Two classes of Asthma medicines: reliever medicines and controller medicines
There are two general classes of medicines used to treat asthma: reliever medicines and controller medicines. The reliever medicines are taken during coughing or wheezing attacks as a “quick fix” to stop those symptoms. The controller medicines are taken every day, or every day during certain seasons or during colds, to help to decrease lung inflammation. For some people, it’s enough to have just the reliever medicine if symptoms are mild and infrequent. If they have more frequent attacks or severe but infrequent episodes, they may need to be on a controller medicine, as well.
Frank Twarog, MD, PhD, Allergist
Oral steroids
The steroid medicines that cause kids to be a little hyper are taken by mouth. When kids get really severe attacks and have to come to the hospital, we will give them oral steroids that they may take for a short period of time (usually between four and seven days). There are some kids who have such severe asthma that they have to be on oral steroids all the time, but that’s rare. When kids take the oral steroids I warn parents that their child may be a little more hyper than usual, but that it’s short lived and that not all kids have that reaction. As long as parents know that that’s what will happen and that it’s a relatively short lived effect, I think most parents are comfortable managing that for that short period of time.
Shari Nethersole, MD, Pediatrician
Inhaled steroids
Some parents are really hesitant about using the controller medicines, the inhaled steroids, because they have the word “steroids” in their name. I make sure that parents understand that these inhaled cortical steroids are different than the steroids they hear about on the news, that they are not the same steroids that some athletes abuse and that they don’t do the same kinds of things or have the same kinds of side effects. Parents often worry that if their child takes steroids every day that the steroids will build up over time. There is some absorption you get of the inhaled steroids into your body, but the amount is much less than is absorbed during a five or six day course of oral steroids which are used during asthma attacks. In other words, if a child has two bad asthma attacks over the course of a year and they need to come into the hospital and take the oral steroids for several days each time, the amount of steroids absorbed during those two asthma attacks is more than the kid would get using inhaled controller steroids every single day for a year. I explain to parents that these steroids have been studied and there are no significant side effects from using inhaled steroids on a daily basis. So I try to point out that it’s a risk/benefit thing: there are very few risks and a lot of benefits.
Shari Nethersole, MD, Pediatrician
Most patients can be controlled with inhaled steroids
The majority of patients with asthma can be controlled without oral steroids. Most patients can be brought under control with inhaled steroids, such as medicines called Flovent or Advair, and they don’t have the same kind of toxicity that the oral steroids do.
Hans Oettgen, MD, PhD, Associate Chief, Division of Immunology