Treatment of Asthma

Treatment of asthma involves not only pharmacologic agents but also recognition and modification of potential triggers. Typical triggers include environmental tobacco smoke, air pollution (both indoor and outdoor), and allergens.

Ideally, in the case of a child with pet-dander allergy, the pet should be removed from the home. However, if pet removal is not feasible or likely, then, at the very least, the pet should not be allowed in the patient’s bedroom.

Dust mite sensitivity should prompt the use of dust mite mattress and pillow covers, regular laundering of bed linens in hot water, and limiting the amount of upholstered furniture, carpeting, and stuffed animals in the child’s bedroom. Finally, parents of a child sensitized to seasonal allergens should be encouraged to keep the child in an air-conditioned environment during peak pollen times day and night.

If the child cannot avoid seasonal allergens, allergy immunotherapy has been shown to modulate pediatric asthma. The pediatric patient with asthma and his or her family should also be educated about all asthma triggers, including exercise and viral illnesses.

Pretreatment with bronchodilator therapy before exercise or planned activity can decrease the likelihood of asthma symptoms. Additionally, a high level of vigilance when a pediatric patient begins to show signs and symptoms of a viral illness can allow detection of asthma symptoms earlier and permit timely intervention.

In 2002, the National Heart, Lung, and Blood Institute (NHLBI) published revised guidelines for the treatment of pediatric asthma. These guidelines recommend treatment based on assessment and categorization of pediatric asthma as mild intermittent, mild persistent, moderate persistent, or severe persistent.

Based on the category of severity, therapies are recommended in a step-wise fashion with inhaled corticosteroids the preferred treatment for mild persistent disease. Combination therapy with inhaled corticosteroids is recommended for moderate to severe persistent disease.

Finally, the guidelines recommend using a higher dose of inhaled steroid to gain control and then step down therapy as tolerated. Updated guidelines are anticipated by late 2007 and will focus on assessing asthma control as a function of the severity and frequency of asthma symptoms. Medications for asthma treatment are generally categorized as controller therapy and rescue therapy.

Controller therapies include inhaled corticosteroids, leukotriene-modifying medications, and long-acting beta-agonists (LABAs). The goal of controller therapy is to minimize symptoms, decrease rescue use of bronchodilators, improve lung function, and prevent exacerbations, all using the least amount of medication possible.