What is the appropriate management for a 16-year-old male with asthma?

Management of Asthma in a 16-Year-Old Male

The appropriate management for a 16-year-old male with asthma should follow a stepwise approach with inhaled corticosteroids (ICS) as the cornerstone of therapy for persistent asthma, along with as-needed short-acting beta-agonists (SABA) for symptom relief. 1

Assessment of Asthma Control

Before initiating or adjusting treatment, assess the patient's:

• Level of asthma control based on two domains:

  • Impairment: Frequency and intensity of symptoms, functional limitations
  • Risk: Likelihood of exacerbations, decline in lung function, medication side effects

• Key symptoms to evaluate:

  • Wheezing
  • Coughing
  • Chest tightness
  • Shortness of breath
  • Sleep disturbance due to symptoms

• Objective measurements:

  • Peak expiratory flow (PEF)
  • Spirometry (FEV1)
  • Use of validated questionnaires like Asthma Control Test (ACT score ≥20 indicates well-controlled asthma)

Stepwise Treatment Approach

Step 1: Mild Intermittent Asthma

• SABA (albuterol) as needed for symptoms 2
• No daily controller medication needed

Step 2: Mild Persistent Asthma

• Preferred: Low-dose ICS-formoterol as needed
• Alternative: Daily low-dose ICS plus as-needed SABA 1

Step 3: Moderate Persistent Asthma

• Preferred: Low-dose ICS-formoterol as maintenance and reliever therapy
• Alternative: Medium-dose ICS plus as-needed SABA 1

Step 4: Moderate-to-Severe Persistent Asthma

• Medium-to-high dose ICS plus LABA (long-acting beta-agonist)
• Consider adding LTRA (leukotriene receptor antagonist) if needed 3

Step 5-6: Severe Persistent Asthma

• High-dose ICS plus LABA
• Consider adding biologics (e.g., omalizumab) for allergic asthma 1
• Consider oral corticosteroids for severe cases 3

Acute Asthma Management

For acute exacerbations:

1. Immediate treatment:

   • High-flow oxygen to maintain SpO2 >92%
   • Nebulized salbutamol/albuterol (5-10 mg) every 15-30 minutes as needed
   • Oral prednisolone (1-2 mg/kg, maximum 40 mg)
   • Consider adding ipratropium bromide (0.5 mg) if no improvement within 15-30 minutes 1

2. Monitoring during acute episodes:

   • Pulse oximetry
   • Peak flow measurements before and after treatment
   • Heart rate and respiratory rate
   • Signs of severe asthma: accessory muscle use, inability to speak in complete sentences, drowsiness 3

Patient Education

Essential components of education for a 16-year-old:

• Proper inhaler technique - demonstrate and have patient demonstrate back
• Difference between controller and reliever medications
• Recognition of early warning signs of worsening asthma
• Written asthma action plan
• Avoidance of triggers (allergens, irritants, exercise-induced symptoms)
• Importance of medication adherence 1

Special Considerations for Adolescents

• Encourage the patient to take responsibility for their own inhalers 3
• Address potential barriers to adherence common in adolescents
• Discuss smoking avoidance/cessation if relevant
• Pre-treatment with SABA 15 minutes before exercise for those with exercise-induced symptoms 1
• Monitor height and weight, particularly with ICS use 1

Follow-up

• Evaluate asthma control in 2-6 weeks after initiating or changing therapy
• If control is not achieved:
  • Review medication adherence and inhaler technique
  • Reassess environmental control measures
  • Consider stepping up therapy
  • Assess for comorbid conditions 3

The goal of asthma management is to achieve and maintain control of symptoms while minimizing the risk of future exacerbations and medication side effects. Regular monitoring and adjustment of therapy based on the patient's response are essential components of effective asthma care.