asthma in children under 5

[surgical06]

i was asked this question and really didn't have a good answer, can anyone help

what is the the management algorithm for childeren under 5 with moderate asthma (significant attacks requiring hospitalization with common URI's. what is the data behind inhaled corticosteroids with respect to side effects. are leukotriene inhibitors first line?

---

Members don't see this ad.

 

[surgical06]

did i phrase the question wrong. is this not an issue?

 

[TeleoDeum]

I believe that inhaled steroids and prn beta agonists are still first line tx. Antihistamines as an adjunct and leukotriene modifiers/inhibitors as a second line in additon to the others. The data on long term inhaled steroid use is pretty good. For high doses ie Flovent 220 2puffs BID or Advair 500/50, there are some systemic steroid side effets after long term use, but these are tolerable as they aviod the morbidity and mortality of asthma/reactive airway disease. The goal is to wean the inhaled steroid dose as the patient tolerates.

Peace,
Greg

 

[edmadison]

The question is a bit more difficult than presented. Patient who only have mild exacerbations with URIs, especially if they are seasona, may not need to be on inhaled steroids. Some can get through the episodes with just a little albuterol. Others, may only need a blast of prelone once a year. If you patient is having asthma symptoms when not sick, is having moderate to severe exacerbatoins or is having frequent mild exacerbations, then he or she should be on a controller medication, which will be inhaled steroids unless the are exceptional circumstances.

edmadison

 

[surgical06]

thanks for the wisdom!

 

[lungdoc]

There are clear guidelines for treatment of asthma in adults and children under 5. It is important to make sure it is indeed asthma since in the <5year group the differential diagnosis for asthma symptoms is very long.

http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.htm

 

[mytirf]

There are clear guidelines for treatment of asthma in adults and children under 5. It is important to make sure it is indeed asthma since in the <5year group the differential diagnosis for asthma symptoms is very long.

http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.htm

Yes the defferential is quite long, but if one has a patient with even 1-2 hospitalizations for asthma symptoms, i.e. wheezing requiring brochodialitors and oral steroids, I think most physicians would start a controller med at least during the winter months. Of course one must consider other possibilities for the symptoms, but even 1-2 exacerbations per year in the setting of a URI would prompt the use of an inhaled steroid by most practitioners. Furthermore, there is some evidence that in younger children (under age 5), treatment does prevent disease progression, so early diagnosis and treatment would seem to be important.

As far as side effects, generally low dose inhaled steroids like flovent used every day for 20-30 years (when done properly) have the same effects as one course of oral steroids. So in the end, I think we don't use controller medications enough, because of the presumed side effects, which are tolerable given the alternative. BTW, really no one is starting anyone on Advair anymore because of the association with long acting Beta2 agonists (Salmetrol) and severe asthma attacks including death.

Just my two cents