Asthma begins with inflammation: The lining of the airways – the breathing tubes leading into your child’s lungs – becomes swollen, inflamed and clogged with mucus and fluid.

The muscles surrounding the airways tighten and contract as they try to keep the passageways open. Inhaled allergens or irritants like secondhand smoke and air pollution act like sandpaper on the raw surfaces. Your child begins to cough and wheeze as he or she struggles to breathe. This is called bronchospasm.

You can prevent asthma symptoms by avoiding the allergens, irritants and infections that inflame and irritate the airways.

There is also a wide range of medications that prevent and treat inflammation and bronchospasm.

Inhaled medications go straight to the airways. There are three types of delivery devices:

• Nebulizer: ^[1] breaks liquid medicine into a mist that can be inhaled slowly; babies and toddlers should always use a mask with their nebulizer
• Metered-dose inhaler ^[2] (MDI): delivers aerosolized medication directly to the airways; children should use a valved holding chamber ^[3], with or without a mask, to increase MDI efficiency
• Dry powder inhaler (DPI): delivers micron-sized particles so lightweight they may seem to float past the throat and into the airways; some DPIs require a forceful inhalation difficult for young children to achieve
• Oral medications are swallowed as pills, tablets or liquids; they reach the airways by circulating through the bloodstream.

There are three basic types of asthma medications: bronchodilators ^[4], anti-inflammatories ^[5] and leukotriene modifiers ^[6].  Each asthma medication your child’s physician prescribes treats a different stage in the asthma process.

Bronchodilators – relax and open the airways to relieve the noisy symptoms of asthma such as wheezing, coughing, choking and shortness of breath.

Short-acting bronchodilators

• will relax the airways and make it easier to breathe within minutes. In addition, many children use short-acting bronchodilators to prevent exercise-induced bronchospasm.
• Some people mistakenly call these “rescue” medications but is a life-threatening misunderstanding. Short-acting bronchodilators should be used to relieve breathing at the first sign of symptoms – the earlier you use the medication, the less you are likely to need.  Don’t wait until your child needs “rescuing”!
• If your child needs to use a bronchodilator more than twice a week (except to prevent symptoms before exercise), that’s a sign of ongoing inflammation; ask your physician about anti-inflammatory medications.
• Short-acting bronchodilators (also called beta2-agonists) include: albuterol (brand names AccuNeb®, ProAir® HFA, Proventil® HFA, Ventolin® HFA), levalbuterol (Xopenex®), pirbuterol (MaxAir®), theophylline

Anticholinergics

• are alternative bronchodilators for children who do not tolerate beta2-agonists, or as add-on medication for acute episodes
• Anticholinergics include: ipratropium (Atrovent® HFA), tiotropium (Spiriva®)

Long-acting (12-hour) bronchodilators

• begin to work gradually and relieve noisy symptoms for up to 12 hours. FDA recommends these medications only as add-on therapy for children already using anti-inflammatory medication.
• Long-acting bronchodilators should not be used to treat acute symptoms of asthma.
• Long-acting bronchodilators include: formoterol (Foradil®), salmeterol (Serevent®)

Anti-inflammatories treat inflammation — the quiet part of asthma that you cannot see or hear happening in your child’s airway. Just as daily brushing with a fluoride toothpaste protects against dental cavities, anti-inflammatory medications protect against the damaging effects of asthma symptoms caused by airway inflammation.

After using an anti-inflammatory medication, your child won’t feel different and you won’t see any immediate changes. That’s because it takes time for airway swelling to subside and the mucus and excess fluid to clear out of the airways. These medications usually need to be taken every day – to prevent symptoms and attacks from occurring.

Anti-inflammatories are sometimes called “controllers,” but like “rescue” this is a misleading and incorrect term. Your asthma action plan will tell you exactly when and why to take your different medications. Learn the correct names and skip the slang shortcuts.

Inhaled corticosteroids

• are the most effective long-term therapy available for asthma. Taken as prescribed, they reduce and prevent fluid and excess mucus and swelling in the airways. Because it is inhaled, the medicine goes directly to the inflamed airways.
• Parents are often tempted to stop using inhaled corticosteroids or other medications when their children with asthma are symptom-free and appear to be well.  However, you would never instruct your children to stop brushing their teeth just because they have no cavities!
• Inhaled corticosteroids include: beclomethasone (QVAR®), budesonide (Pulmicort®), ciclesonide (Alvesco®), flunisolide (AeroBid®), fluticasone (Flovent®), mometasone (Asmanex®), triamcinolone (Azmacort®)

Oral corticosteroids

• may be taken to treat acute asthma episode or severe asthma. They are usually taken for short periods of time to prevent unwanted side effects.
• Oral corticosteroids include: prednisone, prednisolone (Prelone, Pediapred™, Orapred™)

Non-steroidal anti-inflammatory medications

• such as mast cell stabilizers help reduce inflammation, prevent exercise-induced asthma and decrease allergic cellreactions.
• Non-steroidal anti-inflammatories include: cromolyn sodium (Intal®), nedocromil sodium)

Combination medications

• combine an anti-inflammatory corticosteroid with a long-acting bronchodilator and are usually prescribed as daily medications. These medications should NOT be used to treat sudden or severe symptoms of asthma.
• Combination medications include: fluticasone/salmeterol (Advair®), budesonide/formoterol (Symbicort®)

Leukotriene modifiers are oral medications (pills or liquid) that help stop allergens and irritants from increasing inflammation or irritating airways by interrupting one of the many complex immune processes that precede airway inflammation.

• Leukotriene modifiers include: montelukast (Singulair®), zafirlukast (Accolate®)