From the Guidelines
For pediatric asthma patients, particularly those with difficulty clearing secretions, high-frequency chest wall oscillation (HFCWO) devices can be a beneficial adjunctive therapy to standard asthma management, which should include inhaled corticosteroids (ICS) as the preferred long-term control medication, as recommended by the expert panel report 3 (EPR-3) guidelines 1.
Key Considerations for Pediatric Asthma Management
- Inhaled corticosteroids (ICS) are the preferred long-term control medication for initiating therapy in pediatric asthma patients, due to their effectiveness in reducing airway inflammation and improving asthma control 1.
- The benefits of ICSs, such as fluticasone, outweigh concerns about potential risks, and they should be titrated to the lowest dose needed to maintain control 1.
- For patients not well controlled on low-dose ICS, step-up therapy may involve increasing the ICS dose or adding a non-corticosteroid long-term control medication, with close monitoring of response to therapy 1.
Role of HFCWO Devices in Pediatric Asthma
- HFCWO devices, such as the Vest Airway Clearance System, can help loosen mucus from airway walls, increase airflow velocity, and reduce mucus viscosity, making it easier to clear secretions through coughing 1.
- This therapy is particularly useful for children with asthma who have comorbid conditions like cystic fibrosis, bronchiectasis, or those with recurrent pneumonia.
- HFCWO should not replace bronchodilators or anti-inflammatory medications but rather serve as an adjunctive therapy to improve airway clearance and potentially reduce exacerbations in selected patients with secretion management issues.
Monitoring and Adjusting Therapy
- Monitor response to therapy closely, and if a clear and beneficial response is not obvious within 4 to 6 weeks, consider alternative therapies or diagnoses 1.
- If a clear and beneficial response is sustained for at least 3 months, consider a step down to evaluate the need for continued daily long-term control therapy, given the high rates of spontaneous remission of symptoms in young children 1.
From the Research
Oscillator Pediatric Asthma
- The use of oscillators in pediatric asthma is not directly mentioned in the provided studies 2, 3, 4, 5, 6.
- However, the management of acute asthma exacerbations in pediatric patients is discussed in several studies, including the use of inhaled bronchodilators, systemic steroids, and other adjunct therapies 2, 3, 4, 5.
- The studies suggest that the goal of treatment is to achieve effective bronchodilation and reduce inflammation, while also correcting hypoxemia and hypercapnia 2, 3, 4, 5.
- Noninvasive mechanical ventilation is mentioned as a potential treatment option for patients with severe asthma exacerbations, particularly in the ICU setting 5, 6.
- The use of adjunct interventions, such as heliox, inhaled steroids, and paralytics, is also discussed, although the evidence for their use is variable 6.
- Overall, the management of pediatric asthma exacerbations requires a comprehensive approach, taking into account the severity of the exacerbation, the patient's response to treatment, and the potential need for adjunct therapies 2, 3, 4, 5.