How is asthma treated in children?

The aim of asthma medicines is to stop asthma symptoms.

Your child’s GP or asthma nurse will follow expert guidelines on how to treat your child. These cover children under 5 who may not have an asthma diagnosis confirmed yet. And children aged 5-16.

Most children who take their asthma medicines as prescribed and with the right inhaler technique, should:  

• have no symptoms during the day
• not wake up at night because of symptoms
• not need their reliever inhaler (usually blue)
• not have asthma attacks
• not miss school
• not miss out on play or exercise. 

Most children who are diagnosed with asthma have a preventer inhaler and a reliever inhaler. Using a spacer with your child’s metered dose inhaler (MDI) helps the right amount of medicine get to their lungs.  

• Preventer inhalers are the best way to control your child’s asthma. They contain corticosteroids (also known as steroids), which treat inflammation (swelling and narrowing) in your child’s airways. If your child takes their preventer inhaler every day as prescribed, they’re less likely to react to their asthma triggers. Your child’s GP will always aim for the lowest dose possible to prevent symptoms.
• Your child’s reliever inhaler (usually blue) is essential if they start having asthma symptoms or an asthma attack. Make sure it’s always close by, so you or your child can deal with their symptoms quickly.

A good inhaler technique can mean fewer symptoms. It also helps prevent side effects like a sore mouth. Find out more about using inhalers. You can also watch our inhaler technique videos. 

Some children need extra treatments to help them control their symptoms. Your child’s GP may prescribe ’add-on‘ treatments like montelukast or a long-acting bronchodilator. Your child needs to take any add-on treatments alongside their usual preventer inhaler.  

Your child will also still need their reliever inhaler to help when symptoms get worse.

Before prescribing any add-on treatments, your GP or asthma nurse will first:

• check your child is taking all their usual medicines regularly  
• check their inhaler technique
• ask you about any triggers and how well your child is avoiding them. 

Montelukast

Montelukast is a preventer tablet. It can help children whose asthma is not well controlled with just their preventer inhaler. Your doctor might call it an LTRA (leukotriene receptor antagonist).  

Some children taking montelukast get side effects, including nightmares. Talk to your child’s GP or asthma nurse if you’re worried about any side effects.

Find out more about montelukast.  

Long-acting bronchodilators

Long-acting bronchodilators keep your child’s airways open. Your GP may prescribe a long-acting bronchodilator to help your child manage their asthma symptoms better.  

Make sure your GP prescribes a combination inhaler.  

A combination inhaler contains a long-acting bronchodilator medicine and a preventer medicine together in one inhaler. If your child needs a long-acting bronchodilator it is much safer to have it in a combination inhaler.

MART (Maintenance and Reliever Therapy)

Some children may be given a special type of combination inhaler called a MART inhaler. A MART inhaler contains preventer medicine and a certain type of bronchodilator medicine which is long-acting, but can also be used as your child’s emergency reliever inhaler. 

A reliever inhaler, used with a spacer, is the best treatment for symptoms when they get worse, and asthma attacks.

Find out what to do if your child has an asthma attack.  

If your child has an asthma attack and needs to go to hospital, paramedics may give your child reliever medicine through a nebuliser.

They may also need a short course of oral steroids (tablets) to treat their asthma attack.

Find out when you can get your seasonal booster vaccine and how to book it.

A very small number of children with asthma may need specialist support and treatments. This is if the usual asthma treatments plus add-on treatments are not helping as well as they could.  

The specialist team may increase the dose of your child’s steroid preventer inhaler (from a low dose to a medium dose).

Or they may want your child to try steroid tablets - usually prednisolone.

It’s hard to get an asthma diagnosis for children under five. This is because they’re too young to do the usual asthma tests.

• If your child only has asthma symptoms now and then, your GP may suggest a ‘watch and wait’ approach. Some children may only need a reliever inhaler during this time, to take when they get symptoms.  
• If your child is having asthma symptoms three times a week or more, or is waking up at night with symptoms, your GP may want to try some asthma medicines to see if they help. This usually means they will be given a preventer inhaler.

After your child has tried their asthma medicines for six to eight weeks, your GP will check how the medicines worked. If they worked well, it shows that your child is more likely to have asthma. Their GP may suggest that your child continues to take the same asthma medicines until they can do asthma tests to confirm it.

If the asthma medicines make no difference to your child’s symptoms, your GP can look at other reasons for your child’s symptoms and different treatments.  

It can take time to find the right asthma treatments for your child. But your GP or asthma nurse can support you by:  

• checking how your child’s getting on with their medicines
• checking your child’s inhaler technique and making sure they have an inhaler and spacer they find easy to use.

Why does my child need a higher dose?

If your child is still having asthma symptoms, even though they’re taking their preventer inhaler as prescribed, see your GP or asthma nurse to review their treatment plan.  

They may need to increase the dose of their preventer inhaler. As most children start with a ‘very low’ dose, this means they may move to a ‘low’ dose.

Take your child to their regular asthma review so you can check they’re still on the best dose to keep their symptoms under control, and to keep the risk of any side effects low.

Doctors will always aim for the lowest dose possible to keep your child well with their asthma.

Before increasing the dose, your GP will check your child is using their preventer inhaler regularly and well.

They’ll also talk to you about your child’s triggers, including hay fever, cigarette smoke or damp in the house.

It may be that with the right support your child will be able to manage their asthma symptoms without needing to be prescribed higher doses.

Can I reduce my child’s asthma medicine? 

It’s important to take your child to all of their asthma reviews, even if they feel well. They may be able to cut down on the medicine they’re taking if their asthma has been well managed and they’ve had no symptoms for at least three months.  

Find answers to common concerns about your child’s asthma treatments.  

We have more advice on managing your child’s asthma, including helping your child to look after their own asthma