Treatment for a 17-Year-Old with Asthma and Common Cold Symptoms
This patient requires symptomatic treatment for the viral upper respiratory infection combined with optimization of their asthma management—antibiotics are not indicated, but inhaled bronchodilators should be readily available for mild wheezing. 1
Immediate Management Approach
For the Common Cold Component
Do NOT prescribe antibiotics. The common cold is a self-limited viral illness, and antibiotics provide no benefit while increasing adverse effects and antimicrobial resistance. 1 Complications like asthma exacerbation cannot be prevented with antibiotics. 1
Provide symptomatic relief with:
First-generation antihistamine plus decongestant combination (e.g., brompheniramine/diphenhydramine with pseudoephedrine) for cough and rhinorrhea—this has proven efficacy in reducing symptom severity and hastening resolution. 1 Note that newer "non-sedating" antihistamines are ineffective for common cold symptoms. 1
Analgesics such as naproxen, ibuprofen, or acetaminophen for any associated headache, malaise, or throat discomfort—naproxen specifically decreases cough through anti-inflammatory mechanisms. 1
Intranasal saline irrigation to alleviate nasal symptoms with minimal adverse effects. 1
For the Mild Wheezing (Asthma Component)
Ensure the patient has a short-acting beta-agonist (SABA) inhaler readily available. Albuterol 2.5 mg via nebulizer or 2 puffs via MDI every 4-6 hours as needed for wheezing is appropriate. 2 Common cold viruses are the most important trigger for asthma exacerbations in both children and adults. 3, 4
Assess current asthma controller therapy status:
If the patient is already on daily inhaled corticosteroids (ICS), continue the current regimen. 1, 5
If NOT on daily controller therapy but has a history of asthma, strongly consider initiating low-dose inhaled corticosteroids (e.g., fluticasone 100 mcg twice daily or budesonide), as viral respiratory infections commonly trigger asthma exacerbations and ICS reduces this risk. 1, 5, 6
For adolescents with mild persistent asthma, low-dose ICS is the preferred first-line controller medication. 1, 5
Consider a short course of oral corticosteroids ONLY if:
- Peak expiratory flow falls below 60% of patient's best 1
- Sleep is significantly disturbed by asthma 1
- There is diminishing response to inhaled bronchodilators 1
- Symptoms progressively worsen day by day 1
If oral steroids are needed: prednisolone 30-60 mg daily (or 1-2 mg/kg in adolescents) until 2 days after control is established, then stop without tapering. 1
Patient Education and Safety-Netting
Counsel the patient that:
- Common cold symptoms typically last up to 2 weeks and are self-limited. 1
- They should follow up if symptoms worsen or exceed expected recovery time. 1
- Increased asthma symptoms and reliever use during colds is expected. 6
- They should seek immediate care if experiencing severe shortness of breath, inability to speak in full sentences, or if SABA provides less than 4 hours of relief. 4
Provide a written asthma action plan outlining when to increase medications and when to seek help. 1, 5
Critical Pitfalls to Avoid
Do not prescribe antibiotics based on purulent nasal discharge alone—this reflects normal viral inflammation, not bacterial infection. 1 Antibiotics have no place in uncomplicated asthma management. 1
Do not rely on SABA alone for a patient with known asthma—bronchodilators only provide symptom relief without modifying disease progression or preventing exacerbations. 5
Do not use antihistamines alone—they have more adverse effects than benefits when used without decongestants. 1
Do not delay ICS therapy in an adolescent with documented asthma history who is experiencing viral-triggered symptoms—viral URIs are the most common cause of asthma exacerbations, and ICS reduces this risk by 36-52%. 6, 3