By: Clinton Dunn MD, FAAP & Addie Dodson, MD, FAAP
Children with asthma take medication to control symptoms to live a healthy, active life and prevent serious flare-ups that can send them to the hospital. Getting these medicines into your child's body quickly and safely calls for special devices. Here's a guide to asthma medication gear and how to use it correctly.
A quick look at types of asthma medicines for children
There are two kinds of asthma medication your child's doctor may prescribe.
Controller medications help keep your child's airways and lungs working smoothly each day.
Quick-relief medicines or relievers are used only when dangerous symptoms flare up.
It's important to have a personalized asthma action plan. It should list medication your child takes, how often and in what form, and how to handle a breathing emergency. (Here's
how to put your child's asthma action plan together if you don't have one yet.)
The best asthma inhaler for your child's age & stage
Now let's take a look at the different systems that deliver asthma meds. The most widely used systems have a
metered-dose canister—also called a puffer or inhaler—that releases a medicated mist into your child's airways. The canister is used with a
spacer (or holding chamber). The spacer helps regulate the flow of the medicine to be able to reach the lungs.
The type of asthma medicine spacer your child uses will depend on their age and level of development. Here's how they work:
Inhaler spacer with mask
This spacer is designed for babies and toddlers who take asthma medications. A wide tube connects the medicine canister to a small mask that fits over your child's nose and mouth. This video shows you how to make your child comfortable and release the dose while they take deep, slow breaths for about 10 seconds:
Inhaler spacer with mouthpiece
This option is designed for school-age children who have learned to give the medication to themselves. (Adults should oversee the child's medication schedule and oversee each dose.) This spacer consists of a wide tube connecting the canister to a tapered mouthpiece. This video shows the steps your child will follow:
Closed-mouth inhaler
This one-piece system often works well for older kids. It releases a single dose of medication as a mist into an attached mouthpiece, sending concentrated medication directly to the lungs.
Some closed-mouth inhalers are "breath-activated." These deliver medication as soon as your child inhales through the mouthpiece. Press-and-breathe inhalers require your child to push a button to release the dose. This video shows how to use a closed-mouth inhaler:
When inhalers leave a bad taste in the mouth
When using any type of inhaler, your child might notice a strange taste in their mouth after each dose. Although it's unpleasant, the sensation usually fades after a few minutes. Depending on their age, it may be helpful for your child to drink water or use mouthwash after taking the medication. Rinsing the mouth or brushing teeth after using an inhaler that contains corticosteroids may also reduce the risk of oral thrush, an uncommon side effect.
Dry-powder inhalers for children
Some asthma medications use this system, which grinds a tablet into fine powder that your child breathes in. Unlike puffers(inhalers), there's no need to coordinate breathing slowly with dosing. Your child places the tablet in a special chamber, then moves a lever to crack the tablet and grind it up. Then, when they're ready, they take a quick, deep breath to draw the powder into their airways.
With a dry-powder inhaler, your child may not experience a harsh aftertaste. However, younger kids may not have the hand coordination needed to use this device. Your pediatrician or asthma specialist will suggest the system that's likely to work best for your child.
Watch this video showing how to use a dry-powder system:
Nebulizers that work with liquid asthma medicines
A nebulizer is a device that uses an air compressor to turn liquid medicines into a mist that your child breathes in. Though these nebulizer systems are larger than puffers or dry-powder inhalers, some are lightweight and portable.
Your pediatrician may recommend a nebulizer if your child:
Is very young or has trouble controlling their breathing through an inhaler
Has severe symptoms that are best treated with a nebulizer (even if a different method is used for the child's daily controller medication)
Has physical or developmental issues that make inhalers hard to use
Nebulizers release a large volume of medicine, but kids may end up swallowing most of it. Nebulizers also require kids to sit and calmly breathe in their treatments, which may not be ideal with some children's activity levels. A mouthpiece or mask attachment helps assure that more medicine reaches the lungs too.
Tablets and liquid medications for kids with asthma
Your child's asthma action plan might include medicines taken by mouth, either in liquid or pill form. These are more likely to be controller medications that help maintain normal breathing. Your pediatrician or asthma specialist will explain how these drugs work and how to dose your child safely.
Note: Asthma medications may contain the same active ingredients, even when they come in different forms. If you're wondering which medication does what, talk with your child's doctor.
Know what to do when asthma flares up
Fast action during an asthma attack can save your child's life. Share your child's asthma action plan with their school, coaches and other caregivers so they know how to respond.
Call the pediatrician or asthma specialist when:
Your child feels faint, dizzy or weak
Struggles with normal activities
Has a daytime or nighttime cough that won't go away
Wheezes more than usual
Wheezing that won't go away, even after quick-relief medicines
Call 911 immediately if your child:
Breathes a lot faster than usual
Can't talk or walk
Has blue lips or fingernails
Has chest tightness or pain
Opens nostrils wide with every breath (this is called nasal flaring)
Sucks in air so deeply that the skin between their ribs sinks in (this is called retractions)
Partnering with your pediatrician or asthma specialist
Living with asthma can be challenging. Remember that your pediatrician is there for you and your child, no matter what. They can link you with asthma specialists and offer continuous support as your child grows, since symptoms may change with time. Whenever you feel worried about asthma—or any part of your child's health—talk with your pediatrician.
More information
About Dr. Dunn
 Clinton Dunn, MD, FAAP, is a board-certified pediatrician and allergist/immunologist who practices in the Hampton Roads Virginia area. He is a member of the American Academy of Pediatrics (AAP) and the AAP Section on Allergy and Immunology. His clinical interests focus on atopic dermatitis, asthma, food allergy and applying high quality evidence-based medicine for the improvement of pediatric allergic/immunologic diseases.
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About Dr. Dodson Addie Dodson, MD, FAAP, is a board-certified pediatrician and currently completing her fellowship in pediatric pulmonology at Children's Hospital Los Angeles. Dr. Dodson is a member of the AAP Section on Pediatric Pulmonology and Sleep Medicine. She currently serves as the section's executive committee fellow-in-training liaison. Dr. Dodson's clinical interests within pulmonology are growing while she continues in her fellowship, but she has special interests in asthma, use of technology to improve practice, medical education and advocacy.
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