Should fluticasone (Fluticasone) dosage be doubled in a 16-year-old patient with viral asthma exacerbation?

From the Guidelines

Doubling the dose of fluticasone during a viral asthma exacerbation in a 16-year-old is generally not recommended as a first-line approach. Instead, the preferred management is to continue the regular prescribed dose of fluticasone and add a short-acting beta-agonist (SABA) like albuterol (2-4 puffs every 4-6 hours as needed) for symptom relief. If symptoms are moderate to severe, a short course of oral corticosteroids such as prednisone (typically 40-60mg daily for 5-7 days) may be appropriate, rather than simply increasing the inhaled corticosteroid dose. For viral-triggered exacerbations, ensuring good hydration and rest is also important. The rationale behind this approach is that doubling the inhaled corticosteroid dose has not been consistently shown to prevent progression of viral-triggered exacerbations, while oral corticosteroids work more rapidly and effectively for managing acute symptoms 1.

Some key points to consider in the management of asthma exacerbations include:

• The use of inhaled corticosteroids as the most potent and consistently effective long-term control medication for asthma 1
• The recommendation for oral systemic corticosteroids in moderate to severe asthma exacerbations 1
• The importance of monitoring the patient's response to therapy and adjusting treatment as needed 1
• The potential benefits of adding a long-acting inhaled beta2-agonist to a low-to-medium dose of inhaled corticosteroids for moderate persistent asthma 1

It is essential to note that the management of asthma exacerbations should be individualized, and the treatment approach may vary depending on the severity of symptoms, the patient's medical history, and other factors. If the teen's symptoms are worsening despite these measures, they should seek immediate medical attention, as severe asthma exacerbations can be life-threatening and may require more intensive treatment.

From the Research

Management of Asthma Exacerbations

• The management of asthma exacerbations involves the use of inhaled corticosteroids (ICSs) and other medications to reduce inflammation and prevent severe exacerbations 2, 3.
• In patients with viral asthma exacerbations, early treatment or prevention of viral infections might significantly reduce the rate of asthma exacerbation 4.

Use of Fluticasone in Asthma Management

• Fluticasone furoate/vilanterol (FF/VI) is an inhaled corticosteroid/long-acting β2-agonist therapy that reduces the risk of severe asthma exacerbations and improves lung function and symptom control in patients with asthma 5.
• The use of FF/VI has been shown to result in lower use of short-acting β2-agonist (SABA) canisters and fewer asthma-related exacerbations compared to budesonide/formoterol (B/F) 5.

Doubling Fluticasone in Viral Asthma Exacerbation

• There is no direct evidence to support doubling fluticasone in viral asthma exacerbation in a 16-year-old patient.
• However, the use of high-dose ICSs has been shown to have no additional clinical benefit in controlling moderate to severe asthma, but might have potential safety concerns 6.
• The decision to double fluticasone should be based on individual patient needs and medical history, and should be made in consultation with a healthcare professional.

Key Considerations

• Asthma action plans can help patients triage and manage symptoms at home, and may include the use of an inhaled corticosteroid/formoterol combination for those who are not using an inhaled corticosteroid/long-acting beta2 agonist inhaler for maintenance 3.
• Patients with severe exacerbations should be transferred to an acute care facility and treated with oxygen, frequent administration of a short-acting beta2 agonist, and corticosteroids 3.