In some cases, children will have a lot more symptoms when they are younger (age 2-5), but then seem to have fewer symptoms in later childhood years or teenage years. This leads many parents to believe that their children have “outgrown” their asthma. However, if you understand that asthma is basically a tendency of the immune system to over-react to triggers in the environment, and that triggers can change over time, you can understand that they never truly “outgrow” their asthma (basically, they will always have that tendency to over-react). They may just have fewer triggers and thus fewer symptoms. In other cases, asthma can persist or even get more severe as children get older and develop new triggers. In addition, a lot of teenagers and adults do not perceive their asthma symptoms very well, as the changes can be quite gradual such that they don’t notice it – in those cases, objective tests are needed to measure lung function to manage their asthma appropriately. Not knowing the specifics of your situation, I would recommend speaking to his pediatrician or primary care provider about this.
Inhaled Steroids (such as Flovent, Pulmicort, and Qvar): Inhaled steroids can be safely given daily for asthma maintenance control. Because the medication is only going to the lungs (where it is needed) and not to the rest of the body, none of the long-term side effects of oral steroids are experienced. There have been exhaustive studies demonstrating that inhaled steroids given daily are safe and effective, and are considered first line therapy for asthma maintenance. These medications generally take a week or more to reach maximal effectiveness. One should NEVER attempt to use these medications in place of a rescue inhaler for acute symptoms. Because these medications work slowly, we will often start patients on a 3-7 day oral steroid "burst." When the oral steroid is finished, we will often then start an inhaled steroid to safely continue daily anti-inflammatory maintenance therapy.
A Cochrane review found that those treated with continuously nebulized bronchodilators had lower rates of hospitalization, greater improvements in pulmonary function test results, and similar rates of adverse events compared with those treated intermittently. Continuous treatment allows greater compliance with the goal of delivering the equivalent of three intermittent bronchodilator treatments in the first hour of care. In addition, this method will result in less respiratory therapy time and costs; it has been shown to be safe, and it may benefit the sickest patients the most.