From the Guidelines
For a 10-year-old with suspected exercise-induced asthma at their initial visit, I recommend starting with a short-acting beta-agonist (SABA) like albuterol, 2 puffs via metered-dose inhaler with spacer 15-20 minutes before exercise, as this approach serves as both treatment and diagnostic confirmation if symptoms improve, as suggested by 1 and 1.
Initial Assessment and Treatment
The child should undergo spirometry testing to establish baseline lung function and possibly an exercise challenge test to confirm the diagnosis. If symptoms occur more than twice weekly, consider adding a daily controller medication such as montelukast (5mg once daily) or a low-dose inhaled corticosteroid like fluticasone (44-88mcg twice daily) 1.
Importance of Proper Inhaler Technique
Ensure proper inhaler technique is demonstrated and practiced during the visit. The family should keep a symptom diary noting when symptoms occur, their severity, and response to medication.
Pathophysiology of Exercise-Induced Asthma
Exercise-induced asthma occurs when airways narrow during physical activity due to water loss and cooling in the bronchial tubes, causing inflammation and bronchoconstriction, as explained in 1.
Follow-Up
A follow-up visit should be scheduled in 4-6 weeks to assess treatment effectiveness and adjust the management plan as needed, considering the guidelines provided in 1 for managing asthma in young children.
Considerations for Long-Term Control
For long-term control, inhaled corticosteroids are the preferred medication for initiating therapy, with the benefits outweighing concerns about potential risks, as noted in 1. The dose of inhaled corticosteroids should be titrated to as low as needed to maintain control.
Monitoring Response to 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, as suggested in 1.
From the FDA Drug Label
SINGULAIR is used for the prevention of exercise-induced asthma in patients 15 years of age and older. The FDA drug label does not answer the question.
From the Research
Initial Visit for 10-year-old with Exercise-Induced Asthma Symptoms
Treatment Options
- The treatment for exercise-induced asthma in children typically involves the use of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABAs) 2, 3.
- Combination therapies, such as fluticasone/salmeterol and budesonide/formoterol, are commonly used to manage asthma symptoms in children 2, 3.
- Studies have shown that these combination therapies can improve lung function, reduce symptoms, and decrease the need for rescue medication 3, 4.
Comparison of Treatment Options
- A study comparing fluticasone/salmeterol and budesonide/formoterol found that both treatments were effective in improving lung function and reducing symptoms, but there was no significant difference between the two treatments 2.
- Another study found that fluticasone/salmeterol was more effective than budesonide/formoterol in improving lung function and reducing symptoms in patients with uncontrolled asthma 4.
- A review of clinical studies found that formoterol was associated with greater improvement in lung function and better asthma symptom control compared to salmeterol 3.
Switching Therapies
- A study found that switching from salmeterol/fluticasone to formoterol/budesonide combination therapy improved peripheral airway/alveolar inflammation in asthma patients 5.
- The study also found that the proportion of patients with an improvement in asthma control was significantly higher in the formoterol/budesonide group compared to the salmeterol/fluticasone group 5.
Pharmacoeconomic Review
- A pharmacoeconomic review found that salmeterol/fluticasone propionate combination therapy was a cost-effective treatment option for patients with asthma not controlled with inhaled corticosteroids 6.
- The review also found that salmeterol/fluticasone propionate was associated with improvements in health-related quality of life and was a cost-effective treatment relative to monotherapy with montelukast 6.