ASRM Web Daily Day 1 -
[Cached Version]
Published on: 10/26/2001
Last Visited: 4/11/2005
Michael Mellon, MD, pediatric allergist at Kaiser Permanente Medical Center in San Diego, presented his topic, "Considerations in Choosing Controller Therapy in Infants and Young Children."
"We're faced with making decisions with less information available," he said."Long-term treatments appear safe, but early intervention is important.We need to treat the frequent wheeze and follow it closely."
Dr. Mellon said the NAEPP recommendation to use controller medications for persistent asthma in infants and young children is problematic, because the wheezing pattern in this age group tends to be related to seasonal viral infections.
He added that at least 60 percent of all children who wheeze during viral infections have a transient condition that subsides by their early school years.
"Is it asthma?"Dr. Mellon asked."We have to rule out other things.While we don't have good long-term studies for children of pre-school age, if we miss the window of opportunity to treat patients early we will pay for it later on."
The criteria to identify children ages 2 to 4 as being a high risk for asthma include a diagnosed wheezing episode in the past year, along with a parent with asthma, atopic dermatitis or an aeroallergen sensitivity.
Dr. Mellon said the Childhood Asthma Management Program (CAMP) study found long-term inhaled corticosteroid use by children ages 5 to 12 to be safe and effective, with no differences in bone age, bone density or cataract formation.
When compared with placebo, children treated with budesonide (BUD) had a lower rate of hospitalizations, fewer visits for urgent care, more episode-free days, less albuterol use and less use of additional asthma medications.
There were no long-term studies comparable with CAMP in preschoolers, although Dr. Mellon said an early intervention study is underway to study children ages 2 to 4 who are at risk for developing chronic asthma.
He discussed a12-week study conducted in 2000 that followed moderately severe asthmatic children ages 2 to 5 years.They were given BUD via metal spacer, and compared with placebo, the BUD group showed significantly improved asthma symptom scores, asthma exacerbation rates and lung function.
Clinical trials of budesonide inhalation suspension (BIS), the only FDA-approved ICS for children ages 1 to 8, show efficacy at various strengths in children with mild to moderate asthma.U.S. trials show that some patients benefit from low doses, and that once-daily dosing is effective.
Dr. Mellon said the best delivery devices for pre-school aged children with asthma is still the one the patient will tolerate the best.
"It's impossible to separate the drug from the delivery device," he said.He said jet nebulizers were an efficient way to deliver the drug to patients under 2 years of age, while dry powder inhalers were efficient for children 4 or older.
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