From the Guidelines
Reactive airway disease in a 5-year-old typically requires a stepwise approach to treatment, starting with a short-acting beta-agonist like albuterol for mild, intermittent symptoms, and adding a low-dose inhaled corticosteroid like fluticasone for symptoms occurring more than twice weekly 1.
Symptoms of Reactive Airway Disease
The symptoms of reactive airway disease in a 5-year-old child may include wheezing, coughing, shortness of breath, and chest tightness, which can be triggered by viral respiratory infections, allergens, or other environmental factors 1.
Treatment Options
The treatment options for reactive airway disease in a 5-year-old child include:
- Short-acting beta-agonists like albuterol (2 puffs every 4-6 hours as needed) via metered-dose inhaler with a spacer and mask for mild, intermittent symptoms 1
- Low-dose inhaled corticosteroids like fluticasone (44-88 mcg twice daily) for symptoms occurring more than twice weekly 1
- Oral prednisolone (1-2 mg/kg/day for 3-5 days) during acute exacerbations 1
- Environmental trigger avoidance, such as removing dust collectors, using allergen-proof bedding, avoiding tobacco smoke exposure, and maintaining regular cleaning to reduce dust mites and pet dander 1
Monitoring and Follow-up
Regular follow-up every 3-6 months is necessary to monitor control and adjust treatment, and a written asthma action plan should guide parents on medication adjustments based on symptom severity 1.
Medication Administration
Proper inhaler technique is essential for medication effectiveness, so parents should be taught how to correctly administer medications with age-appropriate spacer devices 1.
Considerations for Young Children
When selecting medications for young children, considerations should include the age of the child, the severity of symptoms, and the potential risks and benefits of different medications, with inhaled corticosteroids being the preferred long-term control medication for initiating therapy 1.
From the Research
Symptoms of Reactive Airway Disease (RAD)
- Wheezing
- Severe airway obstruction
- Hypoglycemia and seizures in extreme cases, as a result of impaired hypothalamic-pituitary-adrenal axis function 2
Treatment Options for RAD
- Corticosteroids are the treatment of choice for children with persistent reactive airway disease 2
- Inhaled corticosteroids (ICS) such as fluticasone propionate can be used to suppress the underlying pathologic processes and ensure effective control of the disease 3
- Combination therapy of ICS and long-acting beta-agonist (LABA) can improve lung-function parameters and small-airway dysfunction in patients with mild persistent asthma 4
- However, quintupling the dose of inhaled glucocorticoids at early signs of loss of asthma control did not reduce the rate of severe asthma exacerbations or improve other asthma outcomes in children with mild-to-moderate persistent asthma 5
- Twice-daily treatment with fluticasone propionate and salmeterol was found to be safe and well-tolerated in pediatric patients with persistent asthma 6