Asthma Inhalers for Kids

Inhalers are a mainstay of asthma treatment, including for children who are old enough to know when to use one and how. This is when children are able to remember to use a controller inhaler at specific times as prescribed by a doctor and to recognize the onset of an asthma attack that signals the need to use a rescue inhaler to nip wheezing and other symptoms in the bud.

Many, but not all, medications prescribed for adults with asthma are approved for children; some are appropriate only for kids 12 and over and not for younger children. If you have a child with asthma, their doctor will be able to determine which asthma inhalers are best for them based on their age and the severity of their asthma.

As a parent or caregiver, it will be useful for you to be familiar with the medications your child is prescribed, how they are best used, and any alternatives in the event a change in treatment becomes necessary.

Babies and very young children with asthma who aren't yet able to manage an inhaler typically receive inhaled medications via a nebulizer—a machine that turns the medicine into a mist a little one can inhale through a mask or mouthpiece that fits over their nose and mouth.

Toddler boy with asthma learns to use inhaler
FatCamera / Getty Images

Controller Inhalers

Controller inhalers for treating asthma contain corticosteroids, medications that prevent inflammation. By doing so, they ward off the swelling and excess mucus production that contribute to wheezing, difficulty breathing, and other common symptoms of asthma.

Inhaled corticosteroids (ICSs) are important for asthma management. Because they are designed to prevent symptom flares and asthma attacks, they must be used regularly. For most children, this means several times a day according to a prescribed schedule.

Some children 12 and over who have mild persistent asthma may not need to use an ICS every day, according to asthma management guidelines updated by the National Institutes of Health in December 2020. These children may be able to use an ICS and short-acting inhaler as needed.

When prescribing a controller inhaler for your child, their doctor likely will start with the lowest possible dose needed to control your child's symptoms.

Rescue Asthma Inhalers

Rescue inhalers are used as needed—when a child feels they're having an asthma attack or is about to based on the onset of symptoms (wheezing, chest tightness, shortness of breath, and so on). These inhalers are not meant to be used on a regular basis.

Rescue inhalers contain bronchodilator medications, which work by widening the bronchi (airways) that lead to the lungs. Narrowing of the airways, or bronchoconstriction, is a key aspect of asthma along with inflammation, swelling, and excess mucus.

The rescue medication prescribed most often for children (and adults) is albuterol (a.k.a. salbutamol), a short-acting beta-agonist that relaxes the airways so they can more easily widen. It is available under a number of brand names as well as a generic medication.

If your child seems to need their relief inhaler more than twice a week, let their pediatrician know. Frequent flare-ups of symptoms could be a sign your child's controller inhaler needs to be adjusted.

Combination Inhalers

For children 4 and over (as well as adults) who have moderate to severe persistent asthma (the two most severe categories of asthma), the NIH advises an inhaler containing two medications—an ICS and a drug called formoterol, a long-acting beta agonist (LABA).

This combination inhaler should be used as both a controller medication to be used daily and as a rescue therapy to relieve acute symptoms.

Types of Devices

There are two types of inhaler devices: metered-dose inhalers (MDIs) and dry powdered inhalers (DPIs).

While it's ideal to use the medication that controls asthma best, any medication is only as good as how well it is used. MDIs and DPIs each deliver medication a little differently, and your child might feel that one device is easier to use than the other.

DPIs

DPIs are breath-actuated, which means that medicine comes out as your child breathes in deeply and forcefully.

DPIs typically aren't prescribed until children are at least 5 or 6, as younger kids aren't able to inhale strongly enough to get a full dose of medication. The exceptions are Advair Disk and Asmanex Twisthaler, which both may be prescribed for children as young as 4. Some older children prefer the level of control offered by DPIs.

MDIs

MDIs release medication automatically and require coordinating a deep breath while operating the the inhaler. They contain hydrofluoroalkanes (HFAs), a substance that propels the medication with pressure.

(Another type of MDI, which uses chlorofluorocarbons (CFCs) to pressurize the medication, has been phased out by the Food and Drug Administration because of environmental concerns.)

Asthma Inhaler Medications Approved for Children
Short-Acting Beta Agonists Brand Names Age for Use
Albuterol HFA Proair, Ventolin, Preventil 0 and up
Albuterol dry powder inhaler (DPI) Proair RespiClick 4 and up
Levalbuterol HFA Xopenex 4 and up
Inhaled Corticosteroids
Beclomethasone Qvar, RediHaler 4 and up
Budesonide (DPI) Pulmicort Flexhaler 6 and up
Fluticasone propionate (HFA) Flovent 4 and up
Fluticasone propionate (DPI) Flovent Diskus 4 and up
Fluticasone fluroate (DPI) Arnuity Ellipta 5 and up
Mometasone (HFA) Asmanex 5 and up
Mometasone (DPI) Asmanex Twisthaler 4 and up
Combination ICS/LABAs
Fluticasone, salmeterol  Advair Diskus 4 and up
Fluticasone, salmeterol (HFA)  Advair metered-dose inhaler 12 and up
Fluticasone, salmeterol Wixela Inhub 4 and up
Fluticasone, salmeterol AirDuo RespiClick 12 and up
Mometasone, formoterol Dulera 5 and up
Budesonide, formoterol  ​Symbicort 6 and up
Adapted from the American Academy of Pediatrics Update on Pediatric Asthma Treatment Options, Doses, Label Changes, July 2020

Tips for Inhaler Use

Children may have some trouble learning to use an inhaler. For example, kids who use MDIs often breathe too fast instead of taking a slow, deep inhalation when using the medication.

Other common issues:

  • Blowing out into the inhaler instead of breathing in
  • Positioning the inhaler incorrectly
  • Forgetting to exhale fully before using the inhaler
  • Not holding their breath for about 10 seconds after inhaling the medicine
  • Forgetting to breathe out slowly afterward

A spacer is a small device that can be attached to an MDI inhaler. It has a holding chamber that keeps the medicine inside until a child takes a breath so they don't have to coordinate inhaling with activating the inhaler. Spacers come in different forms, including a mask for infants, toddlers, and children up to 4.

A child can use a spacer for as long as they need one, typically up to age 8 to 10.

A Word From Verywell

An asthma action plan can help you and your child understand when the daily inhalers should be used and when the rescue inhalers are needed. Consult with your child's pediatrician if you need help explaining the importance of asthma management to your child in an age-appropriate way, and help evolve that understanding as they age.

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8 Sources
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