The CDC recommends routine annual influenza vaccination for individuals 6 months or older with no contraindications. High-risk groups such as those with pulmonary disorders including asthma, children aged 6 to 59 months, and patient contacts and caregivers are a priority for annual influenza vaccine to aid in preventing viral infection.7 The CDC also recommends the pneumococcal conjugate vaccine in children with chronic lung disease. (See Figure 2.) Both vaccines may be administered at the same time.31-32
Pharmacists should make every effort to consistently educate patients and caregivers about how cold and flu viruses can colonize on hands. Regular hand washing can help protect from contracting minor respiratory infections, particularly during “cough and cold season.”32 Patients and caregivers should be taught to wash hands for 20 seconds with soap and water; use an alcohol-based hand sanitizer; avoid touching the eyes, nose, and mouth with unwashed hands; stay away from people who are sick; and cough or sneeze into a tissue or upper shirt sleeve, completely covering the mouth and nose.32
During a minor illness, patients and caregivers should also be reminded that OTC medication for children may help relieve some symptoms, such as fever, aches, runny nose, and congestion, but that they do not shorten the length of time children are sick or treat asthma symptoms such as cough, wheeze, or shortness of breath. Proper use of rescue and controller medications are critical during an acute respiratory illness. Ibuprofen or acetaminophen may be given to children 6 months or older (oral ibuprofen, 5 to 10 mg/kg every 6 to 8 hours as needed, maximum 4 doses/day; oral acetaminophen, 10 to 15 mg/kg every 4 to 6 hours as needed, maximum 5 doses/day) for fever or pain.34-35 Saline nose drops, humidifiers, or cool-mist vaporizers can be used to relieve a stuffy nose. Caregivers should not administer OTC cough and cold medications for children younger than 4 years of age unless instructed by their health-care provider.33-35
A stepwise approach to medication management is recommended for patients with asthma, with specific therapy changes based on level of asthma control.36 The recommendations vary slightly with age, but the cornerstone for maintenance therapy is ICS or controller medication for all age groups. Patients with asthma should also be prescribed a rescue inhaler or a short-acting beta-agonist for quick relief of acute symptoms. Barriers to appropriate medication adherence include complexity of medication regimens, inappropriate inhalation technique, cost, and forgetfulness.37 Education strategies should be tailored to the patients’ culture and level of education.
By remaining current in practice guidelines and strategies to attain and maintain asthma control, pharmacists will be well-positioned to make a significant impact on pediatric patients with asthma and their caregivers to promote better outcomes.
The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.