Asthma medications for children age 5 and younger

It can be difficult to decide how to use asthma medication in children age 5 and younger. Children in this age group who have moderate persistent to severe persistent asthma need to be under the care of a specialist. Children younger than 5 who have mild persistent asthma sometimes may need an asthma specialist.

Nebulizers are often used for babies and children who are too young to properly use inhalers. Nebulizers for small children have a face mask that ensures that they inhale the medication. Using a metered-dose inhaler with a spacer and face mask for babies is just as effective as using a nebulizer.

Studies that compare medications in this age range aren't available. However, the U.S. National Asthma Education and Prevention Program (NAEPP) has recommended the following approach for using medication in children age 5 and younger.¹

**Asthma medicine recommendations for children**
Asthma severity	Medicines required to maintain long-term control
Severe persistent	Preferred: High-dose inhaled corticosteroids, AND Long-acting inhaled beta2-agonists, AND IF NEEDED Corticosteroid tablets or syrup long-term (2 mg/kg/day, generally not to exceed 60 mg/day). Make repeated attempts to reduce tablets or syrup, and maintain control with high-dose inhaled corticosteroids. Treatment by a specialist is recommended if your child is using oral corticosteroids long-term.
Moderate persistent	Preferred: Low-dose inhaled corticosteroids and long-acting inhaled beta2-agonists OR Medium-dose inhaled corticosteroids Alternative: Low-dose inhaled corticosteroids and either leukotriene pathway modifier (also called leukotriene receptor antagonist) or theophylline (a methylxanthine)
Moderate persistent	If needed (particularly in children with recurring severe attacks): Preferred: Medium-dose inhaled corticosteroids and long-acting beta2-agonists Alternative: Medium-dose inhaled corticosteroids and either leukotriene pathway modifier or theophylline
Mild persistent	Preferred: Low-dose inhaled corticosteroid Alternative: Cromolyn (a mast cell stabilizer) OR leukotriene pathway modifier
Intermittent	No daily medication needed
Quick relief: All patients	Bronchodilator as needed for symptoms. Intensity of treatment will depend on severity of attack. Preferred: Short-acting beta2-agonists With viral respiratory infection: Bronchodilator every 4 to 6 hours up to 24 hours (longer with physician consult); in general, repeat no more than once every 6 weeks. Consider systemic corticosteroid if attack is severe or if child has a history of previous severe attacks. Use of short-acting beta2-agonists on more than 2 days a week in intermittent asthma (daily, or increasing use in persistent asthma) may indicate the need to start or increase long-term control therapy.

Leukotriene pathway modifiers are available in oral formulations (swallowed rather than inhaled) that may be more convenient for young children.

Cromolyn and nedocromil (mast cell stabilizers) are alternatives in mild persistent asthma, but they do not control asthma as consistently as corticosteroids.²

Infants and young children should receive long-term treatment if they have had more 4 or more wheezing episodes in the past year lasting more than 1 day and they have risk factors for asthma such as allergic rhinitis or a parent with asthma.³

If your child has severe asthma attacks, he or she may need to take corticosteroids by mouth. Corticosteroids by mouth also may be necessary at the beginning of a viral respiratory infection.

In moderate persistent or severe persistent asthma, using a long-acting inhaled beta2-agonist (bronchodilator) along with inhaled corticosteroids is the best combination of medications to improve lung function and symptoms and to reduce overuse of quick-relief medications.¹

A leukotriene pathway modifier or theophylline also may be added to corticosteroids, but they do not improve asthma control as well as a long-acting inhaled beta2-agonist added to corticosteroids.

References

Citations

National Institutes of Health (2002). National Asthma Education and Prevention Program Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma—Update on Selected Topics 2002. Clinical Practice Guidelines (NIH Publication No. 02–5075). Bethesda, MD: U.S. Department of Health and Human Services.

National Institutes of Health (1997). Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. Clinical Practice Guidelines (NIH Publication No. 97-4051). Bethesda, MD: U.S. Department of Health and Human Services.

National Heart, Lung, and Blood Institute (2007). Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. Available online: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.

Credits

Author	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Denele Ivins
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Harold S. Nelson, MD - Allergy and Immunology
Last Updated	March 22, 2007