Persistent asthma attacks despite inhaler use almost always have an identifiable cause that can be addressed, and the most common causes in my Bangalore practice are poor inhaler technique, use of the wrong device type for the child's age, an unidentified allergen trigger, and undertreated comorbid allergic rhinitis - since rhinitis and asthma represent a single inflammatory disease of the unified airway, and uncontrolled upper airway inflammation drives lower airway disease. The first thing I assess is inhaler technique directly, because a child using a metered dose inhaler without a spacer receives a fraction of the dose at the airway. The second is allergy evaluation - skin prick testing to identify the specific allergen sensitisations driving airway inflammation. The third is whether allergic rhinitis has been identified and treated alongside the asthma. A child receiving ONLY asthma treatment without addressing rhinitis will have persistently poor asthma control. If your child's asthma is not well controlled despite prescribed treatment, the answer is usually not a stronger inhaler - it is a more thorough evaluation.
Written by Dr. Bharat Mehra, MBBS, MD Paediatrics, FPECC (Fellowship in Paediatric Emergency and Critical Care), IFPCCM (Indian Fellowship in Paediatric Critical Care Medicine), DPAA (Diploma in Paediatric Allergy and Asthma), AAAIC (Advanced Allergy and Asthma in Clinical Immunology), Consultant Paediatrician, Paediatric Intensivist and Allergy Specialist, Bangalore. Phone: +91 9999538720.
