Inhaled corticosteroids (ICS) are the mainstay treatment for pediatric patients with asthma for maintenance therapy and are referred to as “controller” medications.3-5 Short-acting beta agonists (SABAs) are the agents of choice to relieve sudden symptoms and are referred to as “rescue” or “quick-relief” medications. Other agents used in the treatment of asthma in pediatric patients include long-acting beta agonists (LABAs), combination ICS/LABA agents, and leukotriene modifiers. Oral and/or intravenous corticosteroids may also be warranted in severe asthma exacerbations. (See Table 1, click to expand.) 3-4
According to the 2017 Global Initiative for Asthma (GINA) report and the 2007 Expert Panel Report-3 Guidelines for the Diagnosis and Management of Asthma, a stepwise treatment approach is recommended based on symptom patterns, risk of exacerbations, and side effects.3-4 The route of administration must also be considered when treating pediatric patients; children less than 4 years of age generally require delivery of agents via nebulizer through a face mask that should fit snugly over nose and mouth, while metered-dose and dry-powder inhalers are suitable for children ages 4 and up.4 A regular daily low-dose ICS is recommended as the preferred initial controller treatment in children 5 years of age and younger, and should be given for at least 3 months to establish its effectiveness in achieving asthma control.3-4
Children age 6 and above should also be evaluated to determine symptom control and response to ICS therapy (respiratory symptoms, lung function, airflow limitation) as well as future risk of adverse outcomes.3-4 If patients are deemed to have poor symptom control and poor control of exacerbation on current ICS regimen, the practitioner should assess the following before a step-up in treatment is considered: confirm symptoms are due to asthma and rule out other etiologies, check and correct inhaler technique, confirm adherence to the prescribed dose, and inquire about risk factors and environmental triggers such as allergens and smoke exposure.4,5 Then, a moderate ICS or leukotriene inhibitor may be considered for adequate control.3-4 Patients who exhibit well-controlled asthma should be stepped-down in therapy to a lower-dose ICS and monitored for maintenance of control.4
Pharmacists and Asthma
Pharmacists are especially well equipped to deliver asthma-focused medication therapy management sessions to patients and their caregivers to improve health outcomes.6 Patients can be educated to manage their asthma effectively on their own. This self-management includes assessing the level of asthma control and recognizing symptoms of worsening asthma. Patients can also to be taught to follow a written asthma action plan that includes daily actions to control asthma and how to adjust medications when needed to regain control of symptoms.6
Pharmacists are invaluable assets for providing patient education and patient self-care training in chronic diseases. They practice in various settings and, with asthma, are knowledgeable about the medications commonly prescribed, medication administration technique, recommended immunizations, and sick-day management for children.