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Asthma Treatment

Your child’s asthma can be controlled by taking medication as prescribed by their doctor and by avoiding triggers that may cause asthma symptoms.

Types of asthma medication

There are two types of asthma medications: long-term control and quick relief. Both types can be delivered through either an inhaler or nebulizer.

Long-term asthma control medications

  • Generally taken every day, even when not experiencing asthma symptoms,
  • Keeps asthma under control by reducing swelling and extra mucus in the airways,
  • Makes it less likely to have an asthma episode, and
  • Comes in dry powder inhalers, metered dose inhalers, and pills. 

Quick-relief medications

  • Relieves the squeezing and tightness in the airways,
  • Used as needed for rapid symptom relief during an asthma episode,
  • Should always be available to your child,
  • Should be used when your child feels the first signs of an asthma episode, and
  • May be used before physical activity (even if no symptoms), if recommended by a healthcare provider.

SMART Therapy

The standard asthma treatment described above uses different inhalers for maintenance (control) and rescue (quick-relief) treatment. However, with SMART therapy, your child uses only one inhaler to control their asthma. SMART therapy refers to Single Maintenance and Reliever Therapy.2 This single medication is used for both control and quick-relief. SMART therapy can help minimize the possible negative side effects of long-term steroid use. It can also decrease emergency department visits and hospital stays while also making it easier for your child to take medication consistently.3 

SMART therapy is recommended for children with mild to severe persistent asthma.4 Quick-relief  inhalers usually have only a bronchodilator (which acts to decrease the muscles squeezing around the airways), while maintenance medications contain anti-inflammatory inhaled corticosteroids (which act to decrease the thickness of the airways and the mucus in the airways). However, with SMART therapy, the inhaler combines both an anti-inflammatory inhaled corticosteroid and an inhaled long-acting beta-2 agonist (LABA).5

Currently, you can find this medication combination in two inhalers:

  • budesonide/formoterol (Symbicort®)
  • mometasone/formoterol (Dulera®)

SMART therapy medication is taken in two doses daily, either together or one dose twice daily.

According to asthma guidelines, SMART therapy is recommended for children four years and older with mild to severe persistent asthma. It might also be an option for mild intermittent asthma on an as-needed basis.6 It’s considered an easier treatment plan to follow than standard asthma therapy. Speak with your healthcare provider to see if SMART therapy is right for your child.

Methods of Administering Medication

There are different delivery methods to administer asthma medicine – metered dose inhaler, dry powder inhaler, pill, spacer/holding chamber, and nebulizer.

Metered Dose Inhaler (MDI)

A metered dose inhaler uses an aerosol canister to spray mists of medicine.

Steps to use a metered dose inhaler
  1. Remove any candy, food, or gum from mouth.
  2. Stand up straight.
  3. Take the cap off the inhaler. Make sure to clean out any dust or fuzz so there is nothing inside.
  4. Shake the inhaler for five seconds.
  5. Away from the inhaler, take a deep breath in and breathe out slowly to empty the lungs completely.
  6. Place the inhaler mouthpiece inside the mouth and seal the lips tightly around the mouthpiece.
  7. Press down on the inhaler and at the same time take a quick breath in.
  8. Hold breath for 10 seconds and then breathe out.
  9. Repeat if directions say to do more than 1 puff.
  10. When done with all puffs, if using a controller medicine, rinse the mouth with water and spit water.
Spacer or Holding Chamber

A spacer, or holding chamber, is an add-on device that should be used with metered dose inhalers only. It is a long tube that helps ensure the asthma medicine reaches your child’s lungs slowly and effectively. It is best to use a spacer or holding chamber with their metered dose inhaler because it is hard to coordinate pushing down and breathing in all the medicine at the same time. A spacer is not used with inhaler types other than the metered dose inhaler. 

Steps to use a metered dose inhaler with spacer/holding chamber
  1. Remove any candy, food, or gum from the mouth.
  2. Stand up straight.
  3. Remove the caps of the inhaler and spacer and attach them together. Make sure to clean out any dust or fuzz in both.
  4. Shake the inhaler and spacer for five seconds.
  5. Away from the inhaler and spacer/holding chamber, take a deep breath in and breathe out slowly to empty the lungs completely.
  6. Put the spacer in the mouth and seal the lips around the mouthpiece. If the spacer has a face mask, place the mask firmly on the face.
  7. Press down on the inhaler and take a slow deep breath in.
  8. Hold breath for 10 seconds and then breathe out.
  9. If using a controller medicine, rinse your mouth with water and spit water out.

Children who cannot control their breathing (for example breathe in and hold their breath) should use a face mask along with the spacer and metered dose inhaler. Once they press on the inhaler, children using a face mask should take 6 breaths in and out with the face mask on their face to inhale all the medication.

More information about MDIs and spacers, including how to clean them, is included in the Appendices.

Care and Cleaning of a Metered Dose Inhaler and Spacer
  • Clean your spacer and MDI each week to prevent the buildup of medicine and/or dust. 
  • To clean your inhaler, remove the medical canister from the L-shaped plastic rube. Rinse only the plastic pieces in warm water and let them dry overnight. Do not clean the canister.
  • To clean your spacer, take it apart (per manufacturer’s instructions) and wash each piece separately with warm, soapy water. Do not rinse. Let it air-dry.
Dry Powder Inhaler (DPI)

Steps to use a dry powder inhaler

  1. Remove candy, food, or gum from your mouth.
  2. Stand up straight.
  3. Hold the inhaler level to the floor.
  4. Open the inhaler with the mouthpiece facing you.
  5. Slide the lever away your child until you hear it click. This means the medicine has been released. Be careful not to tip the inhaler or slide the lever again; the medicine will fall out and it will be wasted.
  6. Take a deep breath in and breathe out.
  7. Place the inhaler in the mouth, seal lips tightly around it and take a quick, deep breath in.
  8. Hold breath for 10 seconds, and then breathe out.
  9. Rinse mouth with water and spit water out.
Nebulizer

Nebulizers are small air compressors used to change liquid medicine to mist that is easy to inhale through the mouthpiece of mask. Both long-term controller medicine and quick-relief medicine can be administered using a nebulizer. The medicine comes in liquid vials. One nebulizer treatment takes approximately 10 minutes.

Steps to use a nebulizer

  1. Wash hands.
  2. Open the medication cup and fill it with medicine as directions say or as instructed by healthcare provider.
  3. Secure the cap.
  4. Attach either a mouthpiece or mask to the end of the medication cup.
  5. Hook one end of the tubing to the medication cup and the other end to the nebulizer.
  6. If using a mouthpiece, seal lips tightly around the mouthpiece. If using a mask, place mask firmly on the face.
  7. Turn on the nebulizer. Breathe normally through the mouthpiece or mask. Continue until you no longer see the medication mist (about 10 minutes).
Care and Cleaning of Nebulizer
  • It is important to clean the nebulizer to prevent infections. 
  • Always wash hands prior to touching medicine.
  • After each use, remove the medication cup and rinse with warm water. Place on paper towel and allow to air dry.
  • Once a week clean medication cup in mild soapy water or one part vinegar and two parts water. Rinse well and place on a paper towel to air-dry. 

2https://allergyasthmanetwork.org/news/asthma-smart-therapy/

3Asthma Management Guidelines: https://www.aafp.org/pubs/afp/issues/2021/1100/p446.html

4Asthma Management Guidelines: https://www.aafp.org/pubs/afp/issues/2021/1100/p446.html

5https://allergyasthmanetwork.org/news/asthma-smart-therapy/

6Asthma Management Guidelines: https://www.aafp.org/pubs/afp/issues/2021/1100/p446.html