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Y àontroller medications for children include inhaled and systemic glucocorticosteroids, leukotriene modifiers, long
acting inhaled ɴ2-agonists, theophylline, cromones, and long-acting oral ɴ2-agonists

× 

  
Y ×nhaled glucocorticosteroids are the most effective controller therapy, and are therefore the recommended treatment
for asthma for children of all ages
Y phe potential clinically relevant  


of inhaled glucocorticosteroids on bones in children are osteoporosis

and fracture
Y ct higher doses, small changes in HPc axis function can be detected with sensitive methods
Y adrenal crisis has been reported in children treated with excessively high doses of inhaled glucocorticosteroids
Y the increased level of dental erosion reported in
children with asthma may be due to a reduction in
oral pH that may result from inhalation of ɴ2-agonists
a

 
  a 





àhildren older than 5 years:
Y aeukotriene modifiers provide partial protection
against exercise-induced bronchoconstriction within
hours after administration with no loss of
bronchoprotective effect
Y cs add-on treatment in children whose asthma is
insufficiently controlled by low doses of inhaled
glucocorticosteroids, leukotriene modifiers provide
moderate clinical improvements, including a
significant reduction in exacerbations
Y àombination therapy is less effective in controlling
asthma in children with moderate persistent asthma
than increasing to moderate doses of inhaled
glucocorticosteroids
àhildren 5 years and younger:
Y aeukotriene modifiers reduce viral-induced asthma
exacerbations in children ages 2-5 with a history of
intermittent asthma

Y aong-acting inhaled ɴ2-agonists are primarily used as
add-on therapy in children older than 5 years whose
asthma is insufficiently controlled by medium doses
of inhaled glucocorticosteroids or as single-dose
therapy before vigorous exercise
àhildren older than 5 years:
Y ×nhalation of a single dose of long-acting inhaled ɴ2-
agonist effectively blocks exercise-induced
bronchoconstriction for several hours
Y ¦ith daily therapy the duration of the protection is
somewhat reduced, but is still longer than that
provided by short-acting ɴ2-agonists
àhildren 5 years and younger:
Y àombination therapy with budesonide and formoterol
used both as maintenance and rescue has been
shown to
reduce asthma exacerbations in children ages 4 years
and older with moderate to severe asthma
Side effect:
Y inconsistency of reports on their effects

Y pheophylline has been shown to be effective as
monotherapy and as add-on treatment to inhaled or
 oral glucocorticosteroids in children older than 5 Y §ecause of the side effects of prolonged use, oral
years glucocorticosteroids in children with asthma
Y cdd-on treatment with theophylline has been found should be restricted to the treatment of acute
to improve asthma control and reduce the severe exacerbations, whether viral-induced or
maintenance glucocorticosteroid dose necessary in
otherwise
children with severe asthma treated with inhaled or
oral glucocorticosteroids.
Y phe efficacy of theophylline is less than that of low-
dose inhaled glucocorticosteroids Õ



 
Y Sustained-release products are preferable for Õ



 

   



maintenance therapy, since they enable twice-daily 


dosing Y Õapid-acting inhaled ɴ2-agonists are the most
Y Sustained-release products with reliable absorption effective bronchodilators available and therefore the
profiles and complete bioavailability with and without preferred treatment for acute asthma in children of
concomitant food intake are preferred all ages
Y phe most common
 


of theophylline are Y phe inhaled route results in more rapid

anorexia, nausea, vomiting, and headache
Y ]ild central nervous stimulation, palpitations,
tachycardia, arrhythmias, abdominal pain, diarrhea,
and, rarely, gastric
bleeding may also occur (mainly seen at doses higher
than 10 mg/kg/day)
Y phe risk of adverse effects is reduced if treatment is
initiated with daily doses around 5 mg/kg/day and
then gradually increased to 10 mg/kg/day


 
bronchodilation at a lower dose and with fewer side
effects than oral or intravenous administration
Y ×nhaled therapy offers significant protection against
exercise-induced bronchoconstriction and other
challenges for 0.5 to 2 hours (long acting ɴ2-agonists
offer longer protection)
Y Side effect : skeletal muscle tremor, headache,
palpitations, and some agitation
c

`ot recommended for long-term management of asthma
   
 
   
 in children


Y àonflicting & not better than placebo
Side effect :
Y àough, throat irritation, and broncho-constriction
occur in a small proportion of patients treated
with sodium cromoglycate
Y c bad taste, headache, and nausea are the most
common side effects of nedocromi

a 


Y preatment with long-acting oral ɴ2-agonist such
as slow release formulations of salbutamol,
terbutaline, and bambuterol reduces nocturnal
symptoms of asthma
Y wue to their potential side effects of
cardiovascular stimulation, anxiety, and skeletal
muscle tremor, their use is not encouraged

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