What do Puffers do? The Definition of Asthma, and How to Treat Asthma in Kids

It’s that time of year again when Fall viruses hit and kids everywhere are coughing up a storm. Unfortunately for many kids (and their parents), viral induced coughs and asthma are prevalent and lingering this time of year.

In the depths of winter many children develop colds and coughs. When a child has a persistent cough or difficulty breathing, some physicians will prescribe puffers to help. These children may have asthma (i.e. episodes of recurrent coughing or wheezing) or they may have a viral infection that triggers an inflammatory response in the small airways.

When a child has a persistent cough or difficulty breathing, some physicians will prescribe puffers to help. These children may have asthma, with recurrent episodes of recurrent coughing or wheezing or they may have a viral infection that triggers an inflammatory response in the small airways. In either case, puffers can help open up the airways and clear pesky mucus and inflammation. This can alleviate the cough and lead to better sleep.

How is Asthma Diagnosed?

Asthma is usually diagnosed clinically, with kids having recurrent episodes of persistent coughing or wheezing. Few children will require specialized testing called a methacholine challenge.

Definition of Asthma

Asthma is a chronic inflammatory disease of the airways.

Asthma Pathophysiology

Asthma causes recurring and reversible airflow obstruction and tightening of the airways (bronchospasm)

What are the Symptoms of Asthma?

• Wheezing
• Shortness of breath
• Chest tightness
• Coughing
• Sputum production or vomiting mucous

The most common puffers I see used are Salbutamol (Ventolin) and Fluticasone (Flovent). Here’s how they work:

Salbutamol

(‘the blue one’)

Salbutamol is a bronchodilator. It opens up the airways when they are tight. Salbutamol helps immediately, and will work for a few hours. It is a rescue medication and is to be used when the child is coughing or having difficulty breathing. We typically use it every 4 hours as needed. I find most kids need it more often with sleep, eating or during exercise.

Fluticasone

(‘the orange one’)

Fluticasone is an inhaled steroid and decreases mucus and inflammation over time. We usually prescribe it to be taken morning and night. The medicine will then work through the day to keep the lungs clear of inflammation.

I typically prescribe Salbutamol as needed where there are symptoms of coughing or difficulty breathing and stop when this is no longer a problem. If your child needs it every day, their asthma/cough is not well enough controlled.

Most children can use Fluticasone intermittently when their asthma/cough is flaring up. For virus induced asthma, I start Fluticasone at the beginning of a cold till a week after it is over. This may keep it under better control and reduce visits to the emergency room.

Always use a spacer

(like Aerochamber):

The medicine doesn’t deposit in the lungs properly without an aerochamber. These are plastic devices that space the medicine from the mouth to maximally deposit the particles in the lungs. Without one, most of the medicine goes to the back of the throat, and what’s the point of that?

Watch my video on how to treat a child with a puffer here!

Is your child coughing? Perhaps this article on Croupy Cough will answer a few questions.