From the Guidelines
Asthma treatment in a 3-year-old typically involves a stepwise approach based on symptom severity, with low-dose inhaled corticosteroids such as fluticasone (Flovent) 44-88 mcg twice daily or montelukast (Singulair) 4mg once daily as preferred controller medications, as recommended by the most recent guidelines 1. For mild intermittent asthma, a short-acting beta-agonist like albuterol (Ventolin, ProAir) via inhaler with spacer and mask is recommended as needed, using 2 puffs every 4-6 hours during symptoms. Some key points to consider in asthma treatment for young children include:
- Using a spacer device with a mask for proper medication delivery
- Maintaining an asthma action plan that includes recognizing triggers, monitoring symptoms, and knowing when to seek emergency care
- Regular follow-up with a pediatrician or asthma specialist to adjust treatment as needed
- Considering the potential benefits and risks of different medications, such as the potential for reduced growth velocity with inhaled corticosteroids 1. The medications work by either relaxing airway muscles (albuterol) or reducing inflammation in the airways (corticosteroids, montelukast), addressing the underlying mechanisms of asthma symptoms. It is essential to weigh the possible long-term effects of inadequately controlled asthma against the potential risks of medication side effects, and to carefully monitor the child's response to therapy 1. In deciding when to initiate daily long-term-control therapy, the clinician must consider the child's symptoms, medical history, and risk factors for developing persistent asthma, as well as the potential benefits and risks of different medications 1. The goal of asthma treatment is to achieve and maintain control of symptoms, prevent exacerbations, and minimize the risk of long-term complications, while also considering the potential risks and benefits of different medications 1.
From the FDA Drug Label
Published reports of trials in asthmatic children aged 3 years or older have demonstrated significant improvement in either FEV1 or PEFR within 2 to 20 minutes following a single dose of albuterol inhalation solution
- Asthma treatment in 3-year-old: Albuterol inhalation solution has been shown to be effective in asthmatic children aged 3 years or older, with significant improvement in FEV1 or PEFR within 2 to 20 minutes after a single dose 2.
- Key points:
- Albuterol inhalation solution is effective in children aged 3 years or older.
- Significant improvement in FEV1 or PEFR can be expected within 2 to 20 minutes after a single dose.
- The dosage for children is not explicitly stated in the provided text, but it is mentioned that an increase of 15% or more in baseline FEV1 has been observed in children aged 5 to 11 years up to 6 hours after treatment with doses of 0.10 mg/kg or higher of albuterol inhalation solution 2.
From the Research
Asthma Treatment in 3-Year-Old Children
- Asthma treatment in children aged 1 to 3 years can include inhaled corticosteroids, such as fluticasone propionate and budesonide, which have been shown to be systemically active in this age group 3.
- The goal of asthma therapy is to keep children "symptom free" by preventing chronic symptoms, maintaining lung function, and allowing for normal daily activities 4.
- Inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy for children with persistent asthma, including those aged 1 to 3 years 4.
- Montelukast is approved for children ages ≥ 12 months and is often used for its ease of daily oral dosing, but long-acting beta-2 adrenergic agonists should only be used in combination with an ICS 4.
Treatment Options
- Salmeterol/fluticasone (SFC) may be more effective than montelukast (MON) or combination of montelukast and fluticasone (MFC) in improving asthma control level in children and adolescents aged 4 to 18 years 5.
- First-line treatment for asthma is inhaled salbutamol, used on demand to relieve respiratory discomfort or to prevent attacks due to a known trigger, or on a daily basis if necessary, in combination with an inhaled corticosteroid such as beclometasone 6.
- Inhaled corticosteroids are the most effective class of controller medication available today for treating persistent asthma and are the evidence-based guideline-recommended first-line treatment for controlling asthma 7.
Considerations
- The dose of inhaled corticosteroids should be reduced, or the treatment gradually withdrawn, once asthma is under control to limit adverse effects and drug interactions 6.
- Delivering optimal asthma management requires an understanding and application of basic science and evidence-based guidelines in clinical practice, and overcoming barriers such as competing priorities and time constraints of the physician, as well as the reluctance of patients to actively participate in their own care 7.