From the Guidelines
For a 22-month-old with asthma and an oxygen saturation of 95% on room air, initial management should focus on assessing symptom severity and providing appropriate treatment, with consideration of long-term control therapy if the child has had 4 or more episodes of wheezing in the past year that lasted more than 1 day and affected sleep, and has a positive asthma predictive index 1.
Key Considerations
- The child's oxygen saturation level indicates mild respiratory distress, and treatment should aim to reduce impairment and risk of exacerbations.
- According to the expert panel report 3 (EPR-3) guidelines, long-term control therapy should be considered for infants and young children who have had 4 or more episodes of wheezing in the past year that lasted more than 1 day and affected sleep, and have a positive asthma predictive index, which includes a parental history of asthma, a physician’s diagnosis of atopic dermatitis, or evidence of sensitization to aeroallergens 1.
- Inhaled corticosteroids (ICS) are the preferred long-term control medication for initiating therapy in young children, with benefits outweighing concerns about potential risks of a small, nonprogressive reduction in growth velocity or other possible adverse effects 1.
Treatment Options
- For acute symptoms, a short-acting beta-agonist such as albuterol (2.5 mg via nebulizer or 2-4 puffs via metered-dose inhaler with spacer and mask) every 4-6 hours as needed can be used.
- If the child has moderate symptoms or a history of previous exacerbations, consider adding an oral corticosteroid like prednisolone (1-2 mg/kg/day for 3-5 days).
- For ongoing management, if symptoms occur more than twice weekly, initiate a daily low-dose inhaled corticosteroid such as fluticasone (50 mcg/puff, 1 puff twice daily via spacer with mask) 1.
Monitoring and Follow-up
- Monitor 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 considered 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, as children in this age group have high rates of spontaneous remission of symptoms 1.
From the FDA Drug Label
In controlled clinical trials, most patients exhibited an onset of improvement in pulmonary function within 5 minutes as determined by FEV1. 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 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.
For a 22-month-old child with asthma and an oxygen saturation of 95% on room air, albuterol inhalation can be considered as a treatment option.
- The child's age is below the age range (3 years or older) for which significant improvement in FEV1 or PEFR has been demonstrated in clinical trials.
- However, albuterol is often used in younger children with asthma, and the decision to use it should be made on a case-by-case basis, taking into account the child's individual needs and medical history.
- It is essential to monitor the child's response to treatment and adjust the dosage or add other medications as needed to ensure adequate control of asthma symptoms.
- The dosage of albuterol for a 22-month-old child is not explicitly stated in the provided drug label, and the decision on dosage should be made by a healthcare professional based on the child's weight and medical condition 2.
From the Research
Management of Asthma in a 22-Month-Old Child
Oxygen Saturation of 95% on Room Air
- The child's oxygen saturation level is 95% on room air, which is relatively high compared to the studies that suggest a higher risk of complicated hospital course with oxygen saturation ≤90% 3.
- A study found that children with an initial room air oxygen saturation of 88% or less were more likely to be admitted to the hospital 4.
- However, another study found that initial oxygen saturation alone is not a reliable predictor of hospital admission in children with acute asthma 4.
Treatment Options
- Metered-dose inhalers (MDIs) with spacers have been shown to be effective in reducing follow-up visits to the clinic and emergency department visits within 30 days compared to nebulized albuterol 5, 6.
- A systematic review with meta-analysis found that MDIs with spacers reduced the pulmonary index score and heart rate compared to nebulized albuterol 6.
- Salmeterol/fluticasone propionate, a combination of a long-acting beta(2)-adrenoceptor agonist and a corticosteroid, is an effective and well-tolerated option for the maintenance treatment of asthma 7.