Treating asthma in children age 12 and older

Asthma is ongoing (chronic) inflammation of airways in the lungs. This inflammation makes the airways vulnerable to episodes of difficult breathing (asthma attacks). Common triggers of attacks include allergies, colds and exercise.

Asthma in older children can interfere with sleep, school, sports and social activities. The emotional, social and developmental changes associated with adolescence may sometimes complicate disease management.

Asthma management depends on controlling inflammation with drugs, avoiding triggers when possible and using medications to treat asthma attacks. Your child can learn to minimize symptoms by following a written action plan developed with your child's doctor to monitor and adjust treatment as necessary.

Asthma symptoms in children age 12 and older

Common signs and symptoms of asthma in children age 12 and older may include:

Cough
Wheezing, a high-pitched, whistle-like sound when exhaling
Trouble breathing or shortness of breath
A tight, uncomfortable feeling in the chest

The severity and patterns of symptoms may vary:

Worsening of symptoms at night
Short periods of coughing and wheezing between periods of time with no symptoms
Frequent or chronic symptoms with episodes of worse wheezing and coughing
Seasonal changes based on prevalent infections or allergy triggers

Asthma symptoms may be triggered or worsened by certain events:

Colds or other respiratory infections
Exposure to allergy-causing agents (allergens), such as dust, pet dander or pollen
Activity or exercise
Exposure to cigarette smoke or other airborne irritants
Strong emotional reactions, such as crying or laughing
Menstruation
Changes or extremes in weather

Diagnosis of asthma

A diagnosis of asthma is based primarily on a physical examination, a medical history and a test of how well lungs work.

Medical history

Your doctor will likely ask a number of questions, such as the following:

Is there a family history of asthma?
How often do symptoms occur?
Does coughing wake your child at night?
Do the symptoms accompany a cold or are they unrelated to colds?
Do they occur with exercise?
Does your child avoid normally enjoyed activities because of breathing difficulties?
How often do episodes of breathing difficulty occur?
How long do they last?
Has your child needed emergency care for breathing difficulties?
Does your child have any known pollen, dust, pet or food allergies?
Is your child exposed to cigarette smoke or other airborne irritants?

Lung-function test

The primary diagnostic test is performed with a device called a spirometer, which measures how much air you inhale, how much air you exhale, and how quickly air is exhaled. The results of the test indicate how well the lungs function even when signs and symptoms are not present.

Your doctor may follow up the initial spirometry test with a treatment test. Your child inhales a short-acting asthma drug and then repeats the lung function test with the spirometer. An improvement in results of a second test with the spirometer may help confirm a diagnosis of asthma.

Allergy test

Your doctor may recommend an allergy skin test or allergy blood test if cats, dogs, dust mites, mold or pollen are suspected asthma triggers.

Asthma management

The treatment goals for adolescents include the following:

Treat inflammation in the airways, usually with daily medication, to prevent asthma attacks
Use short-acting drugs to treat asthma attacks
Avoid or minimize the effect of asthma triggers
Maintain normal activity levels
Include the adolescent in creating and managing a treatment plan

Your doctor will use a stepwise approach for treating your child's asthma. The goal is overall management with a minimum number of asthma attacks that require short-term treatment. This means that initially the type or dosage of treatment may be increased until the asthma is stable.

When your child's asthma is stable for a period of time, your doctor may then step down the treatment — this ensures your child takes the minimum drug treatment needed to remain stable. If your doctor determines at some point that your child is using a short-acting drug too often, the long-term treatment will be stepped up to a higher dose or additional medication.

This stepwise approach may result in changes up or down over time, depending on your child's response to treatment and overall growth and development, as well as on seasonal changes, changes in activity levels or other factors.

Medications for long-term control

Long-term control, or maintenance, medications are usually taken daily. Discuss with your doctor risks associated with treatment options and learn signs of adverse reactions.

Types of maintenance medication include the following:

Inhaled corticosteroids are the most common maintenance medications for asthma, as well as the preferred treatment according to the National Asthma Education and Prevention guidelines. These anti-inflammatory drugs include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler, Pulmicort Respules), flunisolide, ciclesonide (Alvesco), beclomethasone (Qvar Redihaler) and mometasone (Asmanex).
Long-acting beta agonists (LABAs) may be added to inhaled corticosteroid treatment when a corticosteroid alone does not result in stable asthma management. Long-acting beta agonists have been linked to severe or life-threatening asthma attacks.

According to current Food and Drug Administration recommendations, LABA medication is given to an adolescent only when the drug is administered in combination with a corticosteroid. These include the combinations fluticasone-salmeterol (Advair Diskus, Advair HFA), budesonide-formoterol (Symbicort) and mometasone-formoterol (Dulera).
Leukotriene modifiers may be used as an alternative to corticosteroids for mild asthma or added to a treatment plan when an inhaled corticosteroid treatment alone doesn't result in stable asthma management. These include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR).

In rare cases, these medications have been linked to psychological reactions such as aggression, anxiousness, hallucinations, depression, irritability and suicidal thinking. Seek medical advice right away if your child has any unusual psychological reaction.
Theophylline is a daily pill that opens the airways (bronchodilator). Theophylline (Theochron) may be used as an alternative for long-term control of mild asthma or added to a corticosteroid treatment.
Oral corticosteroids are used only when asthma cannot be controlled with other treatments.

Short-acting medications

These medications — called short-acting bronchodilators — provide immediate relief of asthma symptoms, and effects last four to six hours. Short-acting bronchodilators for asthma include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA).

For adolescents with mild, intermittent asthma symptoms, the short-acting medication may be the only treatment needed.

For adolescents who have persistent asthma and use maintenance drugs, the short-acting drug is used as a quick-relief, or rescue, medication to treat asthma attacks. It may also be used to prevent asthma symptoms triggered by exercise.

Immunotherapy for allergy-induced asthma

Your doctor may recommend allergy shots (immunotherapy) if an allergy induces asthma attacks and if the allergen cannot be avoided. This treatment may be particularly useful for an allergy to pets, dust mites or pollens.

The purpose of allergy shots is to build up a tolerance by gradually increasing exposure to an allergen. Shots are administered once or twice a week in increasing doses, usually for three to six months. A maintenance dose is administered every two to four weeks for a period of three to five years.

Biological therapy for asthma

A new class of drugs, called biologics, may help target certain cellular substances that promote inflammation during asthma attacks. Your doctor may recommend biological therapy if your child experiences severe asthma that is poorly controlled with other medications. These drugs include benralizumab (Fasenra), dupilumab (Dupixent), and reslizumab (Cinqair).

Medication delivery devices

Most asthma medications are given with a device that allows a child to breathe medication directly into the lungs. Talk to your doctor about the proper use of a device, the delivery options for your child's medication and the appropriate device for your child's needs. Inhalation devices include:

Metered dose inhaler. Small hand-held devices, metered dose inhalers are a common delivery method for asthma medication. This device propels the medication in a puff that needs to be inhaled in a single breath.

An attachment called a spacer can improve medication delivery. A valved holding chamber is a similar attachment, but allows several regular breaths and doesn't allow accidental exhaling into the device.
Dry powder inhaler. This hand-held device doesn't propel the medication. A deep, rapid inhalation activates the release of the drug and is necessary to get a full dose.
Nebulizer. A nebulizer turns medications into a fine mist your child breathes in through a face mask. A nebulizer is a good option for a child who finds it difficult to use other inhalers.

Asthma management with adolescents

Treating asthma requires adherence to an ongoing treatment plan, regular monitoring, adjustments in the plan as needed and self-care. Some studies have shown that asthma management creates a particular set of challenges among adolescents, who are seeking greater autonomy, developing socially and emotionally, and experiencing changes in their relationships with friends and family.

The task of managing a chronic medical condition or taking medication in front of peers may cause embarrassment or self-consciousness. The routine may seem like a burden to greater independence, or there may be denial about the severity of asthma. Adolescents with asthma may be at greater risk of depression and anxiety, and these psychological factors may result in poorer asthma management.

Your child's doctor may address these concerns with several strategies, including the following:

Assessing for symptoms of depression or anxiety
Assessing for risk-taking behaviors
Assessing for proper technique in using medications
Talking with your child about his or her understanding of the disease and the impact of the medication
Talking with your child about how he or she feels about taking medication, especially in front of people
Working with the family to create a plan that gradually shifts more responsibility to your child

Create an action plan

Your doctor can work with you and your adolescent to create a written action plan that outlines self-monitoring and care. You should share the plan with other family members, friends, teachers, coaches and school administrators. A thorough plan includes such things as the following:

Your child's name and age
Physician and emergency contact information
The type, dose and timing of long-term medications
The type and dose of rescue medication
A list of common asthma triggers for your child and tips for avoiding them
A system for rating normal breathing and moderate symptoms and severe symptoms
Instructions for what to do when symptoms occur and when to use rescue medication
Instructions for when to seek emergency care

Monitor and record

Your doctor will likely ask your child to use a peak flow meter at home. This hand-held device measures how well air flows from the lungs when exhaling. It can monitor the effectiveness of your ongoing treatment and assess lung function after using a rescue medication.

You can work with your adolescent to keep a record of peak flow measurements, symptoms and treatment schedule to share with your doctor. These records can help your doctor determine if the long-term treatment plan is effective and make adjustments to the plan. Keep appointments as recommended by your doctor to review records and adjust the action plan as necessary.

Information that should be recorded includes:

Regular, nonattack peak flow measurements as requested by your doctor
The time, duration and circumstances of an asthma attack
Treatment responses to asthma attacks, including peak flow measurements
Peak flow measurements after exercise
Medication side effects
Changes in symptoms
Changes in sleep patterns

Control asthma triggers

Depending on the triggers for your child's asthma, make adjustments as much as possible at home, school and other environments to minimize your child's exposure to triggers. These may include: