From the Guidelines
For a 12-year-old with asthma in Alberta, the most effective inhaled corticosteroid (ICS) options are fluticasone (Flovent) and budesonide (Pulmicort), which are commonly used as first-line treatments. These medications work by reducing airway inflammation, which is the underlying cause of asthma symptoms. The choice of ICS depends on the severity of asthma, with typical starting doses for moderate asthma being fluticasone 100-250 mcg twice daily or budesonide 200-400 mcg twice daily 1.
Some key points to consider when prescribing ICS for a 12-year-old with asthma include:
- Using a spacer device with metered-dose inhalers to improve medication delivery to the lungs
- Rinsing the mouth after each use to prevent oral thrush
- Regular follow-up with a healthcare provider to adjust the dose based on symptom control
- Considering a short-acting bronchodilator like salbutamol for exercise-induced symptoms
- Discussing the benefits and risks of ICS therapy with the patient and their family, including the potential for side effects and the importance of regular use 1.
It's also important to note that long-acting beta2 agonists (LABAs) should not be used as monotherapy for long-term control of persistent asthma, but can be used in combination with ICS for patients whose asthma is not adequately controlled with ICS alone 1.
Overall, the goal of ICS therapy is to reduce airway inflammation and improve symptom control, while minimizing the risk of side effects and ensuring optimal quality of life for the patient 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Inhaled Corticosteroid Options for a 12-year-old with Asthma in Alberta
- The following inhaled corticosteroids (ICS) can be considered for a 12-year-old with asthma in Alberta:
- Combination products, such as Advair (fluticasone propionate/salmeterol), can also be considered for patients with moderate-to-severe persistent asthma 2
- The choice of ICS and dosage should be individualized based on the patient's asthma severity, control, and response to treatment 2, 6, 3
Considerations for ICS Therapy
- ICS therapy is considered the most effective anti-inflammatory treatment for asthma 2
- The addition of a long-acting beta2-adrenergic (LABA) bronchodilator, such as salmeterol, to ICS therapy can provide greater asthma control than increasing the ICS dose alone 2, 6
- The combination of ICS and LABA in a single inhaler can improve patient adherence and reduce morbidity 2
Specific ICS Options
- Fluticasone propionate (FP) is available in various strengths, including 100,250, and 500 microg 2
- Fluticasone furoate (FF) is a novel, once-daily ICS asthma therapy, available in a 50 mcg dose 3, 4
- Budesonide is another ICS option, which has been shown to be effective in controlling acute asthma attacks in children 5