Pediatric Asthma Medication

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http://emedicine.medscape.com/article/1000997-medication#showall 1/10

Pediatric Asthma Medication

Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Michael R Bye, MD more...

Updated: Nov 25, 2013

Medication Summary

Pharmacologic management includes the use of control agents such as inhaled corticosteroids, inhaled cromolyn

or nedocromil, long-acting bronchodilators, theophylline, leukotriene modifiers, and more recent strategies such as

the use of anti-immunoglobulin E (IgE) antibodies (omalizumab). Relief medications include short-acting

bronchodilators, systemic corticosteroids, and ipratropium

Bronchodilators, Beta2-Agonists

Class Summary

These agents are used to treat bronchospasm in acute asthmatic episodes, and used to prevent bronchospasm

associated with exercise-induced asthma or nocturnal asthma. Several studies have suggested that short-acting

beta2-agonists such as albuterol may produce adverse outcomes (eg, decreased peak flow or increased risk of

exacerbations) in patients homozygous for arginine (Arg/Arg) at the 16th amino acid position of beta-adrenergicreceptor gene compared with patients homozygous for glycine (Gly-Gly). Similar findings are reported for long-

acting beta2-agonists, such as salmeterol.

View full drug information

Albuterol sulfate (Proventil HFA, Ventolin HFA, ProAir HFA)

This beta2-agonist is the most commonly used bronchodilator that is available in multiple forms (eg, solution for

nebulization, MDI, PO solution). This is most commonly used in rescue therapy for acute asthmatic symptoms.

Used as needed. Prolonged use may be associated with tachyphylaxis due to beta2-receptor downregulation and

receptor hyposensitivity.


Pirbuterol(Maxair Autohaler)

Pirbuterolis available as a breath-actuated or ordinary inhaler. The ease of administration with the breath-actuated

device makes it an attractive choice in the treatment of acute symptoms in younger children who otherwise cannot

use an MDI. The Autohaler delivers 200 mcg per actuation.

Nonracemic Form of the Beta2-Agonist Albuterol

Class Summary

This nonracemic form of albuterol offers a significant reduction in the adverse effects associated with racemic

albuterol (eg, muscle tremors, tachycardia, hyperglycemia, hypokalemia).


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Levalbuterol (Xopenex)

Nonracemic form of albuterol, levalbuterol (R isomer) is effective in smaller doses and is reported to have fewer

adverse effects (eg, tachycardia, hyperglycemia, hypokalemia). The dose may be doubled in acute severe

episodes when even a slight increase in the bronchodilator response may make a big difference in the

management strategy (eg, in avoiding patient ventilation). It is available as an MDI (45 mcg per actuation) or

solution for nebulized inhalation.

Long-Acting Beta2-AgonistsClass Summary

Long-acting bronchodilators (LABA) are not used for the treatment of acute bronchospasm. They are used for the

preventive treatment of nocturnal asthma or exercise-induced asthmatic symptoms, for example.

Currently, 2 LABA are available in the United States: salmeterol (Serevent) and formoterol (Foradil). Salmeterol

and formoterol are available as combination products with inhaled corticosteroids in the United States (Advair,

Symbicort, Dulera).

LABA may increase the chance of severe asthma episodes and death when those episodes occur. Most cases

have occurred in patients with severe and/or acutely deteriorating asthma; they have also occurred in a fewpatients with less severe asthma.

LABAs are not considered first-line medications to treat asthma. LABAs should not be used as isolated

medications and should be added to the asthma treatment plan only if other medicines do not control asthma,

including the use of low- or medium-dose corticosteroids. If used as isolated medication, LABAs should be

prescribed by a subspecialist (ie, pulmonologist, allergist).


Salmeterol (Serevent Diskus)

This long-acting preparation of a beta2-agonist is used primarily to treat nocturnal or exercise-induced symptoms.It has no anti-inflammatory action and is not indicated in the treatment of acute bronchospastic episodes. It may

be used as an adjunct to inhaled corticosteroids to reduce the potential adverse effects of the steroids. The

medication is delivered via a Diskus DPI.


Formoterol (Foradil Aerolizer)

Formoterol relieves bronchospasm by relaxing the smooth muscles of the bronchioles in conditions associated

with asthma.

Methylxanthines

Class Summary

These agents are used for long-term control and prevention of symptoms, especially nocturnal symptoms.


Theophylline (Theo-24, Theochron, Uniphyl)

Theophylline is available in short-acting and long-acting formulations. Because of the need to monitor serum

concentrations, this agent is used infrequently. The dose and frequency depend on the particular product selected.

Inhaled Corticosteroids

Class Summary
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Steroids are the most potent anti-inflammatory agents. Inhaled forms are topically active, poorly absorbed, and

least likely to cause adverse effects. They are used for long-term control of symptoms and for the suppression,

control, and reversal of inflammation. Inhaled forms reduce the need for systemic corticosteroids.

Inhaled steroids block late asthmatic response to allergens; reduce airway hyperresponsiveness; inhibit cytokine

production, adhesion protein activation, and inflammatory cell migration and activation; and reverse beta2-receptor

downregulation and subsensitivity (in acute asthmatic episodes with LABA use).


Ciclesonide (Alvesco)

Ciclesonide is an aerosol inhaled corticosteroid indicated for maintenance treatment of asthma as prophylactic

therapy in adult and adolescent patients aged 12 y and older. Not indicated for relief of acute bronchospasm.

Corticosteroids have wide range of effects on multiple cell types (eg, mast cells, eosinophils, neutrophils,

macrophages, lymphocytes) and mediators (eg, histamines, eicosanoids, leukotrienes, cytokines) involved in

inflammation.

Individual patients experience variable time to onset and degree of symptom relief. Maximum benefit may not be

achieved for 4 wk or longer after initiation of therapy.

After asthma stability is achieved, it is best to titrate to lowest effective dosage to reduce the possibility of adverse

effects. For patients who do not adequately respond to the starting dose after 4 wk of therapy, higher doses may

provide additional asthma control.


Beclomethasone (QVAR)

Beclomethasone inhibits bronchoconstriction mechanisms; causes direct smooth muscle relaxation; and may

decrease the number and activity of inflammatory cells, which, in turn, decreases airway hyperresponsiveness. It

is available as 40 mcg/actuation or 80 mcg/actuation.


Fluticasone (Flovent Diskus, Flovent HFA)

Fluticasone has extremely potent vasoconstrictive and anti-inflammatory activity. It has a weak hypothalamic-

pituitary adrenocortical axis inhibitory potency when applied topically. It is available as an MDI aerosolized product

(HFA) or DPI (Diskus).


Budesonide inhaled (Pulmicort Flexhaler or Respules)

Budesonide has extremely potent vasoconstrictive and anti-inflammatory activity. It has a weak hypothalamic-

pituitary adrenocortical axis inhibitory potency when applied topically. It is available as a DPI in 90 mcg/actuation

(delivers about 80 mcg/actuation) or 180 mcg/actuation (delivers about 160 mcg/actuation). A nebulized susp (ie,

Respules) is also available for young children.


Mometasone furoate inhalation powder (Asmanex Twisthaler)

Mometasone is a corticosteroid for inhalation. It is indicated for asthma as prophylactic therapy.

Systemic Corticosteroids

Class Summary

These agents are used for short courses (3-10 d) to gain prompt control of inadequately controlled acute asthmatic
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episodes. They are also used for long-term prevention of symptoms in severe persistent asthma as well as for

suppression, control, and reversal of inflammation. Frequent and repetitive use of beta2-agonists has been

associated with beta2-receptor subsensit ivity and downregulation; these processes are reversed with

corticosteroids.

Higher-dose corticosteroids have no advantage in severe asthma exacerbations, and intravenous administration

has no advantage over oral therapy, provided that GI transit time or absorption is not impaired. The usual regimen

is to continue frequent multiple daily dosing until the FEV1or peak expiratory flow (PEF) is 50% of the predicted or

personal best values; then, the dose is changed to twice daily. This usually occurs within 48 hours.


Prednisone (Deltasone, Orasone) and prednisolone (Pediapred, Prelone, Orapred)

An immunosuppressant for the treatment of autoimmune disorders, prednisone may decrease inflammation by

reversing increased capillary permeability and suppressing polymorphonuclear neutrophil (PMN) act ivity.


Methylprednisolone (Solu-Medrol)

Methylprednisolone may decrease inflammation by reversing increased capillary permeability and suppressingPMN activity.

Leukotriene Modifiers

Class Summary

Knowledge that leukotrienes cause bronchospasm, increased vascular permeability, mucosal edema, and

inflammatory cell infiltration has led to the concept of modifying their action by using pharmacologic agents. These

are either 5-lipoxygenase inhibitors or leukotriene-receptor antagonists.


Zafirlukast (Accolate)

Zafirlukast is a selective competitive inhibitor of LTD4 and LTE4 receptors.


Montelukast (Singulair)

The last agent introduced in its class, montelukast has the advantages that it is chewable, it has a once-a-day

dosing, and it has no significant adverse effects.

Monoclonal Antibodies

Class Summary

These agents bind selectively to human IgE on the surface of mast cells and basophils.


Omalizumab (Xolair)

Omalizumab is a recombinant, DNA-derived, humanized IgG monoclonal antibody that binds selectively to humanIgE on surface of mast cells and basophils. It reduces mediator release, which promotes allergic response. It is

indicated for moderate-to-severe persistent asthma in patients who react to perennial allergens in whom symptoms

are not controlled by inhaled corticosteroids.
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Combination Inhaled Steroids/Long-Acting Beta2-Agonists

Class Summary

These combinations may decrease asthma exacerbations when inhaled short-acting beta2-agonists and

corticosteroids have failed. Refer to previous discussion in the LABAs section regarding increased risk of severe

asthma episodes and death with LABAs. In a recent study, use of combination therapy using fluticasone

propionate and salmeterol prolonged time to first severe asthma exacerbation.[61]

Budesonide is an inhaled corticosteroid that alters level of inflammation in airways by inhibiting multiple types of

inflammatory cells and decreasing production of cytokines and other mediators involved in the asthmatic response.

Available as MDI in 2 strengths; each actuation delivers formoterol 4.5 mcg with either 80 mcg or 160 mcg.


Budesonide/formoterol (Symbicort)

Formoterol relieves bronchospasm by relaxing the smooth muscles of the bronchioles in conditions associated

with asthma. Budesonide is an inhaled corticosteroid that alters the level of inflammation in airways by inhibiting

multiple types of inflammatory cells and decreasing production of cytokines and other mediators involved in the

asthmatic response. This combination is available as an MDI in 2 strengths; each actuation delivers formoterol 4.5-mcg with either 80-mcg or 160-mcg of budesonide.


Mometasone and formoterol (Dulera)

This is a combination corticosteroid and LABA metered-dose inhaler. Mometasone elicits local anti-inflammatory

effects in the respiratory tract with minimal systemic absorption. Formoterol elicits bronchial smooth muscle

relaxation.

This combination is indicated for prevention and maintenance of asthma symptoms in patients inadequately

controlled with other asthma controller medications (eg, low-dose to medium-dose inhaled corticosteroids) orwhose disease severity clearly warrants initiation of treatment with 2 maintenance therapies, including a LABA.

Available in 2 strengths; each actuation delivers mometasone/formoterol 100 mcg/5 mcg or 200 mcg/5 mcg.


Salmeterol/fluticasone inhaled (Advair)

This is a combination corticosteroid and LABA metered-dose inhaler. Fluticasone inhibits bronchoconstriction

mechanisms, produces direct smooth muscle relaxation, and may decrease number and activity of inflammatory

cells, in turn decreasing airway hyper-responsiveness. It also has vasoconstrictive activity. Salmeterol relaxes the

smooth muscles of the bronchioles in conditions associated with bronchitis, emphysema, asthma, or

bronchiectasis and can relieve bronchospasms. Its effect may also facilitate expectoration. Adverse effects aremore likely to occur when administered at high or more frequent doses than recommended. Two delivery

mechanisms are available (ie, powder for inhalation [Diskus], metered-dose inhaler [MDI]). Diskus is available as a

combination of salmeterol 50 mcg with fluticasone 100 mcg, 250 mcg, or 500 mcg. The MDI is available as 21

mcg salmeterol with fluticasone 45 mcg, 115 mcg, or 230 mcg.

Anticholinergic Agents

Class Summary

These agents may be added to beta2-agonist therapy for treatment of acute exacerbations.


Ipratropium (Atrovent)

Chemically related to atropine, protropium has antisecretory properties and, when applied locally, inhibits
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secretions from serous and seromucous glands lining the nasal mucosa. The MDI delivers 17 mcg/actuation.

Solution for inhalation contains 500 mcg/2.5 mL (ie, 0.02% solution for nebulization).

Contributor Information and DisclosuresAuthor

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Director, Section of Pediatric Pulmonology and

Rush Cystic Fibrosis Center, Rush Medical College; Senior Attending, Department of Pediatrics, Rush

University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies:American Academy of

Pediatrics,American College of Chest Physicians,American Thoracic Society, and Royal College of

Physicians of Ireland

Disclosure: Nothing to disclose.

Coauthor(s)

Payel Gupta, MD Department of Allergy and Immunology, ENT Faculty Practice

Payel Gupta, MD is a member of the following medical societies:American College of Physicians


Specialty Editor Board

Thomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of

Pediatrics, Rutgers Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the

Advancement of Science,American Society for Biochemistry and Molecular Biology,American Thoracic

Society, Society for Pediatric Research, and Society for Pediatric Research


Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College ofPharmacy; Editor-in-Chief, Medscape Drug Reference


Charles Callahan, DO Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics,

American College of Chest Physicians,American College of Osteopathic Pediatricians,American Thoracic

Society,Association of Military Surgeons of the US, and Christian Medical & Dental Society


Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of

Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies:American Academy of Pediatrics,American

College of Chest Physicians, andAmerican Thoracic Society


References

1. National Health Interview Survey, National Center for Health Statistics. CDC. Available at

http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-05/asthma03-05.htm.

2. London S. Study Validates Asthma Symptom Tracker. Medscape Medical News[serial online]. Nov 11

2013;Accessed Nov 20 2013. Available at http://www.medscape.com/viewarticle/814123.
http://www.medscape.com/viewarticle/814123http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-05/asthma03-05.htmhttp://www.thoracic.org/http://www.chestnet.org/http://www.aap.org/http://www.cirtl.org/cmds.htmhttp://www.amsus.org/http://www.thoracic.org/http://www.acopeds.org/http://www.chestnet.org/http://www.aap.org/http://www.aps-spr.org/http://www.aps-spr.org/http://www.thoracic.org/http://www.asbmb.org/http://www.aaas.org/http://www.acponline.org/http://www.rcpi.ie/http://www.thoracic.org/http://www.chestnet.org/http://www.aap.org/


7/10



3. Nkoy FL, Stone BL, Fassl BA, et al. Longitudinal validation of a tool for asthma self-monitoring.

Pediatrics . Nov 11 2013;[Medline].

4. [Guideline] Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-

Summary Report 2007. J Allergy Clin Immunol. Nov 2007;120(5 Suppl):S94-138. [Medline].

5. National Heart, Lung, and Blood Institute. Global Initiative for Asthma. National Institute for Health

Publication. 1995;95-3659.

6. Global strategy for asthma management and prevention. Global initiative for asthma (GINA) 2006.

Available at http://ginasthma.org.

7. Akinbami LJ, Moorman JE, Garbe PL, Sondik EJ. Status of childhood asthma in the United States, 1980-

2007. Pediatrics . Mar 2009;123 Suppl 3:S131-45. [Medline].

8. Anderson WJ, Watson L. Asthma and the hygiene hypothesis. N Engl J Med. May 24 2001;344(21):1643-

4. [Medline].

9. Goksr E, Alm B, Thengilsdottir H, Pettersson R, Aberg N, Wennergren G. Preschool wheeze - impact of

early fish introduction and neonatal antibiotics. Acta Paediatr. Dec 2011;100(12):1561-6. [Medline].

10. Bousquet J, Jeffery PK, Busse WW, Johnson M, Vignola AM. Asthma. From bronchoconstriction to

airways inflammation and remodeling.Am J Respir Crit Care Med. May 2000;161(5):1720-45. [Medline].

11. Ege MJ, Mayer M, Normand AC, Genuneit J,et al. Exposure to environmental microorganisms and

childhood asthma. N Engl J Med. Feb 24 2011;364(8):701-9. [Medline].

12. Zucker, M. Asthma phenotype, genotype may guide future therapies. http://www.pulmonaryreviews.com

[serial online]. June 2003;8:Available at

http://www.pulmonaryreviews.com/jun03/pr_jun03_phenotype.html.

13. Drazen JM, Yandava CN, Dub L, Szczerback N, Hippensteel R, Pillari A, et al. Pharmacogenetic

association between ALOX5 promoter genotype and the response to anti-asthma treatment. Nat Genet.

Jun 1999;22(2):168-70. [Medline].

14. Thompson EE, Pan L, Ostrovnaya I, Weiss LA, Gern JE, Lemanske RF Jr, et al. Integrin beta 3 genotypeinfluences asthma and allergy phenotypes in the first 6 years of life. J Allergy Clin Immunol. Jun

2007;119(6):1423-9. [Medline].

15. Wechsler ME, Lehman E, Lazarus SC, Lemanske RF Jr, Boushey HA, Deykin A, et al. beta-Adrenergic

receptor polymorphisms and response to salmeterol.Am J Respir Crit Care Med. Mar 1 2006;173(5):519-

26. [Medline]. [Full Text].

16. Moore WC, Meyers DA, Wenzel SE, Teague WG, et al. Identification of asthma phenotypes using cluster

analysis in the Severe Asthma Research Program.Am J Respir Crit Care Med. Feb 15 2010;181(4):315-


17. Torgerson DG, Ampleford EJ, Chiu GY, et al. Meta-analysis of genome-wide association studies ofasthma in ethnically diverse North American populations. Nat Genet. Jul 31 2011;43(9):887-92. [Medline].

18. Ferreira MA, Matheson MC, Duffy DL, et al. Identification of IL6R and chromosome 11q13.5 as risk loci for

asthma. Lancet. Sep 10 2011;378(9795):1006-14. [Medline].

19. Bisgaard H, Jensen SM, Bnnelykke K. Interaction between Asthma and Lung Function Growth in Early

Life.Am J Respir Crit Care Med. Jun 1 2012;185(11):1183-9. [Medline].

20. Lemanske RF Jr, Jackson DJ, Gangnon RE, Evans MD, Li Z, Shult PA, et al. Rhinovirus illnesses during

infancy predict subsequent childhood wheezing. J Allergy Clin Immunol. Sep 2005;116(3):571-7.

[Medline].

21. [Best Evidence] Guilbert TW, Morgan WJ, Zeiger RS, Mauger DT, Boehmer SJ, Szefler SJ, et al. Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med. May 11

2006;354(19):1985-97. [Medline].

22. Vesper S, McKinstry C, Haugland R, et al. Development of an Environmental Relative Moldiness index for

US homes. J Occup Environ Med. Aug 2007;49(8):829-33. [Medline].
http://reference.medscape.com/medline/abstract/17693779http://reference.medscape.com/medline/abstract/16687711http://reference.medscape.com/medline/abstract/16159626http://reference.medscape.com/medline/abstract/22461370http://reference.medscape.com/medline/abstract/21907864http://reference.medscape.com/medline/abstract/21804549http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2822971/http://reference.medscape.com/medline/abstract/19892860http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662935/http://reference.medscape.com/medline/abstract/16322642http://reference.medscape.com/medline/abstract/17556058http://reference.medscape.com/medline/abstract/10369259http://www.pulmonaryreviews.com/jun03/pr_jun03_phenotype.htmlhttp://reference.medscape.com/medline/abstract/21345099http://reference.medscape.com/medline/abstract/10806180http://reference.medscape.com/medline/abstract/21767307http://reference.medscape.com/medline/abstract/11374368http://reference.medscape.com/medline/abstract/19221156http://ginasthma.org/http://reference.medscape.com/medline/abstract/17983880http://reference.medscape.com/medline/abstract/24218469


8/10



23. Reponen T, Vesper S, Levin L, et al. High environmental relative moldiness index during infancy as a

predictor of asthma at 7 years of age.Ann Allergy Asthma Immunol. Aug 2011;107(2):120-6. [Medline].

24. Farah CS, Kermode JA, Downie SR, et al. Obesity is a determinant of asthma control independent of

inflammation and lung mechanics. Chest. Sep 2011;140(3):659-66. [Medline].

25. Quinto KB, Zuraw BL, Poon KY, Chen W, Schatz M, Christiansen SC. The association of obesity and

asthma severity and control in children. J Allergy Clin Immunol. Nov 2011;128(5):964-9. [Medline].

26. Goleva E, Searing DA, Jackson LP, Richers BN, Leung DY. Steroid requirements and immuneassociations with vitamin D are stronger in children than adults with asthma. J Allergy Clin Immunol. Feb

11 2012;[Medline].

27. Mitchell EA, Beasley R, Keil U, Montefort S, Odhiambo J. The association between tobacco and the risk

of asthma, rhinoconjunctivitis and eczema in children and adolescents: analyses from Phase Three of the

ISAAC programme. Thorax. Jun 12 2012;[Medline].

28. Lumia M, Luukkainen P, Kaila M, Tapanainen H, Takkinen HM, Prasad M, et al. Maternal dietary fat and

fatty acid intake during lactation and the risk of asthma in the offspring. Acta Paediatr. Aug

2012;101(8):e337-e343. [Medline].

29. Mathilda Chiu YH, Coull BA, Cohen S, Wooley A, Wright RJ. Prenatal and postnatal maternal stress andwheeze in urban children: effect of maternal sensitization.Am J Respir Crit Care Med. Jul 15

2012;186(2):147-54. [Medline]. [Full Text].

30. Harpse MC, Basit S, Bager P, Wohlfahrt J, Benn CS, Nhr EA, et al. Maternal obesity, gestational

weight gain, and risk of asthma and atopic disease in offspring: A study within the Danish National Birth

Cohort. J Allergy Clin Immunol. Nov 1 2012;[Medline].

31. Donohue KM, Miller RL, Perzanowski MS, Just AC, Hoepner LA, Arunajadai S, et al. Prenatal and

postnatal bisphenol A exposure and asthma development among inner-city children. J Allergy Clin

Immunol. Mar 2013;131(3):736-742.e6. [Medline].

32. Barclay L. BPA Exposure Linked to Childhood Asthma Risk. Available at

http://www.medscape.com/viewarticle/780110. Accessed March 12, 2013.

33. Asthma prevalence and control characteristics by race/ethnicity--United States, 2002. MMWR Morb

Mortal Wk ly Rep. Feb 27 2004;53(7):145-8. [Medline].

34. Moorman JE, Rudd RA, Johnson CA, King M, Minor P, Bailey C, et al. National surveillance for asthma--

United States, 1980-2004. MMWR Surveill Summ. Oct 19 2007;56(8):1-54. [Medline].

35. Arshad SH, Karmaus W, Raza A, Kurukulaaratchy RJ, Matthews SM, Holloway JW, et al. The effect of

parental allergy on childhood allergic diseases depends on the sex of the child. J Allergy Clin Immunol.

May 17 2012;[Medline].

36. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in thefirst six years of life. The Group Health Medical Associates. N Engl J Med. Jan 19 1995;332(3):133-8.

[Medline].

37. Castro-Rodrguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in

young children with recurrent wheezing.Am J Respir Crit Care Med. Oct 2000;162(4 Pt 1):1403-6.

[Medline].

38. [Best Evidence] Coffman JM, Cabana MD, Yelin EH. Do school-based asthma education programs

improve self-management and health outcomes?. Pediatrics. Aug 2009;124(2):729-42. [Medline]. [Full

Text].

39. Wu AC, Tantisira K, Li L, Schuemann B, Weiss ST, Fuhlbrigge AL. Predictors of Symptoms are Different

from Predictors of Severe Exacerbations from Asthma in Children. Chest. Feb 3 2011;[Medline].

40. Stern G, de Jongste J, van der Valk R, Baraldi E, Carraro S, Thamrin C, et al. Fluctuation phenotyping

based on daily fraction of exhaled nitric oxide values in asthmatic children. J Allergy Clin Immunol. Aug

2011;128(2):293-300. [Medline].
http://reference.medscape.com/medline/abstract/21489612http://reference.medscape.com/medline/abstract/21292760http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875148/http://reference.medscape.com/medline/abstract/19651589http://reference.medscape.com/medline/abstract/11029352http://reference.medscape.com/medline/abstract/7800004http://reference.medscape.com/medline/abstract/22607991http://reference.medscape.com/medline/abstract/17947969http://reference.medscape.com/medline/abstract/14985651http://www.medscape.com/viewarticle/780110http://reference.medscape.com/medline/abstract/23452902http://reference.medscape.com/medline/abstract/23122630http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406080/http://reference.medscape.com/medline/abstract/22582161http://reference.medscape.com/medline/abstract/22578184http://reference.medscape.com/medline/abstract/22693180http://reference.medscape.com/medline/abstract/22330698http://reference.medscape.com/medline/abstract/21820711http://reference.medscape.com/medline/abstract/21415135http://reference.medscape.com/medline/abstract/21802019


9/10



41. Robroeks CM, van Vliet D, Jbsis Q, Braekers R, Rijkers GT, Wodzig WK, et al. Predict ion of asthma

exacerbations in children: results of a one-year prospective study. Clin Exp Allergy. May 2012;42(5):792-

8. [Medline].

42. Wu AC, Tantisira K, Li L, Fuhlbrigge AL, Weiss ST, Litonjua A. Effect of vitamin D and inhaled

corticosteroid treatment on lung function in children.Am J Respir Crit Care Med. Sep 15 2012;186(6):508-


43. Holbrook JT, Wise RA, Gold BD, et al. Lansoprazole for children with poorly controlled asthma: a

randomized controlled trial. JAMA. Jan 25 2012;307(4):373-81. [Medline].

44. Brozek JL, Kraft M, Krishnan JA, Cloutier MM, Lazarus SC, Li JT, et al. Long-Acting 2-Agonist Step-off

in Patients With Controlled Asthma: Systematic Review With Meta-analysis.Arch Intern Med. Aug 27

2012;1-11. [Medline].

45. [Best Evidence] Nelson HS, Weiss ST, Bleecker ER, Yancey SW, Dorinsky PM. The Salmeterol

Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual

pharmacotherapy plus salmeterol. Chest. Jan 2006;129(1):15-26. [Medline].

46. [Best Evidence] Salpeter SR, Wall AJ, Buck ley NS. Long-acting beta-agonists with and without inhaled

corticosteroids and catastrophic asthma events.Am J Med. Apr 2010;123(4):322-8.e2. [Medline].

47. US Food and Drug Administration. FDA Drug Safety Communication: New safety requirements for long-acting inhaled asthma medications called Long-Acting Beta-Agonists (LABA). Human Department of

Health and Human services. Feb 18, 2010;1-4. [Full Text].

48. Lemanske RF, Mauger DT, Sorkness CA, et al. Step-up therapy for children with uncontrolled asthma

receiving inhaled corticosteroids. N Engl J Med. March 30, 2010;362:975-85.

49. [Best Evidence] Rachelefsky G. Inhaled corticosteroids and asthma control in children: assessing

impairment and risk. Pediatrics. Jan 2009;123(1):353-66. [Medline].

50. Martinez FD, Chinchilli VM, Morgan WJ, Boehmer SJ, Lemanske RF Jr, Mauger DT, et al. Use of

beclomethasone dipropionate as rescue treatment for children with mild persistent asthma (TREXA): a

randomised, double-blind, placebo-controlled trial. Lancet. Feb 19 2011;377(9766):650-7. [Medline].

51. Quon BS, Fitzgerald JM, Lemire C, Shahidi N, Ducharme FM. Increased versus stable doses of inhaled

corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev.

Dec 8 2010;CD007524. [Medline].

52. Agertoft L, Pedersen S. Effect of long-term treatment with inhaled budesonide on adult height in children

with asthma. N Engl J Med. Oct 12 2000;343(15):1064-9. [Medline].

53. Long-term effects of budesonide or nedocromil in children with asthma. The Childhood Asthma

Management Program Research Group. N Engl J Med. Oct 12 2000;343(15):1054-63. [Medline].

54. Rodrigo GJ, Neffen H, Castro-Rodriguez JA. Efficacy and safety of subcutaneous omalizumab vs placebo

as add-on therapy to corticosteroids for children and adults with asthma: a systematic review. Chest. Jan2011;139(1):28-35. [Medline].

55. Busse WW, Morgan WJ, Gergen PJ, Mitchell HE, Gern JE, Liu AH, et al. Randomized trial of

omalizumab (anti-IgE) for asthma in inner-city children. N Engl J Med. Mar 17 2011;364(11):1005-15.

[Medline].

56. Omalizumab May Help Kids With Uncontrolled Allergic Asthma. Medscape[serial online]. Apr 4

2013;Accessed Apr 9 2013. Available at http://www.medscape.com/viewarticle/781963.

57. Deschildre A, Marguet C, Salleron J, et al. Add-on omalizumab in children with severe allergic asthma: a

one year real life survey. Eur Respir J. Mar 21 2013;[Medline].

58. [Best Evidence] Cates CJ, Bestall J, Adams N. Holding chambers versus nebulisers for inhaled steroids

in chronic asthma. Cochrane Database Syst Rev. Jan 25 2006;CD001491. [Medline].

59. [Best Evidence] Vuillermin PJ, Robertson CF, Carlin JB, Brennan SL, Biscan MI, South M. Parent

initiated prednisolone for acute asthma in children of school age: randomised controlled crossover trial.
http://reference.medscape.com/medline/abstract/16437434http://reference.medscape.com/medline/abstract/23520319http://www.medscape.com/viewarticle/781963http://reference.medscape.com/medline/abstract/21410369http://reference.medscape.com/medline/abstract/20688929http://reference.medscape.com/medline/abstract/11027739http://reference.medscape.com/medline/abstract/11027740http://reference.medscape.com/medline/abstract/21154378http://reference.medscape.com/medline/abstract/21324520http://reference.medscape.com/medline/abstract/19117903http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm200776.htmhttp://reference.medscape.com/medline/abstract/20176343http://reference.medscape.com/medline/abstract/16424409http://reference.medscape.com/medline/abstract/22928176http://reference.medscape.com/medline/abstract/22274684http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480528/http://reference.medscape.com/medline/abstract/22798322http://reference.medscape.com/medline/abstract/22515395


10/10


Medscape Reference 2011 WebMD, LLC

BMJ. Mar 1 2010;340:c843. [Medline]. [Full Text].

60. Halterman JS, Szilagyi PG, Fisher SG, Fagnano M, Tremblay P, Conn KM, et al. Randomized controlled

trial to improve care for urban children with asthma: results of the school-based asthma therapy trial. Arch

Pediatr Adolesc Med. Mar 2011;165(3):262-8. [Medline].

61. Postma DS, O'Byrne PM, Pedersen S. Comparison of the effect of low-dose ciclesonide and fixed-dose

fluticasone propionate and salmeterol combination on long-term asthma control. Chest. Feb

2011;139(2):311-8. [Medline].

62. Scott M, Roberts G, Kurukulaaratchy RJ, Matthews S, Nove A, Arshad SH. Multifaceted allergen

avoidance during infancy reduces asthma during childhood with the effect persisting until age 18 years.

Thorax. Dec 2012;67(12):1046-51. [Medline].
http://reference.medscape.com/medline/abstract/22858926http://reference.medscape.com/medline/abstract/21088114http://reference.medscape.com/medline/abstract/21383275http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830420/http://reference.medscape.com/medline/abstract/20194353

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