Many young people are prone to developing intermittent wheezing, usually with viral respiratory infections that can be potentially severe. This is an important issue this time of year when respiratory viruses become more common.
Various strategies have been used to prevent these episodes, including treating the child with inhaled steroids or the asthma pill Singulair year round. Another strategy is to start the inhaled steroid the moment the patient comes down with a cold and treating for about 7 to 10 days.
There was a recent study in the medical journal Pediatrics that compared these different strategies. They found that all three strategies are about equally effective in reducing significant asthma exacerbations. These treatments all decrease the likelihood of a bad exacerbation by about 30-40%.
It is important to recognize that recurrent wheezing, which may be able to be treated with just “as needed” inhaled steroids, is a different type of asthma from “persistent asthma.” Persistent asthma is when the patient has asthma symptoms such as wheezing, chest tightness, shortness of breath, and coughing on a regular basis, usually more than twice a week. This type of asthma almost always requires daily therapy to prevent symptoms and complications.
Another important concept relating to recurrent wheezing is that if patients do not respond to the three strategies described above, they often will do very well by receiving a daily preventive treatment with a “combination inhaler.” Combination inhalers contain both an inhaled steroid, as well as a second ingredient called a long-acting bronchodilator. If your child has either symptoms of recurrent wheezing or more persistent asthma, we can discuss the best treatment strategies for your individual case.