What is the recommended treatment for a 12-year-old patient with influenza (flu) and mild asthma exacerbation?

Treatment of 12-Year-Old with Influenza and Mild Asthma Exacerbation

For a 12-year-old with influenza and mild asthma exacerbation, initiate oseltamivir 75 mg orally twice daily for 5 days if symptoms have been present for ≤48 hours, and intensify asthma controller therapy with short-acting beta-agonists as needed for bronchodilation. 1, 2

Antiviral Therapy for Influenza

• Start oseltamivir immediately at 75 mg orally twice daily for 5 days if the child has fever >38.5°C and has been symptomatic for ≤2 days 1, 2
• Treatment should not be delayed while awaiting confirmatory testing, as rapid antigen tests have poor sensitivity and negative results should not rule out influenza 1
• Oseltamivir reduces illness duration by approximately 1.5 days and decreases antibiotic-requiring complications by 35% in children 3
• Do not withhold oseltamivir beyond 48 hours if the child is severely ill or has progressive disease, as later treatment may still provide benefit 1
• Common side effects include nausea and vomiting in 5-6% of children, but these are typically mild and transient 2

Asthma Management During Viral Illness

• Increase short-acting beta-agonist use (albuterol/salbutamol) as needed for bronchodilation during the exacerbation 1
• If the child is on daily inhaled corticosteroids, continue the current dose without interruption 1, 4
• Monitor asthma control closely using these criteria: symptoms ≤2 times per week, nighttime awakenings ≤2 times per month, short-acting beta-agonist use ≤2 times per week, no interference with normal activity 1
• Viral respiratory infections, particularly influenza, are major triggers for asthma exacerbations in children 1, 5

Antibiotic Considerations

Do not routinely prescribe antibiotics unless specific signs of bacterial superinfection develop 2. However, antibiotics become necessary if the child develops:

• Breathing difficulties with increased work of breathing 1
• Severe earache suggesting otitis media 1
• Vomiting for >24 hours 1
• Signs of pneumonia (focal chest findings, persistent high fever) 1

If antibiotics are indicated, use co-amoxiclav as first-line for children under 12 years to cover S. pneumoniae, S. aureus, and H. influenzae 1. For children ≥12 years, doxycycline is an alternative 1.

Red Flags Requiring Hospital Assessment

Seek immediate medical attention if the child develops:

• Respiratory distress or increased work of breathing 1, 2
• Cyanosis or oxygen saturation ≤92% 2
• Severe dehydration 1, 2
• Altered level of consciousness or drowsiness 1, 2
• Signs of septicemia 1, 2

Fever Management

• Use ibuprofen 10 mg/kg every 6-8 hours (maximum 3 doses in 24 hours) for fever control 6
• Acetaminophen is equally safe in children with asthma and does not increase exacerbation risk 7
• Tepid sponging can be used as an adjunct to pharmacological antipyresis 6

Important Clinical Pitfalls

• Do not rely on rapid antigen tests to exclude influenza, as they have poor sensitivity especially for H1N1 strains 1
• Do not use as-needed short-acting beta-agonists alone in patients at higher risk for exacerbation without appropriate controller therapy 4
• Influenza vaccination does not reduce asthma exacerbation frequency during flu season, though it remains recommended for preventing influenza complications 1
• Children with asthma are at increased risk for influenza-related complications including hospitalization, making early antiviral treatment particularly important 1, 5