What is the starting dose of Flovent (fluticasone) for a 9-year-old patient already using Albuterol (salbutamol)?

Starting Dose of Flovent for a 9-Year-Old Using Albuterol

For a 9-year-old patient already using albuterol, the recommended starting dose of Flovent (fluticasone) is 88 mcg twice daily administered via metered-dose inhaler (MDI) with a valved holding chamber.

Dosing Recommendations for Inhaled Corticosteroids

• For children 5-11 years of age with persistent asthma, low-dose inhaled corticosteroid (ICS) therapy is the preferred initial controller medication as part of Step 2 therapy 1
• Fluticasone propionate should be administered twice daily for optimal effect in pediatric patients 1
• The American Academy of Allergy, Asthma, and Immunology recommends twice daily administration for most ICS formulations, including fluticasone 1

Administration Technique

• For optimal delivery in children, fluticasone should be administered using a valved holding chamber (spacer) 1
• The mouth should be rinsed after each treatment to prevent local side effects such as oral thrush 1
• For children who have difficulty with proper inhalation technique, a face mask that fits snugly over the nose and mouth may be used with the spacer 1

Stepwise Approach to Treatment

• If the child is using only albuterol (SABA) as needed, they are likely at Step 1 and moving to Step 2 therapy with the addition of Flovent 1
• Step 2 therapy consists of low-dose ICS as the preferred controller medication 1
• If asthma symptoms are not well controlled with low-dose ICS, consider:
  • Step 3: Low-dose ICS plus long-acting beta agonist (LABA) or medium-dose ICS 1
  • Step 4: Medium-dose ICS plus LABA 1

Monitoring and Follow-up

• Assess asthma control at 2-6 week intervals initially, then every 1-6 months depending on control 1
• Monitor for potential local side effects including cough, dysphonia, and oral thrush 1
• Systemic effects are rare at low-to-medium doses but may include adrenal suppression and growth velocity reduction in children 1

Important Considerations

• Fluticasone has been shown to significantly reduce asthma exacerbations, asthma symptoms, and rescue albuterol use in children when used appropriately 2
• In clinical trials, fluticasone 88 mcg twice daily demonstrated a 13% greater improvement in symptom-free days compared to placebo in young children 2
• Treatment failure (asthma exacerbation) occurred in approximately half as many fluticasone-treated patients compared to placebo-treated patients 2

Caution

• When using inhaled corticosteroids in children, use the lowest effective dose to minimize potential effects on growth velocity 1, 2
• Growth should be monitored regularly in children receiving ICS therapy 1
• Fluticasone treatment has not been associated with significant systemic effects when used at appropriate doses 2