How is it treated and managed?
Mild, moderate and severe Asthma treatments
Initial ‘add on’ therapy – step 3 of the SIGN guidelines
Mild, moderate and severe Asthma treatments
The following drugs are used in mild to moderate asthma and are effective in the vast majority of children. Children with severe asthma are likely to also take many of these drugs and still have poor control. The section on drugs used in severe asthma lists the drugs that may be taken in addition to the ones listed below.
Short acting beta agonist inhalers (Reliever Inhalers)
These drugs are used in mild, moderate and severe asthma.
Salbutamol (ventolin) dose - 100-200mcg (1-2 puffs) as necessary and can be given via
- Metered dose inhaler (MDI)
- Breath actuated inhalers e.g. ‘easibreathe’
- MDI Inhaler and spacer device
- Nebuliser
- dry powder inhaler (DPI) – ventodisks using ‘accuhaler’
Other trade names for salbutamol include Maxivent, Salamol, Airolin, and Airomir.
Terbutaline (bricanyl) can be given via
- Metered dose inhaler (MDI)
- Inhaler and spacer device
- Nebuliser – trade name for nebuliser doses is Respules
- dry powder inhaler (DPI)– Turbohaler
Steroid inhalers (Preventer inhalers)
There are several different types of steroid inhaler and doses are not equivalent between different types. A table of doses categorised as high and low dose steroid inhaler use by age is provided. Steroid inhalers are usually taken twice a day every day to control inflammation in the lungs and reduce the risk of uncontrolled asthma. The use of steroid inhalers in mild to moderate asthma enables a normal active life with minimal asthma related interruption to activities including sleep and exercise. Steroid inhalers can be given using a standard metered dose inhaler or other methods including dry powder formulation, breath actuated inhaler or nebuliser. The methods used will reflect the age of the child and ability to use an inhaler rather than the severity of the asthma. The prescribed dose of steroid inhaler used will give a good indication of severity of asthma as high dose steroid inhalers are avoided as much as possible in children because of potential effects on growth of the child.
Steroid inhalers dosing information: - To use the tables (see link at bottom of page), work out which steroid drug the inhaler contains and then work out the dose of steroid inhaler used -:
E.g. Qvar 50 (50mcg) is prescribed
Dosing instructions are 2 puffs twice a day = 4 puffs in total
Each dose = 2 puffs times 50mcg = 100mcg twice daily
Total daily dose is 200mcg daily. Note the total daily dose is given in the SIGN treatment guidelines pages.
Sodium Cromoglicate (Preventer inhalers)
These drugs should always be considered equivalent to low dose steroid inhalers and are used in mild to moderate asthma. They are taken twice daily like steroid inhalers and dose may be increased during asthma exacerbations. Trade names include Intal and Tilade.
Initial ‘add on’ therapy – step 3 of the SIGN treatment guidelines
These treatments are used in addition to regular ‘preventer’ steroid inhalers and use of reliever inhalers to improve asthma control and reduce exacerbations of asthma.
Leukotriene inhibitors
These are tablet treatments taken to improve asthma control. The usual dose is 1 tablet per day. Drug names include Montelukast (Singulair) and Zafirlukast (Accolate) - side effects are rare. This tablet treatment is used without ‘preventer’ inhalers to treat rhinitis (inflammation of the mucous membranes of the nose), which may or may not accompany asthma. This drug is starting (in 2009) to be used in step 2, instead of low dose steroid inhalers to treat asthma, especially in younger children. Use of these drugs does not necessarily indicate moderate asthma.
Long acting beta agonist inhalers (LABA)
These drugs are inhalers containing long acting beta agonist drugs similar to the beta agonist drugs used in reliever inhalers like Salbutamol (Ventolin). These drugs have a longer lasting airway opening effect and are taken twice daily with steroid inhalers to improve asthma control. Names of drugs include Salmeterol (Serevent) and Formoterol. Use of these drugs indicates at least moderate asthma.
Theophylline (Slo-phyllin, Nuelin SA, Uniphyllin Continus)
This is a tablet treatment for asthma. Doses are given twice a day. Use of these drugs indicates at least moderate asthma.
Short courses of oral steroids for acute asthma exacerbations
Short courses of high dose oral steroid (up to 40mg prednisolone per day) for 3-5 days are commonly given to children with acute asthma and are not an indication that asthma is severe. However, 5 or more short courses in one year is an indicator of severe asthma.
Note: The Alphabetical List of Medication and the Steroid Inhaler Doses by age tables below should be used together with the information provided in the appropriate Sign treatment guidelines table for the child’s age. See the links below.
SIGN treatment guidelines for under 5s
SIGN treatment guidelines for 5s and over
Drug treatments only for severe asthma
Inhalers & other drug delivery devices
Podcasts – Spacer Devices used to treat Asthma – one (2.2MB) MP3
Podcasts – Spacer Devices used to treat Asthma – two (2.3MB) MP3
