Treatment of bronchial asthma in children

The basis of therapy for bronchial asthma in children is anti-inflammatory therapy.

Anti-inflammatory therapy includes: cromolyn sodium (intal), sodium nedocromyl (tiled), glucocorticosteroids, antileukotriene drugs, antiallergic drugs. 

Cromones (intal, tayled, kropoz) protect the mucous membrane of the respiratory tract and inhibit the action of substances that cause allergic inflammation, preventing exacerbation of bronchial asthma. These drugs are used in the treatment of children with mild forms and in some patients with moderate asthma. Long-term treatment with cromons reduces the frequency of exacerbations of bronchial asthma and reduces the need for other medications. Cromones are available in inhaled forms. Their side effect is minimal, addiction does not develop to them. In rare cases, after inhalation, a sore throat, cough occurs.  

Inhaled corticosteroids have a local, anti-inflammatory effect that is superior to that of cromones. The most common inhaled corticosteroids include beclomethasone, fluticasone, budesonide. 

Inhaled corticosteroids as well as cromons are prophylactic drugs, the purpose of their appointment is to reduce inflammation in the mucous membrane of the respiratory tract, and prevent asthma attacks.

The dose and duration of treatment are determined by the doctor depending on the age of the child and the severity of the course of bronchial asthma. When using IR: 

  • Be sure to rinse your mouth and throat after inhalation
  • No immediate effect expected
  • Sudden drug withdrawal is unacceptable
  • The duration of treatment and the dose of the medicine are determined by the doctor

Currently, combined preparations (Seretide / Symbicort) have been created containing inhaled corticosteroids (fluticasone / budesonide) and long-acting bronchodilators (salmeterol / formoterol).

Their advantage is the ability to achieve control of asthma with low doses of hormonal drugs, the prevention of exacerbations of asthma.

Seretide is used in children from 4 years old, Symbicort – from 12 years old .

Leukotriene inhibitors and second- generation antihistamines prevent and reduce allergic reactions in the airways. More often used for mild asthma or as an addition to other anti-asthma therapy.  

For children with mild to moderate asthma, anti-inflammatory therapy is carried out using non-steroidal anti-inflammatory drugs; in severe cases, inhaled corticosteroids must be used.

One of the causes of widespread phobia in the administration of drugs is due to the uncontrolled administration of systemic drugs, the use of which is very limited. Inhaled corticosteroids have a significant advantage over systemic drugs.

In children of the first years of life, when asthma is combined with allergic manifestations of a different localization, ketotifen, which has a wide spectrum of antiallergic activity, can be used.   

In patients with moderate to severe asthma, the effectiveness of anti-inflammatory therapy is increased by the administration of prolonged theophyllins or prolonged beta 2-agonists.   

With an insufficient effect of basic therapy, prolonged bronchodilators are added to the therapy complex . 

Antileukotriene preparations . In connection with the proven role of leukotrienes in the formation of the most important pathogenetic links in asthma, the use of these drugs has become a promising area of ​​pharmacological correction in children with mild to moderate asthma.

Ketotifen (zaditen ) has the ability to inhibit the synthesis and excretion of allergy mediators, inhibits the development of allergic inflammation in the airways, skin, gastrointestinal tract, the drug reduces bronchial hyperreactivity. For this reason, ketotifen is used in the treatment of asthma in children with mild to moderate asthma, especially in young children when combined with skin or gastrointestinal allergies.

Antiallergic immunoglobulin, histaglobulin . The use of these drugs can lead to a reduction in exacerbations and a milder course of AD in children, and in some of them to achieve clinical remission of the disease. In patients treated with these drugs, there is a decrease in the incidence of acute respiratory infection.

Specific immunotherapy .

In pediatric allergology, SIT is a fairly common treatment method and has been used for over 30 years. This pathogenetically substantiated method for the treatment of AD, hay fever, allergic rhinosinusitis, conjunctivitis consists in the introduction of increasing doses of one or more cause-significant allergens to the patient’s body. The effectiveness of this method in bronchial asthma is due to many mechanisms, in particular, is associated with a decrease in the activity and proliferation of Th1 and an increase in the activity and proliferation of Th1 CD 4+ lymphocytes and an increase in the production of blocking IgG antibodies.   

In AD in children, SIT is carried out by house dust allergens , Dermatophagoides pteronyssimus, Dermatophagoides farinae, pollen, epidermal and fungal allergens. SIT is indicated for children with atopic bronchial asthma of mild and moderate course with clear evidence of the causative significance of allergens, in cases of low effectiveness of the pharmacotherapy and the inability to eliminate cause-significant allergens from the environment.  

Emergency drugs.

Short-acting beta2-agonists (salbutamol, terbutaline, fenoterol). When inhaled, they give a quick, after 5-10 minutes, bronchodilating effect. Drugs of this series can be used to relieve asthma attacks, for the prevention of asthma attacks associated with physical stress.

Short-acting inhaled beta 2 agonists are prescribed no more than 4 times a day. In order to stabilize the condition of patients can be carried out short, up to 7-10 days, treatment courses.

For mild seizures, oral forms of beta 2 agonists (salbutamol, ventolin) can be used. With an increase in the frequency of use of agonists more than 3-4 times a day, a review and strengthening of basic therapy is necessary.

The main drugs of the beta 2-agonist group.

International nameTradenameDaily dose
Short-acting beta2 agonists  
SalbutamolVentolin, Salbutamol400 mcg
TerbutalineBrikanil1000 mcg
FenoterolBerotek400 mcg
Long-acting beta2-agonists  
SalmeterolSerevent100 mcg
FormoterolForadil24 mcg

Indications for the hospitalization of children with asthma

With exacerbation of bronchial asthma in children, referral to inpatient treatment is indicated in the following situations:

  • Inability or inefficiency (within 1-3 hours) of treatment at home
  • Severe severity of the patient’s condition
  • Children at high risk for complications and for social reasons
  • If necessary, establish the nature and selection of therapies for the first time asphyxiation attacks.

Non-drug treatments:

  1. Diet therapy
  2. Respiratory therapy
  3. Massage and vibration massage
  4. Physiotherapy
  5. Speleotherapy and mountain climatic treatment
  6. Physiotherapy
  7. Acupuncture
  8. Phytotherapy
  9. psychotherapy
event_note May 9, 2020

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