From the Guidelines
The most effective treatment for exercise-induced asthma in pediatric patients is the use of short-acting beta-agonists (SABAs) like albuterol 15-30 minutes before exercise, as it provides bronchodilation that typically lasts 2-4 hours, as recommended by the most recent and highest quality study 1.
Treatment Approach
The treatment of exercise-induced asthma (EIA) in pediatric patients involves a combination of pre-exercise medication and appropriate exercise modifications.
- Short-acting beta-agonists (SABAs) are the first-line treatment, providing bronchodilation that typically lasts 2-4 hours.
- For children with persistent symptoms, daily controller medications may be necessary, including inhaled corticosteroids or leukotriene modifiers.
- Proper warm-up for 10-15 minutes before vigorous activity can reduce EIA symptoms by triggering a refractory period.
- Children should also be encouraged to breathe through the nose during exercise when possible, wear a face mask or scarf in cold weather, and maintain good hydration.
Medication Options
- Inhaled beta-agonists, such as albuterol, are effective in preventing EIB for more than 80% of patients, as stated in 1.
- Leukotriene receptor antagonists can attenuate EIB in as many as 50% of patients, as mentioned in 1.
- Combination therapy with inhaled corticosteroids and long-acting beta-agonists may be recommended for inflammation, but should not be used in persons with normal or near-normal baseline lung function, as noted in 1.
Non-Pharmacologic Therapies
- Use of face masks can promote humidification and prevent water loss, attenuating EIB, as suggested in 1.
- Swimming is often better tolerated than running or outdoor winter sports.
- Parents and coaches should ensure rescue medication is always available during physical activities, and children should be taught proper inhaler technique with spacer devices for optimal medication delivery.
From the FDA Drug Label
The efficacy of SINGULAIR, 10 mg, when given as a single dose 2 hours before exercise for the prevention of exercise-induced bronchoconstriction (EIB) was investigated in three (U. S. and Multinational), randomized, double-blind, placebo-controlled crossover studies that included a total of 160 adult and adolescent patients 15 years of age and older with exercise-induced bronchoconstriction. In pediatric patients 6 to 14 years of age, using the 5-mg chewable tablet, a 2-day crossover study demonstrated effects similar to those observed in adults when exercise challenge was conducted at the end of the dosing interval (i.e., 20 to 24 hours after the preceding dose).
Treatment of Exercise-Induced Asthma in Pediatric Patients:
- For pediatric patients 6 to 14 years of age, the recommended dose is one 5-mg chewable tablet taken at least 2 hours before exercise, but not more than once daily.
- For pediatric patients 2 to 5 years of age, the recommended dose is one 4-mg chewable tablet or one packet of 4-mg oral granules taken at least 2 hours before exercise, but not more than once daily.
- The medication should be taken at the same time every day, and the entire dose should be mixed with food, baby formula, or breast milk and given to the child right away. The studies 2 and 2 support the use of montelukast for the prevention of exercise-induced bronchoconstriction in pediatric patients. However, it is essential to consult a doctor before taking any medication, especially for children.
From the Research
Treatment Options for Exercise-Induced Asthma in Pediatric Patients
- Inhaled corticosteroids (ICSs) are the first-choice controller drugs for exercise-induced asthma (EIA) in children with persistent asthma 3.
- Short-acting beta(2)-agonists (SABAs) are recommended for use only as needed, which should be relatively infrequent 4.
- Long-acting beta(2)-agonists (LABAs) provide effective bronchodilatation and bronchoprotection when used as intermittent, single-dose treatment of asthma in children, but not when used as regular treatment 5.
- Leukotriene receptor antagonists (LTRAs) have a well-balanced efficacy-safety profile in preventing the occurrence of EIB symptoms in children and produce persistent attenuation of EIB 3.
Comparative Effects of Different Treatments
- A single 50-microgram dose of salmeterol powder provided effective and safe protection against EIB for at least 12 hours in asthmatic children and provided a significantly more prolonged effect than albuterol aerosol (180 micrograms) 6.
- Single doses of the currently available leukotriene receptor antagonists provide prompt effective and persistent defense against EIA that equals that seen with a long-acting beta(2)-agonist 7.
- The synthesis inhibitor zileuton affords a comparable magnitude of prophylaxis but has a considerably shorter duration of action 7.
Safety and Efficacy
- Safety profiles of inhaled SABAs, anticholinergics, and montelukast in approved dosages seem sufficient enough to recommend use of these drugs in the prevention of EIB symptoms in children 3.
- Regular treatment with salmeterol in children with or without corticosteroids provides statistically significant bronchodilatation, but the degree of improvement in lung function or bronchoprotection against exercise and nonspecific irritants is small with regular use 5.
- Partial tolerance develops when long-acting beta(2)-agonists are used as regular treatment, including cross-tolerance to short-acting beta(2)-agonists 5.