From the Guidelines
Asthma symptoms in children should be managed with inhaled corticosteroids (ICS) as the preferred long-term control medication, as they have been shown to reduce impairment and risk of exacerbations, and their benefits outweigh concerns about potential risks, as stated in the expert panel report 3 (EPR-3) guidelines 1. Asthma symptoms in children can vary in severity and may include wheezing, coughing, shortness of breath, chest tightness, and rapid breathing. According to the EPR-3 guidelines, for infants and young children who had 4 or more episodes of wheezing in the past year that lasted more than 1 day and affected sleep, and who have a positive asthma predictive index, ICS should be recommended for reducing impairment and risk of exacerbations 1. Some key considerations for managing asthma symptoms in children include:
- Initiating long-term control therapy depends on diagnosis and prognosis, and should be considered for children who consistently require symptomatic treatment more than 2 days per week for a period of more than 4 weeks 1.
- Selecting medications should be based on individual drug efficacy studies, and ICS are the preferred long-term control medication for initiating therapy, with options such as budesonide nebulizer solution and fluticasone dry powder inhaler available for young children 1.
- Monitoring response to therapy closely is crucial, and treatment should be stopped if a clear and beneficial response is not obvious within 4 to 6 weeks, and alternative therapies or diagnoses should be considered 1.
- For children whose asthma is not well controlled on low-dose ICS, adding a noncorticosteroid long-term control medication to medium-dose ICS may be considered before increasing the dose of ICS to high-dose, to avoid potential risks of side effects with high doses of medication 1.
From the Research
Asthma Symptoms in Children
- Approximately one-half of children with asthma present with symptoms before 3 years of age 2
- Typical symptoms include recurrent episodes of wheezing and/or cough triggered by a viral upper respiratory infection (URI), activity, or changes in weather 2
- Children with asthma often take longer than the usual week to fully recover from their respiratory symptoms after a viral URI 2
- Wheezing and coughing during exercise or during laughing or crying, and episodes triggered in the absence of infection suggest asthma 2
Diagnosis and Management
- A trial of bronchodilator medication should show symptomatic improvement 2
- The goal of asthma therapy is to keep children "symptom free" by preventing chronic symptoms, maintaining lung function, and allowing for normal daily activities 2
- Avoidance of triggers identified by a history, such as second-hand cigarette smoke exposure, and allergens identified by skin-prick testing can significantly reduce symptoms 2
- Inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy for children with persistent asthma symptoms 2, 3
Treatment Options
- Montelukast is approved for children ages ≥ 12 months and is often used for its ease of daily oral dosing 2
- Long-acting beta-2 adrenergic agonists should only be used in combination with an ICS 2
- Biologic therapy has been developed for more-severe or difficult-to-control phenotypes, which targets the type of inflammation present 2
- Single inhaler combination regimens (e.g. budesonide/formoterol and fluticasone/salmeterol) were frequently more effective in improving treatment outcomes than either monotherapy alone 4