Treatments: Taking Medications Side Effects Tips

If your child needs a reliever medicine more than 3 - 4 times a week, you should ask your doctor for some kind of preventer treatment. Usually a non-steroid preventer is prescribed. However if this doesn’t stop the attacks then inhaled corticosteroids are usually the next step. Steroid medication is unproved to be safe or effective on children under five years of age so ask about other alternatives such as the non-steroid preventers available.

Taking Medications
There are a number of delivery mechanisms for asthma medication. The choices are between aerosol, powder inhalers, tablet, syrup medication and nebulised. It is important to find one that best suits your child’s needs. Some people fail to get their asthma under control because they are not using their inhalers properly. Tell your doctor if your child is having difficulty or for some reason doesn’t feel happy with the device.

Metered Dose Inhalers
The most common way of treating asthma is by a Metered Dose Inhaler or MDI for short. By using an MDI you inhale the medication straight into your lungs, unlike tablets which have to be digested and absorbed through the bloodstream.

The MDI is generally considered the best way to take asthma medication because:

you get faster, targeted relief
 
a minimal dose can be prescribed
 
there is less risk of side-effects, particularly if the medication is a steroid

However, MDI’s are difficult for young children to use properly, because they require co-ordination in ejecting the drug and inhaling at the correct time. If your child uses an MDI it is recommended they use it with a “spacer” which will ensure more medication is received by the lungs. Basically, a spacer is a plastic apparatus with a space for the MDI at one end and a mouthpiece at the other. A puff of the drug is puffed into the spacer and remains there until it is inhaled through the mouth piece. Spacers with masks are available for very small children.

If you do not feel that your child is getting her medication because of administering difficulties, talk to your doctor. It may mean using tablets or syrup or a Nebuliser until the child can master an inhaler.

Powder Inhalers:
Powder Inhalers dispense the medication in dry powder form. They are quite useful for children, as you simply breathe in to activate these devices, thus eliminating the need for co-ordination.

Tablet and syrups:
Very young children are often prescribed reliever drugs Salbutamol and Terbutaline) in syrup form. Tablet and syrup medications need to be absorbed into the bloodstream to reach the lungs, and this has two effects: they are slower to work and they need to be given in higher doses, thus increasing the risk of side-effects. As a result, doctors will encourage your child to use inhalers as soon as they are able.

Nebulisers:
A nebuliser is a machine that breaks down the medicine into a liquid solution that is then inhaled via a face mask or mouthpiece. Nebulisers are not better than metered dose inhalers, they simply deliver a larger dose of medication which is why they seem to work better.

Many health professionals have concerns about the use of nebulisers for the following reasons:

if they are used on a regular basis you may not recognise that the child’s
 
Asthma is deteriorating or when to seek emergency treatment
 
it is difficult to measure the dosage actually received
 
they need a power supply and are not easily carried around
 
they deliver large doses of medication, raising the risk of side-effects
 
they can cause hypoxia (lack of oxygen in the blood) which can be fatal

Nebulisers should only be used for a young child who cannot manage any inhalers or who has brittle asthma - attacks that build up rapidly with no warning and are life threatening.

If your child inhales steroids via a nebuliser, then she should wear goggles to decrease the risk of glaucoma and carefully wash the face afterwards.

Side-effects:
Asthma drugs do have side-effects. Which ones will depend on the amount of medication she is taking and her individual susceptibility.

Bronchodilators have been associated with the following side-effects - increased heart rate, trembling and headaches. Several studies have indicated that the overuse of relievers can make asthma worse. They should be used only as needed.

Parents are particularly concerned when their child is taking steroids from a young age. When taken orally they can produce alarming side effects, including:

suppression of growth
 
adrenal suppression
 
thinning of bones
 
“moon” shaped face
 
impaired skin collagen synthesis, skin thinning and increased bruising
 
cataracts - especially during treatment with nebulised steroids which may
 
expose the eyes to high doses
 
metabolic disturbances
 
diabetes
 
effect on central nervous system.
 
acne
 
increased blood pressure

If you child has been on oral steroids for more than a few weeks, he or she needs to come off them gradually and under medical supervision. A sudden withdrawal of steroids can make asthma life-threatening.

Inhaled steroids are not as strong as oral steroids and consequently, they have less side effects. However they may have similar side effects if taken in large quantities or when taken over a long period.

In childhood the suppression of growth is the main concern of steroid therapy. Recent controlled clinical studies suggest that inhaled corticosteroids may cause a small reduction in the rate of growth in children. The average reduction in growth rate observed in the studies was about one centimeter (a third of an inch) per year.

Growth retardation has not been reported when inhaled corticosteroid doses were less than or equal to 400 micrograms. However, some cases with individual reactions to low doses of inhaled steroids are known: therefore, close clinical control of children on inhaled steroids is extremely important. It is recommended that children not take more than 800 mcg daily.

Minor side effects of taking inhaled corticosteroids common in 10 to 30% of people taking them are oral candidiasis, dysphonia and coughing.

While all of these side-effects sound alarming, you have to balance them against the severity of your child’s condition. Asthma can range from being a slight nuisance to debilitating and life-threatening. So the risks of the treatment need to be weighed up against the benefits of controlled asthma.

		To effectively manage Asthma It is important for you and your child to establish which triggers cause attacks   Monitor asthma on a day-to-day basis to ensure symptoms are not worsening   Recognise the signs of an imminent attack   Use your management plan to get asthma under control again   Seek medical advice if (A) reliever medication becomes less effective and is required on a more frequent basis, (B) if you or your child become frightened by the severity of the attack.