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Asthma in children younger than 12 years: Treatment of persistent asthma with controller medications

Authors
Gregory Sawicki, MD, MPH
Kenan Haver, MD
Section Editors
Robert A Wood, MD
Gregory Redding, MD
Deputy Editor
Elizabeth TePas, MD, MS

INTRODUCTION

The use of long-term controller medications in the treatment of persistent asthma in children younger than 12 years of age is reviewed here. The recommendations that follow are based upon the United States National Asthma Education and Prevention Program (NAEPP) expert panel guidelines published in 2007 [1], which are similar to other major published asthma guidelines [2,3]. Assessing initial asthma severity, determining when to start daily controller therapy, and assessing and monitoring control to determine if therapy modifications are needed are discussed in detail separately. (See "Asthma in children younger than 12 years: Initiating therapy and monitoring control".)

The initial evaluation and diagnosis of asthma, use of rescue medications, and management of acute exacerbations in children are all discussed separately. A general overview of asthma management and control of triggers are also presented separately, as is the management of asthma in adolescents and adults. (See "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Asthma in children younger than 12 years: Rescue treatment for acute symptoms" and "Acute asthma exacerbations in children: Emergency department management" and "Acute asthma exacerbations in children: Inpatient management" and "An overview of asthma management" and "Trigger control to enhance asthma management" and "Treatment of intermittent and mild persistent asthma in adolescents and adults" and "Treatment of moderate persistent asthma in adolescents and adults".)

OUR APPROACH

Our approach to the treatment of persistent asthma with daily controller medications in children younger than 12 years is consistent with the recommendations of the National Asthma Education and Prevention Program (NAEPP) expert panel guidelines for the management of chronic childhood asthma in children aged 0 to 4 years and 5 to 11 years (figure 1 and table 1 and table 2 and figure 2 and table 3 and table 4) [1]. Their recommendations for the management of asthma in adolescents and adults are presented separately. (See "Treatment of intermittent and mild persistent asthma in adolescents and adults" and "Treatment of moderate persistent asthma in adolescents and adults".)

Controller medications for children younger than 12 years of age include inhaled glucocorticoids (also called inhaled corticosteroids [ICSs]) (table 5), oral leukotriene receptor antagonists (LTRAs), inhaled long-acting beta agonists (LABAs) in combination with inhaled glucocorticoids, oral glucocorticoids, inhaled chromones, and sustained-release oral theophylline (table 6). The evidence for our recommended treatment approach is reviewed in the sections on each class of agents below.

Initiating controller therapy — We suggest low-dose daily inhaled glucocorticoids as the first-line controller therapy for children with mild, persistent asthma (step 2 therapy) (figure 1 and table 1 and figure 2 and table 3 and table 5) [1,4,5]. We suggest medium-dose daily inhaled glucocorticoids as the first-line controller therapy for children zero to four years of age with moderate-to-severe, persistent asthma (step 3 therapy). For children 5 to 11 years of age with moderate-to-severe, persistent asthma, we suggest medium-dose daily inhaled glucocorticoids (step 3 therapy), or medium-dose inhaled glucocorticoids plus a LABA or a LTRA (step 4 therapy). The child and caregivers should receive instruction regarding the proper use of the medication delivery system(s) prescribed to ensure that the child receives the full benefit of the medication(s). Indications for starting controller therapy are discussed in greater detail separately. (See 'Inhaled glucocorticoids' below and "Use of medication nebulizers in children" and "The use of inhaler devices in children" and "Asthma in children younger than 12 years: Initiating therapy and monitoring control".)

                               

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