From the Guidelines
For a 2-year-old with newly diagnosed asthma experiencing nightly coughing, I recommend starting with a low-dose inhaled corticosteroid (ICS) such as budesonide (Pulmicort) 0.25-0.5 mg twice daily via a nebulizer, as it is FDA-approved for children as young as 1 year old 1. This approach is based on the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma, which suggest that inhaled corticosteroids are the preferred long-term control medication for initiating therapy in infants and young children 1. The benefits of ICSs outweigh any concerns about potential risks of a small, nonprogressive reduction in growth velocity or other possible adverse effects 1. It is essential to monitor the child's response to therapy closely, and if a clear and beneficial response is not obvious within 4 to 6 weeks, treatment should be stopped, and alternative therapies or alternative diagnoses should be considered 1. Additionally, keeping a rescue medication like albuterol (Proventil, Ventolin) 2 puffs every 4-6 hours as needed for acute symptoms is crucial. Establishing a consistent bedtime routine, elevating the head of the child's bed slightly, and implementing environmental control measures, such as removing dust-collecting items from the bedroom and eliminating exposure to tobacco smoke and other irritants, can also help reduce nighttime coughing 1. Regular follow-up with a pediatrician within 2-4 weeks is important to assess treatment effectiveness and potentially adjust the medication regimen 1. If symptoms worsen or don't improve within a week, seeking medical attention promptly is necessary. It is also important to note that the decision to start long-term daily therapy should be based on consideration of issues regarding diagnosis and prognosis, and that not all wheeze and cough are caused by asthma, so caution is needed to avoid giving inappropriate, prolonged therapy 1.
From the FDA Drug Label
Wixela Inhub® is indicated for the twice-daily treatment of asthma in patients aged 4 years and older. For patients with asthma aged 4 to 11 years who are not controlled on an ICS, the dosage is 1 inhalation of Wixela Inhub® 100/50 twice daily, approximately 12 hours apart.
The patient is 2 years old, which is below the recommended age for Wixela Inhub®. Asthma treatment for a 2-year-old patient who wakes up every night coughing should be approached with caution.
- The FDA drug label does not provide guidance for the treatment of asthma in children under 4 years old with Wixela Inhub®.
- Alternative treatments should be considered for this patient, and consultation with a pediatrician or a specialist is recommended to determine the best course of treatment.
- No conclusion can be drawn from the provided drug labels regarding the treatment of asthma in a 2-year-old patient. 2 2
From the Research
Treatment Options for Asthma in 2-Year-Olds
- Inhaled corticosteroids (ICS) are a common treatment for asthma, and fluticasone propionate is a potent ICS that has been shown to be effective in improving lung function and symptoms in patients with asthma 3.
- For young children, such as 2-year-olds, the treatment options may be limited due to the availability of inhalation devices and the child's ability to use them properly.
- However, there are studies that suggest the use of fluticasone propionate in children, including those as young as 2 years old, although the dosage and device used may need to be adjusted accordingly.
Nighttime Coughing and Treatment
- Nighttime coughing is a common symptom of asthma, and treatment with ICS such as fluticasone propionate can help to reduce the frequency and severity of coughing episodes 3, 4.
- Combination therapies, such as fluticasone propionate/salmeterol, may also be effective in reducing nighttime coughing and improving overall asthma control 5, 4.
- It is essential to work with a healthcare provider to determine the best treatment plan for a 2-year-old with asthma, as the treatment needs may vary depending on the severity of the disease and the child's response to different medications.
Safety and Efficacy of Fluticasone Propionate
- Fluticasone propionate has been shown to have a good safety profile, with a low propensity for systemic side effects and a low incidence of local side effects 6.
- The efficacy and safety of fluticasone propionate have been extensively studied in both children and adults, and it is considered a well-tolerated and effective treatment option for asthma 3, 5, 4.