What is the recommended treatment for a 12-year-old boy with asthma?

From the Guidelines

The recommended treatment for a 12-year-old boy with asthma typically involves a stepwise approach starting with a short-acting beta-agonist (SABA) like albuterol (2 puffs every 4-6 hours as needed) for mild, intermittent symptoms, as supported by 1. For persistent asthma, a low-dose inhaled corticosteroid (ICS) such as fluticasone (88 mcg, 1-2 puffs twice daily) is usually the first-line controller medication, according to 1 and 1. Some key points to consider in the treatment of asthma in a 12-year-old boy include:

• The use of ICSs as the most consistently effective long-term control medication for asthma, as stated in 1.
• The importance of using a spacer device with inhalers to improve medication delivery, as mentioned in 1.
• The need for a written asthma action plan to detail daily management and how to recognize and respond to worsening symptoms.
• Regular follow-up appointments every 3-6 months to assess control and adjust medications as needed, as implied by the guidelines in 1 and 1. If symptoms remain uncontrolled, the treatment may be stepped up to include a long-acting beta-agonist (LABA) like salmeterol in combination with the ICS, or the ICS dose may be increased, as suggested by 1 and 1. It is essential to note that long-acting beta2 agonists are not recommended for use as monotherapy for long-term control of persistent asthma, as stated in 1. All children with asthma should have a rescue inhaler available at all times, including at school. These medications work by reducing airway inflammation and relaxing bronchial smooth muscle to prevent and relieve the airway constriction characteristic of asthma, as explained in 1.

From the FDA Drug Label

For oral inhalation only. • Treatment of asthma in patients aged 12 years and older: 1 inhalation of Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50 twice daily. Starting dosage is based on asthma severity.

The recommended treatment for a 12-year-old boy with asthma is 1 inhalation of Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50 twice daily. The starting dosage is based on asthma severity 2.

• Asthma severity will determine the appropriate dosage.
• The treatment options include Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50.

From the Research

Asthma Treatment in a 12-Year-Old Boy

The recommended treatment for a 12-year-old boy with asthma can be determined based on the severity of the condition and the patient's response to different medications.

• Inhaled Corticosteroids (ICS): ICS remain the cornerstone of anti-inflammatory therapy in asthma, as stated in recent international guidelines 3. They are effective in reducing inflammation and preventing symptoms.
• Combination Therapy: For patients with moderate-to-severe persistent asthma, combination therapy with ICS and a long-acting beta2-adrenergic (LABA) bronchodilator, such as fluticasone propionate and salmeterol, may be recommended 4.
• Leukotriene Receptor Antagonists (LTRA): LTRA, such as montelukast, may be considered as an alternative treatment for mild asthma, especially in patients who experience viral-related wheeze 3.
• Theophylline: Theophylline is another option for asthma treatment, but its use is limited due to its side effects and the need for regular monitoring 3.

Treatment Options for Mild Asthma

For patients with mild asthma, a combination fixed-dose beta agonist and steroid inhaler, such as budesonide and formoterol, may be used as required 5. This treatment option has been shown to reduce exacerbations and hospital admissions compared to using a short-acting beta agonist alone.

Growth Effects of Inhaled Corticosteroids

Inhaled corticosteroids may have a suppressive effect on linear growth in children, with a mean reduction of 0.48 cm/y in linear growth velocity and a 0.61-cm change from baseline in height during a one-year treatment period 6. However, the effect size of ICS on linear growth velocity appears to be associated more strongly with the ICS molecule than with the device or dose.

Comparison of Treatment Options

A systematic review of fluticasone and budesonide, and formoterol and salmeterol, found that fluticasone and formoterol provided improved therapeutic benefits compared to budesonide and salmeterol, respectively 7. The review also found that combination therapy with ICS and LABA was more effective than monotherapy with either agent alone.

• Key Findings:
  • ICS are the cornerstone of anti-inflammatory therapy in asthma.
  • Combination therapy with ICS and LABA may be recommended for moderate-to-severe persistent asthma.
  • LTRA and theophylline are alternative treatment options for mild asthma.
  • Inhaled corticosteroids may have a suppressive effect on linear growth in children.
  • Fluticasone and formoterol provided improved therapeutic benefits compared to budesonide and salmeterol, respectively.