Treatment Of Childhood Asthma

 Beta Agonists
These are the most commonly prescribed asthma drugs in children. The most widely used of the beta agonists is albuterol, sold under a number of trade names such as Ventolin and Proventil. These drugs work by stimulating beta receptors on the surface of the muscles surrounding the airways. When these receptors are stimulated, they send signals to the muscle to relax, thereby easing the bronchospasm during the early phase of asthma. This will help asthma symptoms, but do little to control the underlying inflammation. Beta receptors exist in other parts of the body and when stimulated can cause side effects, most notably hyperactivity, increased heart rate, and jitteriness. These medicines can be administered in a several ways, including orally, by injection, inhaler, or in a nebulizer.

Theophylline
This is one of the oldest drugs used to treat asthma. While still widely used in adults, it is not as frequently used in children any more. Its method of action is still not entirely known, but it is used primarily to relieve symptoms, not control inflammation. It has a lot of side effects. When first taken, this drug may make a child feel jittery or nauseous. If too much medication is used, it can cause heart palpitations, insomnia, agitation, or vomiting, and blood levels must be monitored to insure safe use of the medication. Theophylline is administered orally or intravenously.

Mast cell stabilizers
This class of drugs is very useful. They prevent mast cells from calling up the inflammatory response and thus are very effective in preventing inflammation. They are not useful in an acute attack since they do not actually relieve symptoms, but instead help control the underlying inflammatory process. The most commonly used of these drugs are cromolyn and nedcromil, sold under the brand names of Intal and Tilade. These medicines are available by inhaler or nebulizer only. They have extremely few side effects.

Leukotriene inhibitors
This is a new class of drugs and has just recently come into use. These drugs inhibit the inflammatory effects of leukotrienes. They help control the inflammatory response in asthma and are taken orally. Trade names include Singulair and Accolate. The medications have some side effects and are not helpful in relieving immediate symptoms.

Steroids
Steroids are the most potent anti-inflammatory agents known. Taken orally, they are very effective in the relief of all asthma symptoms as well as in the relief of inflammation. Unfortunately, oral steroids such as prednisone, dexamethasone, and others can have severe side effects, particularly when used for more than 1 week at a time. If used for extended periods, they may result in a number of unfortunate side effects, including poor wound healing and stunted growth. They are most useful for short "bursts" of treatment to improve the condition of the patient. Fortunately, steroids have been developed that can be used in an inhaler. These can be given chronically with excellent results and much fewer side effects. Close monitoring is essential when using this class of medications.

Monoclonal Antibodies are also finding their way into the management of Asthma. Omalizumab (?Xolair) was approved by the FDA in 2003 for patients who are inadequately controlled on the current regimen of corticosteroids and broncodilators. This medication is indicated only for patients 12 years and up, with a positive skin test, who have moderate to severe uncontrolled asthma. Omalizumab works by blocking the IG-E antibody from attaching to some of the inflammatory cells, such as mast cells and basophiles, thereby reducing the symptoms of asthma.

Some of the major concerns of this new approach to treating asthma is the growing concern of malignancy and sever allergic reaction known as anaphylaxis. The other major drawback is the fact that it is currently only available in an injectable form. Thus it is important to consult with the doctor regarding such precautions.

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