How to manage asthma in kids if medication isn't working?

Question

Hello doctor,

My 12-year-old daughter’s asthma has gotten worse since she started middle school. She had to stop halfway through her last two track meets because she couldn’t catch her breath. The school nurse has already called twice this month; both times were for asthma attacks during physical education class.

We’ve been giving her the brown inhaler every morning and evening as prescribed, but she’s still struggling. She’s feeling discouraged that she can’t keep up with her friends when they’re running, and she’s also starting to miss school.

Her pediatrician gave us a peak flow meter, but her readings are almost always in the yellow zone. We’re doing everything we were told, but it isn’t enough.

Can you please advise us on what to do next?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I can understand how concerning it must be to see your daughter struggling with asthma (a chronic lung disease that causes inflammation and tightening of muscles around the airways, which causes difficulty breathing), especially when it’s impacting her daily activities, school performance, and emotional well-being.

The cornerstone of asthma management is regular use of inhaled medications. The proper inhaler must be used consistently, at the correct dose, and with proper technique to control asthma effectively.

If your daughter hasn’t had a complete evaluation yet, these are the key tests to consider for new or uncontrolled asthma:

Complete blood count (CBC).
Serum total IgE (immunoglobulin E).
Chest X-ray.
Pulmonary function test (spirometry before and after using a bronchodilator).

There are several common reasons why asthma symptoms may continue or worsen:

Coexisting conditions like allergic rhinitis, acid reflux (gastroesophageal reflux disease or GERD), or obesity.
Incorrect use or poor technique with inhalers.
Using the wrong inhaled medications or doses.

If asthma is confirmed, these steps should be followed for better control:

Begin using an inhaler such as Budetrol (Formoterol and Budesonide 200/6) daily, one puff twice a day with a spacer. Always follow it with mouth rinsing. Continue this daily for at least six months, unless otherwise advised by a lung specialist.
To ensure proper delivery, use a spacer (like a MAC spacer) with the inhaler. Spacer technique videos are widely available online.
Follow up regularly with a pulmonologist in person or virtually at least once a month.
Make sure she’s received all age-appropriate vaccines.
Treat other related conditions like nasal allergies or reflux, which can often worsen asthma symptoms.
Have a written asthma action plan that outlines daily care, how to handle worsening symptoms, and when to seek emergency help. This can help her feel more in control.
Identifying and avoiding triggers such as smoke, strong odors, allergens, or certain foods can reduce flare-ups.
Some programs offer asthma education and breathing exercises, which may help improve lung strength and confidence with physical activity.
Encourage a healthy lifestyle, including regular exercise (as tolerated), balanced nutrition, and stress management.
Keep using the peak flow meter daily to track her lung function. This can help you catch early warning signs of worsening asthma. Some apps also allow you to log symptoms and medication use.
Ensure she always has access to her rescue inhaler and knows when and how to use it.
Let her track coaches and teachers know about her asthma so they can support her and watch for symptoms during activities.
Stay in touch with the school nurse about her asthma and any accommodations she might need during physical education or track.

Please complete the tests listed above if they haven't already been done, and follow up in one week with the results. We’ll be able to determine how well her asthma is being controlled and what steps need to be taken next.

Managing asthma can be challenging, especially for an active child, but with the proper support and treatment, most children can live active, healthy lives. You’re doing a great job staying proactive and supportive. Keep up the good work, and I hope she feels better soon.

Please don’t hesitate to reach out with any further questions. We’re here to help.

Thank you.