From the Guidelines
For pediatric patients with intermittent asthma, the recommended initial treatment is as-needed use of a Short-Acting Beta Agonist (SABA) such as albuterol (salbutamol) for symptom relief. Albuterol is typically administered via metered-dose inhaler (MDI) with a spacer device, 2 puffs every 4-6 hours as needed for wheezing, cough, or shortness of breath. For children under 4 years, a face mask should be attached to the spacer. Low-dose Inhaled Corticosteroids (ICS) are not routinely recommended for initial treatment of intermittent asthma but may be considered if symptoms occur more than twice weekly, as suggested by 1. Parents should be instructed to use the SABA at the first sign of symptoms and to seek medical attention if the child requires the medication more than twice weekly, needs it more frequently than every 4 hours, or doesn't experience relief within 15-20 minutes of administration. This approach targets bronchodilation with SABAs to provide immediate relief of bronchospasm while avoiding unnecessary daily medication. The rationale is that intermittent asthma, by definition, involves infrequent symptoms that don't warrant daily controller therapy, though treatment should be reassessed if symptom frequency increases, as noted in 1 and 1. Key considerations include:
- Monitoring response to therapy closely, because treatment of young children is often in the form of a therapeutic trial, as mentioned in 1.
- If a clear and beneficial response is not obvious within 4 to 6 weeks and the patient’s/family’s medication technique and adherence are satisfactory, treatment should be stopped, and alternative therapies or alternative diagnoses should be considered, as suggested in 1.
- The benefits of ICSs outweigh any concerns about potential risks of a small, nonprogressive reduction in growth velocity or other possible adverse effects, as noted in 1. Given the most recent and highest quality evidence from 1, as-needed use of SABA is the preferred initial treatment for pediatric patients with intermittent asthma, with low-dose ICS considered for those with more frequent symptoms.
From the FDA Drug Label
If asthma symptoms arise in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief. The FDA drug label does not answer the question.
From the Research
Recommended Initial Treatment for Pediatric Patients with Intermittent Asthma
The recommended initial treatment for pediatric patients with intermittent asthma is a topic of ongoing research and debate.
- Short-Acting Beta Agonist (SABA): SABA is commonly used as a reliever medication for intermittent asthma symptoms 2.
- Low-Dose Inhaled Corticosteroid (ICS): Low-dose ICS is also considered a viable option for initial treatment, with studies suggesting that it can be effective in reducing asthma symptoms and improving lung function 3, 4.
Comparison of SABA and Low-Dose ICS
Studies have compared the efficacy of SABA and low-dose ICS in pediatric patients with intermittent asthma.
- Efficacy: Low-dose ICS has been shown to be effective in reducing asthma symptoms and improving lung function, with some studies suggesting that it may be more effective than SABA in certain cases 2, 3.
- Safety: Both SABA and low-dose ICS are generally considered safe for use in pediatric patients, although low-dose ICS may have a slightly better safety profile due to its anti-inflammatory effects 4, 5.
Considerations for Pediatric Patients
When considering the initial treatment for pediatric patients with intermittent asthma, several factors should be taken into account.
- Age: The age of the patient may influence the choice of treatment, with younger patients potentially requiring closer monitoring and more frequent follow-up 4.
- Asthma Severity: The severity of the patient's asthma should also be considered, with more severe cases potentially requiring more intensive treatment 2, 3.
- Patient Preferences: Patient preferences and lifestyle should also be taken into account, with some patients preferring the convenience of a reliever medication like SABA, while others may prefer the preventative benefits of low-dose ICS 5.