Acute asthma in children
First Line Drugs
- PREDNISOLONE (H02AB06)
- BUDESONIDE (R01AD05)
Reference
Comments/Instructions
In children discharged from the emergency department with mild to moderately severe exacerbations of asthma, treatment with steroids results in fewer treatment failures than treatment with montelukast (Singulair). (LOE = 1b)
http://www.ncbi.nlm.nih.gov/pubmed/19656525?dopt=Abstract
Doses of budesonide <400 µg/day or equivalent (see Table 1) have minimal systemic side effects. Studies indicate that there is an initial decrease in growth rate during the first year of inhaled corticosteroid use, but it is not sustained with long-term therapy and does not affect final adult height
Table 1: Comparative Dose Equivalencies for Inhaled Corticosteroids in Children (6–11 years)
Drug Low Dose Moderate Dose High Dose
Beclomethasone dipropionate pMDI ≤200 µg/day 201–400 µg/day >400 µg/day
Budesonide DPI ≤400 µg/day 401–800 µg/day >800 µg/day
Ciclesonide ≤200 µg/day 201–400 µg/day >400 µg/day
Fluticasone DPI or pMDI plus spacer ≤200 µg/day 201–500 µg/day >500 µg/day
Dose equivalencies in children <6 years are similar due to smaller tidal volumes and, consequently, reduced lung deposition in this younger age group. Young children should use a pMDI with a spacer.
Addendum Jan 5, 2012
The excess of serious asthma-related events attributable to LABAs was greatest among children:
The US Food and Drug Administration performed a meta-analysis of controlled clinical trials comparing the risk of LABA use with no LABA use for patients 4 to 11, 12 to 17, 18 to 64, and older than 64 years old. The effects of age on a composite of asthma-related deaths, intubations, and hospitalizations (asthma composite index) and the effects of concomitant inhaled corticosteroid (ICS) use were analyzed.
RESULTS: One hundred ten trials with 60 954 patients were included in the meta-analysis. The composite event incidence difference for all ages was 6.3 events per 1000 patient-years (95% confidence interval [CI]: 2.2-10.3) for using LABAs compared with not using LABAs. The largest incidence difference was observed for the 4- to 11-year age group (30.4 events per 1000 patient-years [95% CI: 5.7-55.1]). Differences according to age were statistically significant (P = .020). Results for the subgroup of patients with concomitant ICS use (n = 36 210) were similar to the overall results; with assigned ICSs (n = 15 192), the incidence difference was 0.4 events per 1000 patient-years (95% CI: -3.8 to 4.6), and there was no statistically significant difference according to age group.
http://www.ncbi.nlm.nih.gov/pubmed/22025595?dopt=Abstract&otool=icamculib
Tags
- Respiratory System
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