There are two types of inhaled asthma medicines:
Preventer inhalers prevent the inflammation (swelling) inside the airways, which is the underlying cause of asthma. These inhalers also reduce the amount of mucus produced inside the airways and the long-term damage to the lungs. Most preventer inhalers contain a type of medicine called a corticosteroid. These reduce the risk of an asthma flare-up and need to be used every day as a regular scheduled maintenance treatment to help keep your child’s asthma under control. Some preventer inhalers contain a single ingredient medicine only and others contain a combination of two medicines. Depending on the severity of their asthma, not all children will be prescribed a preventer inhaler.
Single ingredient preventer inhalers for children include Flixotide®, Pulmicort®, Beclazone® and Qvar®. These medicines need to be taken every day as a regular scheduled maintenance treatment. If your child only takes their preventer inhaler occasionally, or stops taking it when they are feeling well, it can cause their asthma to flare-up and get worse.
These inhalers need to be used with a separate fast-acting reliever inhaler like Ventolin®, Respigen®*, SalAir® or Bricanyl®, which provide immediate relief of asthma symptoms (cough, wheeze, tightness in the chest, shortness of breath).
Combination 2-in-1 inhalers contain both a preventer medicine and a long-acting reliever medicine in one inhaler.
These inhalers also need to be taken every day as a regular scheduled maintenance treatment and used alongside a separate fast-acting reliever inhaler like Ventolin®, Respigen®*, SalAir®, or Bricanyl® to provide immediate relief of asthma symptoms (cough, wheeze, tightness in the chest, shortness of breath).
Children with moderate to severe asthma may be prescribed the combination inhaler Symbicort®, on specialist advice. This medicine can be used as both a regular scheduled maintenance AND a reliever treatment. This means that you use this inhaler every day as you would a preventer inhaler and also when needed for the immediate relief of asthma symptoms (cough, wheeze, tightness in the chest, shortness of breath). There is no need to use a separate fast-acting reliever inhaler when using Symbicort®.
All types of preventer inhalers in New Zealand contain an anti-inflammatory medicine called a corticosteroid. This is sometimes referred to as a ‘steroid’. Corticosteroids are not the same as steroids used by body builders. There is a huge amount of research which shows that inhaled corticosteroids are effective and safe when used long-term.
It is important that children use their preventer medicine (if prescribed) every day as a maintenance treatment to control their asthma, rather than relying on just their reliever inhaler when their asthma flares up.
There can be side effects from preventer inhalers. These can include a husky voice, a sore throat or oral thrush. These side effects can be reduced by using a spacer (if you are using a puffer inhaler) and getting your child to rinse their mouth with water and spit out after using their preventer inhaler.
Reliever inhalers relax the tightened bands of muscle around your child’s airways to help the air flow in and out more freely. Relievers work quickly, within five minutes, to relieve symptoms like wheezing, coughing, tightness in the chest and breathlessness. These are used as needed to deal with asthma symptoms or before exercise. In children under 12 years of age, a reliever inhaler can be used on its own for the treatment of mild asthma.
Common reliever inhalers include Ventolin®, Respigen®* and SalAir®. All three of these inhalers contain the same medicine, salbutamol, and give the same dose. There is also another reliever called Bricanyl®. This contains a medicine called terbutaline which works in a similar way to salbutamol.
If you child needs to use their reliever inhaler more than twice a week for symptoms, then their asthma is not under control, and you should get them checked by your healthcare practitioner.
*Note: The Respigen brand of salbutamol inhaler has been discontinued, due to the factory making Respigen inhalers being closed down (Pharmac notification, 11 October 2023). There may still be some stock in the supply chain, hence its inclusion in the information above.
Your healthcare practitioner may prescribe additional medication if your child’s asthma remains uncontrolled, even with regular inhaler use.
Your child may be prescribed prednisolone liquid (brand name Redipred®) or prednisone tablets. These medicines contain a type of anti-inflammatory medication called a corticosteroid. This medicine helps to bring down the swelling inside the airways and reduce the amount of mucus produced. Oral corticosteroid medicine is usually taken for three to five days for an asthma flare-up.
Children who need frequent or continuous use of this medication (more than 14 days in a 12-month period) should be referred to a paediatric respiratory physician for review. Read more here.
Note: Corticosteroids are not the same as ‘steroids’ used by body builders. There is a huge amount of research which shows that oral corticosteroids are effective and safe when used in single, short courses. There can be some side effects from prednisone, see here, and for some children it can affect their growth, although this is not considered to be clinically significant.
Montelukast is an add-on treatment that your healthcare practitioner may prescribe your child if they are having difficulty controlling their asthma. It will be used alongside their regular inhalers.
Montelukast works by blocking some of the chemicals that cause inflammation and narrowing of the airways. It usually prescribed as a chewable tablet for children and should be taken on an empty stomach. Read more.
Biologic treatments are a new add on treatment available to some children with severe, uncontrolled asthma. They are used in addition to regular asthma medications. Biologics are also known as monoclonal antibody therapy.
Biologics reduce flare-ups and reduce the need for oral corticosteroid medicines (prednisolone and prednisone). They work by recognising and blocking substances in the lungs that cause lung inflammation and asthma symptoms.
Omalizumab (brand name: Xolair®) injections can be prescribed for children 6 years of age and over, and are used for severe allergic asthma. Injections are given every four weeks.
This medicine is funded in New Zealand for children who meet specific criteria. Your child’s healthcare practitioner can refer you to a specialist, who will assess if your child meets the criteria.
Illnesses like the flu can lead to asthma flare-ups, especially in children with poorly controlled asthma. You can protect your children’s health by ensuring they get the annual seasonal flu vaccine and regular COVID-19 boosters.
The flu vaccine is free for people using preventer asthma medications. It is also free for children aged between six months and five years who have a history of significant respiratory illness. See the latest Ministry of Health guidance for information about the annual flu vaccine.
The COVID-19 vaccine is safe and effective for people with asthma. See the latest Ministry of Health guidance for immunisation against COVID-19.