterol can also be given in the form of a liquid solution vaporized by a special machine. This machine is commonly referred to as a nebulizer. The albuterol solution is put inside the machine, and the machine nebulizes the albuterol into a mist. This mist is subsequently inhaled by the child.

The advantage of using a nebulizer is that it can be administered to very young infants or active toddlers who will not tolerate having the masked spacer on their faces. However, the medication cannot be given unless the machine is working. The machine is not very portable, and it needs an electrical outlet to function. These logistical limitations restrict its usefulness.

After an introduction to the various ways to administer albuterol, parents need to know when to use this medication. It is often called the “fast-onset” asthma medicine because it kicks in after about ten to fifteen minutes. Its effect lasts for two to four hours. During an asthma attack, it may need to be administered repeatedly to control the wheezing or coughing.

The way albuterol works is that it relaxes the lungs. Imagine someone suffering from nasal allergy as having an itchy nose. Well, children with asthma basically have “itchy” lungs. Albuterol temporarily takes this itchiness away and expands the lungs.

Steroid

Another major type of asthma medication is the steroid. This is a powerful drug that is more important for chronic asthmatics than albuterol. Steroids can be administered in three different ways as well, just like albuterol. The advantages and disadvantages of each method of administration are similar to those described for albuterol.

Inhaled steroids are used to control asthma on a long-term basis. They are frequently referred to as the “maintenance” asthma medication. Unlike albuterol, they do not work immediately after administration. In fact, it can take eight to twelve hours before they even start to work. For this reason, steroid inhalers cannot be used to relieve a sudden asthma attack. By the time they kick in, it may be too late to relieve your child with a severe asthma attack.

Even though inhaled steroids take a long time to kick in, they work wonders in extinguishing the inflammation caused by asthma when they are used over the long term. Because it is important to prevent lung inflammation at all times, these medications must be used daily in order to be effective. They are useless if used only sporadically or on an as-needed basis.

It's a good analogy to compare the use of steroid inhalers to tooth brushing. You can't have your child brush her teeth only after she starts having a toothache. By the time she has a cavity, it's obviously too late to brush it away. Similarly, you can't wait until your child has an asthma attack to give her the inhaled steroid. By the time the asthma has flared up, the inflammation has already set in, and the damage done to the lung tissue has already occurred.

There are some new inhaled steroids that do not come in an aerosolized canister. One of the most popular ones is called Advair. This is actually a combination medication that includes both a steroid component and a long-acting form of albuterol. Advair is different from other inhalers in that the medication is sucked out of a plastic discus instead of being sprayed and inhaled. Unlike a traditional inhaler, this discus is not used with a spacer. However, not all children know how to suck the medication out of the dispenser. If your child can use the medication with the correct technique, this medication should be considered.

While it is crucial for chronic asthmatics to use inhaled steroids on a daily basis, doctors know that inhaled steroids can slow down vertical growth. However, this temporary reduction in height is small and transient. Since most children grow out of their asthma problem as they get older, it is likely that your child will stop using her steroid inhaler at some point in the future. Children who take inhaled steroids catch up on their height within six months to a year after the medication is stopped.

Steroid syrup taken orally works similarly to the inhaled steroid, but it cannot be used on a long-term basis. Unlike inhaled steroids, oral steroid becomes absorbed into the body and travels everywhere. Even though this is by far the most potent form of steroid and it powerfully suppresses a severe asthma attack, it can also cause serious side effects if it is used for more than two weeks. It only has a short-term role in controlling severe asthma attack.

On very rare occasions, oral steroid is used to control severe chronic asthma on a long-term basis. All of these patients have asthma so severe that it does not respond to any other medication. Your child's doctor will weigh the benefits and risks of using oral steroid chronically. These children are the exceptions rather than the rule.