What treatment should be given to a 16-year-old asthmatic boy with a persistent dry cough?

Treatment for 16-Year-Old Asthmatic with Persistent Dry Cough

The 16-year-old asthmatic boy with persistent dry cough should be started on inhaled corticosteroids (ICS) as the first-line controller medication, with a short-acting beta-agonist (SABA) as needed for symptom relief. 1

Assessment and Initial Management

1. Evaluate current asthma control:

   • Persistent dry cough suggests inadequate asthma control
   • Assess for other symptoms: nighttime awakening, activity limitation, frequency of SABA use
   • Determine if this represents cough variant asthma, which presents primarily with cough rather than wheezing 2

2. Controller medication:

   • For persistent asthma symptoms (like ongoing dry cough), inhaled corticosteroids are the mainstay of preventive treatment 3, 1
   • Start with low-dose ICS if new to controller medication
   • If previously on ICS but not taking it regularly, restart at appropriate dose for severity

3. Reliever medication:

   • Prescribe short-acting beta-agonist (like salbutamol/albuterol) for as-needed symptom relief
   • Ensure proper inhaler technique is demonstrated and understood 1

Medication Selection and Delivery

• For a 16-year-old:

  • Can use metered-dose inhaler (MDI) with spacer or dry powder inhaler
  • Ensure proper inhaler technique is demonstrated and verified 3
  • Consider combination ICS-formoterol for both maintenance and relief if symptoms are moderate 1

• Dosing considerations:

  • Start at appropriate step based on symptom severity
  • For persistent cough suggesting moderate persistent asthma, consider medium-dose ICS 1
  • Reassess in 2-4 weeks to evaluate response 1

Follow-up Plan

• Schedule follow-up within 2-4 weeks to assess response to therapy 1
• If symptoms persist despite optimal therapy with ICS:
  • Consider stepping up therapy (increasing ICS dose or adding long-acting beta-agonist)
  • Reassess inhaler technique
  • Consider comorbidities (allergic rhinitis, GERD)

Patient Education

• Provide written asthma action plan that includes:
  • Daily controller medication instructions
  • When and how to use reliever medication
  • Signs of worsening asthma requiring medical attention 1
• Emphasize importance of daily medication adherence even when asymptomatic
• Explain difference between "relievers" and "preventers" 1

Common Pitfalls to Avoid

• Undertreatment: Nearly 48% of persistent asthmatics receive inadequate treatment according to guidelines, leading to poor control 4
• Overreliance on SABAs alone: Using only rescue medication without controller therapy leads to ongoing inflammation and symptoms 1
• Poor inhaler technique: Ensure proper demonstration and regular technique checks
• Misdiagnosis: Confirm asthma diagnosis if treatment response is inadequate 1
• Non-adherence: Studies show 66% of persistent asthmatics don't use their medication daily as prescribed 4

Remember that adequate treatment following guidelines significantly improves asthma control, with studies showing patients on appropriate medication having fewer asthma attacks 4. The goal is to achieve minimal symptoms during the day, no nighttime awakening, and full participation in activities and sports 3.