What are the asthma management guidelines for a pediatric patient?

From the Guidelines

Asthma Management Guidelines for Pediatric Patients The recommended treatment approach for pediatric patients with asthma typically involves a stepwise management plan 1.

Initial Treatment

For mild intermittent asthma, an as-needed inhalation of a short-acting beta2-agonist (SABA) such as albuterol (2.5 mg via nebulizer or 1-2 puffs from an inhaler) is suggested 1.

Persistent Asthma Treatment

For persistent asthma, daily use of a low-dose inhaled corticosteroid (ICS) like fluticasone (50-100 mcg twice daily) is recommended 1.

• If symptoms persist, a medium-dose ICS (100-250 mcg twice daily) or the addition of a long-acting beta2-agonist (LABA) like salmeterol to the ICS may be considered 1.
• Inhaled corticosteroids are the preferred long-term control medication for initiating therapy in pediatric patients, as their benefits outweigh concerns about potential risks 1.

Monitoring and Adjustments

It's crucial to monitor symptoms and adjust treatment under the guidance of a healthcare provider, ensuring the use of a spacer device with an inhaler for better medication delivery 1.

• Regular follow-up and education on proper inhaler technique and asthma management are also essential 1.

Special Considerations

• For children whose asthma is not well controlled on low-dose ICS, adding a noncorticosteroid long-term control medication to medium-dose ICS may be considered before increasing the dose of ICS to high-dose 1.
• Omalizumab is recommended for consideration in youths 12 years of age who have allergies or for adults who require step 5 or 6 care (severe asthma) 1.

From the FDA Drug Label

For patients with asthma aged 4 to 11 years who are not controlled on an ICS, the dosage is 1 inhalation of Wixela Inhub® 100/50 twice daily, approximately 12 hours apart. The asthma management guidelines for a pediatric patient are to administer 1 inhalation of Wixela Inhub® 100/50 twice daily, approximately 12 hours apart, for patients aged 4 to 11 years who are not controlled on an inhaled corticosteroid (ICS). If asthma symptoms arise between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief 2. Key points to consider are:

• Dosage: 1 inhalation of Wixela Inhub® 100/50 twice daily
• Age: 4 to 11 years
• Previous therapy: Not controlled on an ICS
• Additional treatment: Inhaled, short-acting beta2-agonist for immediate relief between doses 2

From the Research

Asthma Management Guidelines for Pediatric Patients

• The management of asthma in children is a highly patient-specific disease, with various guideline-based approaches available 3.
• The National Asthma Education and Prevention Program and the Global Initiative for Asthma have published guidelines for the diagnosis, assessment, and treatment of asthma in adults and children, with a stepwise approach to treatment 3, 4.
• The treatment of asthma in children involves the use of bronchodilators, inhaled corticosteroids, and other medications, with the goal of achieving and maintaining control of the disease 5, 6.
• For severe asthma, guidelines recommend the use of high-dose inhaled glucocorticoids plus a second controller and/or systemic corticosteroids to achieve control 7.
• The management of acute asthma exacerbations in children involves the use of beta-2 adrenergic agonists, corticosteroids, and other medications, with the goal of preventing and controlling exacerbations 5, 6.

Stepwise Approach to Treatment

• The stepwise approach to treatment involves escalating therapy in response to worsening symptoms or inadequate control, with the goal of achieving and maintaining control of the disease 3, 5.
• The approach involves the use of medications such as beta-2 adrenergic agonists, corticosteroids, and leukotriene modifiers, with the goal of achieving and maintaining control of the disease 4.
• For children under 5 years of age, recommendations are limited due to a lack of evidence, but treatment may involve the use of bronchodilators and inhaled corticosteroids 3.

Emerging Treatments

• Emerging treatments for pediatric asthma include biologics, such as omalizumab, which is used for patients with confirmed IgE-mediated allergic asthma 4.
• Other emerging treatments include immunomodulatory agents and anti-inflammatory medications, which may be used for patients with severe or difficult-to-treat asthma 3, 7.