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Treatment Strategy: Moderate Childhood Asthma
Children with moderate persistent asthma experience daily symptoms and have more than two attacks each week. These patients require higher dosages of the inhaled corticosteroids and the addition of a long-acting B2-agonist such as salmeterol. The anti-leukotriene montelukast may also be used as an alternative anti-inflammatory agent.
Salmeterol
The long-acting B2-adrenergic agonist, salmeterol, may be used for the control of moderate persistent asthma in children aged five and older. The pediatric dosage is one to two inhalations every twelve hours. Children with primarily nocturnal symptoms may use one dose nightly.
Theophylline
Theophylline should be considered for use in the childhood asthmatic who is uncontrolled on the above therapy. Unfortunate side effects such as nervousness, however, limit its usefulness. Recent studies have raised the question of a learning disability that may be attributed to theophylline. Additional adverse effects are stomach upset and headache. As in adults, blood levels must be monitored to ensure an effective therapeutic level.
Anticholingergic Agents
The anticholinergic agent ipratropium bromide may be used in children aged twelve and older as a second or third-line agent. Since most childhood asthmatics are allergic, it is not likely that this agent would provide significant bronchodilatation. It is available in a nebulizer form as well as an MDI.
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