There are two classes of medicine that are used to treat asthma: bronchodilators and anti-inflammatory medications. Bronchodilators keep the bronchioles open and can be used when there is chest tightness, wheezing, and coughing. They may also be used before exercise or activities that cause asthma flare-ups. The strongest anti-inflammatory medications are inhaled steroids; they are gold standard for controlling asthma but other medicines can be added to treat the inflammation that occurs. All of these medicines are discussed in the medication section below.
Treating the inflammation component of asthma is very important. It is important to arrest and treat the inflammation as quickly as possible, thus preventing collagen deposition (or scarring) in the lungs. Inflammation involves a complex immune system reaction where different cells in the lung tissue release chemical substances that cause damage and thickening of the bronchioles. Collagen deposition is the way our skin heals when it is injured; a scar is a thick build-up of collagen. As collagen builds up (remodeling) the lungs do not work as well and permanent damage begins to appear. Sadly, permanent damage can begin to develop within the first 6-12 months that asthma appears.
Early detection and treatment are important. Inhaled steroids are the only medications that have been proven to reduce inflammation in a significant manner. Inhaled steroids are recommended as treatment for patients with asthma that is persistent including nighttime awakenings due to asthma, using albuterol more than 4 times a week, limitation of activity due to asthma, and emergency room visits.
When asthma flares up, you need to follow an Asthma Action Plan. This plan enables patients to treat asthma flare-ups at home, rather than going to the emergency room. The Asthma Action Plan will tell you when to use albuterol, when to add an oral steroid, and when to contact the doctor or call emergency medical services.
Your Asthma Action Plan
Our Asthma Action Plan is given to parents as a document to refer to when their child experiences symptoms of shortness of breath, chest tightness, wheezing and/or coughing related to asthma. It instructs the patient and their parents on how and when to use Albuterol and Prednisone.
In the event that a patient begins to experience asthmatic symptoms (shortness of breath, chest tightness, wheezing and/or coughing), follow the steps below:
- Take 2 puffs of Albuterol.
- If symptoms persist after 20 minutes, take 2 more puffs of albuterol up to 4 times 20 minutes apart.
- If symptoms are still apparent after 4 doses of Albuterol, start Prednisone – 1 dose twice a day for up to 3 days. Call office during business hours to inform us that you started prednisone, of course if you feel it is an emergency, call us at any time.
- For coughing, may use cough syrup to suppress the cough.
Liquid Prednisone Dosage by Weight:
- 10-12 lbs: 1/4 tsp
- 12-21 lbs: 1/2 tsp
- 22-29 lbs: 3/4 tsp
- 30-36 lbs: 1 tsp
- 38-44 lbs: 1 1/4 tsp
- 45+ lbs: 1 1/2 tsp
Prednisone 5mg Pill Dosage by Age:
- Under 16 Years of Age: Take 4 tablets (20mg)
- Over 16 Years of Age: Take 6 tablets (30mg)
NOTE: While on Prednisone, be aggressive with albuterol (may take 2 puffs of albuterol every hour and try to spread to every 2 to 3 hours as needed).
Cough Syrup Dosage by Age:
- 2-5 Years of Age: 1/4 to 1/2 teaspoon
- Older Children or Adults: 1/2 to 1 teaspoon
Every hour for 3 doses then try to spread out to every 4 hours. Monitor for breathing and how sleepy and tired the patient is.
More About Asthma