Asthma therapy Stepwise summary

4th Pediatric Infectious Diseases Conference

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Asthma in Children

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ASTHMA IN CHILDREN

Dr C.T.Deshmukh
Professor of Pediatrics, K.E.M Hospital

Stepwise Asthma Therapy Summary

Continued...

Step 3:

If symptoms are not controlled or daily short acting bronchodilators are needed then two drugs may be required for proper control.

Try with moderate dose of inhaled steroids first.

Add slow release theophylline or inhaled salmeterol if no response.

Alternate-morning administration of shorter-acting oral corticosteroids such as prednisone, prednisolone, or methylprednisolone can be given as an alternative to inhaled corticosteroids for most patients who cannot or will not comply with inhaled corticosteroids.

One or two maintenance medications at a twice-daily schedule with judicious use of a pre-exercise beta-2 agonist and appropriate measures of intervention, is generally sufficient for control of asthma.

Step 4:

Patients who are still not free from symptoms and need more than once a day short acting bronchodilators need at least two drugs for prevention of asthma.

High dose inhaled steroids are given.

And long acting bronchodilator (inhaled or oral ?2 agonist or theophylline)

And / Or oral steroids
All patients requiring maintenance medication should, in general be evaluated to determine the role of environmental factors involved in their symptoms. This evaluation involves careful history and skin testing for specific IgE. This would be particularly relevant for patients requiring more than either theophylline or low-dose inhaled steroids for maintenance. Specific immunotherapy may be tried in severe asthma who need two drugs for control. Each visit special attention is taken to evaluate the compliance and method of delivery of drugs.

Next : Asthma Investigations(Contd.)

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ASTHMA IN CHILDREN : EXPERTISE VIEWS

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