Choosing the Best Option for Managing Mild Persistent Asthma in Children

Findings from a recent study can help you work with your doctor to choose the best option for managing your child's mild persistent asthma.

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Asthma is a common illness that can make it hard to breathe. Asthma can range from mild to severe, depending on how often symptoms occur. Children with mild persistent asthma usually have symptoms two or more days each week, but not every day. These children may experience symptoms less often if their asthma is well-controlled.

Children and teens use different kinds of inhalers to help control their asthma symptoms. Inhalers are handheld devices that push medicine into a person’s lungs. The medicine is in the form of a mist or spray. A quick-relief inhaler is used when symptoms get worse, which may happen suddenly. This inhaler usually contains a medicine called albuterol. A control inhaler helps prevent asthma symptoms. It usually contains corticosteroids. This inhaler can keep daily symptoms from getting worse.

Findings

A PCORI-funded study of children and teens with mild persistent asthma found that using the control inhaler as needed worked the same as daily use in improving asthma control, number of asthma flares, how well the lungs work, and quality of life. Children and teens using the inhaler as needed used about one-fourth the amount of corticosteroid medicine as children and teens using it daily.

There are two main approaches for using a control inhaler:

Daily use, as directed by the doctor. Children use their control inhaler every day, whether or not they have symptoms that day. Doctors adjust the amount of medicine in the inhaler when necessary.

Symptom-based, or as-needed, use. Children use their control inhaler only on days when they have symptoms and need to use their quick-relief inhaler. Children using this approach use less corticosteroid medicine overall.

The research team wanted to see if using a control inhaler as needed worked as well as using it every day for children and teens who have mild persistent asthma.

Daily use of the control inhaler may not work well if parents and children can’t visit the doctor regularly or if they often get care in the emergency room. Also, some families may prefer the as-needed approach because it doesn’t rely on repeated doctor visits. But as-needed use of the control inhaler may not work well if parents and children don’t recognize asthma flares when they happen.

Questions to Ask My Child's Doctor

You may want to talk with your doctor about which treatment approach—daily or as needed—would work best for your child. Your doctor can help you create an Asthma Action Plan that best fits your lifestyle and needs. Questions to ask your doctor might include:

Is using a control inhaler only as needed, rather than daily, an option for my child?

Is there anything about my child’s asthma that we should think about when choosing an approach to managing asthma?

What else should we consider when making this choice?

If we use the as-needed approach, how can we tell if it’s working well to control my child’s asthma?

Be sure that the treatment approach you choose with your doctor is written in your child’s Asthma Action Plan. If your child has asthma symptoms, the Asthma Action Plan will help other people in your child’s life, such as other family members, school nurses, and teachers, know how to treat your child.

About the Study

In 2013, PCORI launched an initiative called Treatment Options for African Americans and Hispanics/Latinos with Uncontrolled Asthma to fund research studies on this topic. African-American children are more likely than other children to have asthma and to get sicker and die from it. In this study, the research team enrolled 206 African American children and teens ages 6-17 with mild persistent asthma. The research team assigned the children and teens by chance to use their control inhaler daily or only as needed based on their symptoms. Then the team looked at the health outcomes for the children and teens after one year.

Read more about this study at www.pcori.org/Sumino282

Download this Evidence Update

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Partner logos for the PCORI Evidence Update on Choosing the Best Option for Managing Mild Persistent Asthma in Children: The logos for PCORI and the Allergy & Asthma Network

Sources

© 2011–2021 Patient-Centered Outcomes Research Institute. “Comparing Two Ways to Manage Asthma in African American Children -- The ASIST Study.” Last Updated September 30, 2020. https://www.pcori.org/Sumino282

Sumino K, Bacharier LB, Taylor J, et al. A Pragmatic Trial of Symptom-Based Inhaled Corticosteroid Use in African-American Children with Mild Asthma. J Allergy Clin Immunol In Practice. 2020; 8(1): 176-185 e2. https://doi.org/10.1016/j.jaip.2019.06.030

The information in this publication is not intended to be a substitute for professional medical advice. This update summarizes findings from a PCORI research award to Kaiser Permanente Washington Health Research Institute.

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