What is the treatment for asthma in a 7-year-old child?

From the Guidelines

Treatment for asthma in a 7-year-old typically begins with a short-acting beta-agonist (SABA) like albuterol (2 puffs every 4-6 hours as needed) for symptom relief, and if the child has persistent symptoms, a low-dose inhaled corticosteroid (ICS) like fluticasone or budesonide should be added as controller therapy, as recommended by the expert panel report 3 (EPR-3) guidelines 1.

Key Considerations

• The decision to start long-term daily therapy depends on the diagnosis and prognosis of asthma, and the chronic airway inflammatory response in asthma can develop in the preschool years 1.
• Inhaled corticosteroids are the preferred long-term control medication for initiating therapy, and the benefits of ICSs outweigh any concerns about potential risks of a small, nonprogressive reduction in growth velocity or other possible adverse effects 1.
• The following long-term control medications are FDA-approved for young children: ICS budesonide nebulizer solution (1-8 years of age), ICS fluticasone dry powder inhaler (>4 years of age), LABA salmeterol dry powder inhaler, alone or in combination with ICS (>4 years of age), and LTRA montelukast (chewable tablets, 2-6 years of age; granules, down to 1 year old) 1.

Treatment Approach

• For children who have exacerbations with viral infections, exacerbations are often severe, yet the child has no significant symptoms in between these exacerbations, and these children have a low level of impairment but a high level of risk 1.
• Most young children who wheeze with viral respiratory infection experience a remission of symptoms by 6 years of age, perhaps due to growing airway size, but two-thirds of children who have frequent wheezing AND also have a positive asthma predictive index are likely to have asthma throughout childhood 1.
• Select medications with considerations for young children, including the use of a face mask and either a nebulizer or an MDI with a VHC for children <4 years of age, and the use of a spacer device with an inhaler for children who can use it 1.

Monitoring and Follow-up

• Monitor response to therapy closely, because treatment of young children is often in the form of a therapeutic trial, and if a clear and beneficial response is not obvious within 4 to 6 weeks, treatment should be stopped, and alternative therapies or alternative diagnoses should be considered 1.
• If a clear and beneficial response is sustained for at least 3 months, consider a step down to evaluate the need for continued daily long-term control therapy, as children in this age group have high rates of spontaneous remission of symptoms 1.

From the FDA Drug Label

• Twice-daily treatment of asthma in patients aged 4 years and older. (1.1) • Treatment of asthma in patients aged 4 to 11 years: 1 inhalation of Wixela Inhub® 100/50 twice daily. (2.1)

The treatment for asthma in a 7-year-old patient can be Wixela Inhub® 100/50, with a dosage of 1 inhalation twice daily 2.

• Key points:
  • Age range: 4 to 11 years
  • Dosage: 1 inhalation of Wixela Inhub® 100/50 twice daily
  • Treatment: Twice-daily treatment of asthma 2

From the Research

Treatment Options for Asthma in 7-Year-Old Children

• The treatment of asthma in children involves the use of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) 3, 4, 5.
• A study published in 2023 found that fluticasone propionate/salmeterol (FP/SAL) is an effective treatment option for children with moderate-to-severe asthma, with improvements in lung function, symptom control, and reduced risk of asthma-related emergency department visits and hospitalizations 3.
• Another study published in 2005 found that salmeterol/fluticasone propionate is at least as effective as concurrent salmeterol plus fluticasone propionate in improving lung function and symptoms in patients with asthma 4.
• A systematic review published in 2009 compared the clinical effectiveness and tolerability of ICSs (fluticasone propionate and budesonide) and LABAs (formoterol fumarate and salmeterol xinafoate) administered alone or in combination, and found that single inhaler combination regimens were frequently more effective in improving treatment outcomes than either monotherapy alone 5.

Safety and Efficacy of Treatment Options

• A study published in 2024 found that moderate-to-high daily doses of ICS were associated with an increased risk of cardiovascular events, pulmonary embolism, and pneumonia, highlighting the importance of using the lowest effective ICS dose 6.
• The Global Initiative for Asthma (GINA) 2021 guidelines recommend the use of low-dose ICS-LABA, very low-dose formoterol-ICS, medium-dose ICS, and ICS-leukotriene receptor antagonist (LTRA) combination for children aged 6-11 years 7.
• A retrospective study published in 2023 found that ICS-LABA therapy was associated with optimal patient outcomes and lung functions in children with asthma, followed by ICS-LTRA and ICS group 7.

Key Findings

• FP/SAL is an effective treatment option for children with moderate-to-severe asthma 3.
• ICS-LABA therapy is associated with optimal patient outcomes and lung functions in children with asthma 7.
• Moderate-to-high daily doses of ICS should be used with caution due to the increased risk of adverse events 6.