Categories: Ask Dr. Lanny
      Date: Nov  1, 2007
     Title: Asthma (Part 2)

Asthma (Part 2)

By Dr. Alan Freshman

When last we met, I had completed an answer to a query about diagnosing asthma, but I ran out of space before beginning to touch on treatment.

When last we met, I had completed an answer to a query about diagnosing asthma, but I ran out of space before beginning to touch on treatment.

The following is meant as an overview of asthma treatment and not an exhaustive treatise. I hope readers will gain some new knowledge and questions to discuss with their health care providers.

If you read the previous column (on diagnosis, in the October issue of Family Times), you know that asthma is a recurring and reversible narrowing of the air passages following any one of a number of stimuli such as viruses, vigorous exercise, allergies or irritants. Symptoms can include coughing, wheezing, chest pain and respiratory distress.

Diagnosis is not always simple, and mistakes of over- and under-diagnosis are common. For the remainder of this article, please assume that your child’s diagnosis is accurate—but always feel comfortable asking your health care provider to justify his or her reasoning.

In many cases therapy may well start without medication. If your child only coughs or wheezes in certain situations, such as visiting the barn on Grandma’s farm, it is safe to assume that there are irritants there. Keeping out of the barn, or wearing a respiratory mask, may be all that is needed.

Similarly, if you live in a split-level home with a moist, below-ground-level bedroom, mold may be the cause of your child’s nighttime cough. Moving him upstairs may well “cure” his asthma.

Exercise-induced asthma should not stop your child from participating in sports. Conditioning and medications will allow full activity in almost all children with asthma.

I’m sure I don’t have to say this, but I can’t stop myself. Cigarette smoke is bad for all living things, particularly if they have asthma. I understand that cigarettes are terribly addictive and hard to give up, but if you can’t give them up you must smoke outdoors. Only smoking in the bedroom, or the den, is not good enough. Remember: This is your child we’re talking about.

If you have addressed the aforementioned examples, or made other alterations in your child’s environment and symptoms of asthma continue, treatment with medication will be your next step. Asthma medicines are largely divided into short-acting controllers, also called rescue medicines, and longer-term controllers, or maintenance medicines.

Almost everyone has seen someone using a “puffer.” This device, also called an inhaler, delivers medicine directly to the lungs, and consequently has little effect on the rest of the body. Most people with “mild” asthma use a puffer, with either albuterol or Xopenex, to control occasional symptoms. These similar medicines act rapidly and tend to be quite effective. Although the inhaler seems simple to use, it is very dependent on proper technique. When not used exactly as it should, its value decreases dramatically, often leading to the unnecessary prescription of more medications.

Everyone, child, adolescent or adult, will do better if they use a holding chamber (also called a spacer) along with their puffer. This tube-shaped device can be used with children as young as 5. When used properly it is as effective as an electric nebulizer. Please ask your doctor to show you and your child the proper technique for puffers and spacers.

Short-acting puffers are sufficient treatment for most children with only occasional symptoms, or for those with exercise-induced asthma. Those children with more frequent problems are classified as having “persistent” asthma, and are at greater risk for long-term lung problems. These children need a daily maintenance medication as well as their occasional rescue medicine. Some children may use a pill (most commonly Singulair), but asthma specialists will more frequently recommend a steroid inhaler.

“Steroids! Are you crazy?” Whenever I say steroids in front of a parent, that is the reaction. These steroids are not what athletes use to illegally build muscles. They are powerful anti-inflammatory medicines used to treat conditions as diverse as poison ivy and leukemia. They are extremely useful, remarkably inexpensive, and, in an inhaled form, very safe.
It is important to use maintenance medications on a daily basis. They are not meant to be used only when your child is ill. That is the job of the rescue medicine.

Medicines like Singulair, albuterol and a host of inhaled steroids are more alike than different. Do not be taken in by TV advertising. Always consult your doctor if you hear of something new, or have questions about something old. In truth, there is very little new under the sun.

I hadn’t anticipated going on this long, and I’ve not covered all that is asthma. Send in any questions you might have, or better still, talk to your own doctor.

Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at