Mild Asthma in Preschoolers, Children & Adolescents Flashcards
Definition of Asthma Severity
Is based on the level of treatment needed to maintain asthma control.
Severity can only be accurately determined when asthma is well controlled and adherence and correct inhaler technique have been accounted for
Age cut off for spirometry
6 years or older
Criteria for day time symptoms and need for reliever
less than or equal to 2 days a week
Definition of mild exacerbation
does not require
> systemic steroids,
an emergency department (ED) visit,
hospitalization.
Should you prescribe SABA only PRN for Very Mild/ Mild Asthma + Higher risk of exacerbation?
No
Young people considered at higher risk for exacerbation AND who need to be assessed for risk of exacerbation [beyond asthma severity]
are those who:
(1) Have any history of a previous severe
asthma exacerbation (i.e., requiring use of systemic steroids, or an
ED visit, or hospitalization);
(2) Have poorly controlled asthma;
(3) Over-use SABA (i.e., use more than two SABA
inhalers over a 1-year period); or
(4) Currently smoke. Passive exposure
to smoke and the inhalation of other substances (e.g., vaping,
cannabis)
Treatment of Asthma
1] Asthma Action Plan
2] Asthma Trigger Identification
3] Environmental Modifications Discussion
4] Treatment by Age + Severity
Very Mild Asthma, treatment required:
PRN SABA
Mild Asthma, treatment required:
Low-dose ICS (or LTRA) + PRN SABA or
PRN budesonide/formoterol
Moderate Asthma, treatment required:
Low-dose ICS + a second controller + PRN
SABA or
moderate doses of ICS +/− a second
controller
+ PRN SABA or
low-to-moderate-dose budesonide/
formoterol + PRN budesonide/formoterol
Severe Asthma, treatment required:
High-dose ICS + a second controller or
systemic
steroids for 50% of the previous year even if severe asthma is not controlled with this treatment
Preschooler [1 to 5 years] Doses Low
Beclomethasone
dipropionate HFA
(QVAR)…………………………….100
Budesonide*
(Pulmicort)………………………n/a
Ciclesonide*
(Alvesco)………………………..100
Fluticasone furoate*
(Arnuity)………………………….n/a
Fluticasone propionate
(Flovent, Aermony)………..<200
Mometasone furoate*
(Asthmanex)……………………n/a
Preschooler [1 to 5 years] Doses Medium
Beclomethasone
dipropionate HFA
(QVAR)…………………………….200
Budesonide*
(Pulmicort)………………………n/a
Ciclesonide*
(Alvesco)…………………………200
Fluticasone furoate*
(Arnuity)………………………….n/a
Fluticasone propionate
(Flovent, Aermony)…………………200-250
Mometasone furoate*
(Asthmanex)……………………n/a
Children [6 to 11 years] Doses Low
Beclomethasone
dipropionate HFA
(QVAR)………………………….≤200
Budesonide*
(Pulmicort)……………………≤400
Ciclesonide*
(Alvesco)……………………….≤200
Fluticasone furoate*
(Arnuity)………………………….n/a
Fluticasone propionate
(Flovent, Aermony)……………………..≤200
Mometasone furoate*
(Asthmanex)……………………100
Children [6 to 11 years] Doses Medium
Beclomethasone
dipropionate HFA
(QVAR)…………………..201 - 400
Budesonide*
(Pulmicort)……………..401 - 800
Ciclesonide*
(Alvesco)…………………201 - 400
Fluticasone furoate*
(Arnuity)………………………….n/a
Fluticasone propionate
(Flovent, Aermony)…201 - 400
Mometasone furoate*
(Asthmanex)…….≥200 to <400
Children [6 to 11 years] Doses High
Beclomethasone
dipropionate HFA
(QVAR)…………………………>400
Budesonide*
(Pulmicort)……………………>800
Ciclesonide*
(Alvesco)……………………….>400
Fluticasone furoate*
(Arnuity)…………………………n/a
Fluticasone propionate
(Flovent, Aermony)………..>400
Mometasone furoate*
(Asthmanex)………………….≥400
Adolescents & Adults [12 years and over] Doses Low
Beclomethasone
dipropionate HFA
(QVAR)………………………..≤200
Budesonide*
(Pulmicort)……………………≤400
Ciclesonide*
(Alvesco)……………………….≤200
Fluticasone furoate*
(Arnuity)……………………….100
Fluticasone propionate
(Flovent, Aermony)..≤250, 110
Mometasone furoate*
(Asthmanex)…………..100 - 200
Adolescents & Adults [12 years and over] Doses Medium
Beclomethasone
dipropionate HFA
(QVAR)……………………201 - 500
Budesonide*
(Pulmicort)……………..401 - 800
Ciclesonide*
(Alvesco)………………..201 - 400
Fluticasone furoate*
(Arnuity)……………………….n/a
Fluticasone propionate
(Flovent, Aermony)…………..251 – 500, 226
Mometasone furoate*
(Asthmanex)………..> 200 - 400
Adolescents & Adults [12 years and over] Doses High
Beclomethasone
dipropionate HFA
(QVAR)……………………….500 (max 800)
Budesonide*
(Pulmicort)…………………..> 800 (max 2,400)
Ciclesonide*
(Alvesco)……………………….>400 (max 800)
Fluticasone furoate*
(Arnuity)……………………….200 (max 200)
Fluticasone propionate
(Flovent, Aermony)……………………..>500 (max 2000)
Mometasone furoate*
(Asthmanex)…………………>400 (max 800)
Once daily dosing inhalers
Budesonide*
(Pulmicort)
Ciclesonide*
(Alvesco)
Fluticasone furoate*
(Arnuity)
Mometasone furoate*
(Asthmanex)
Low dose QVAR Preschoolers
Indication for
Beclomethasone
dipropionate HFA
(QVAR)
100
Medium dose QVAR in Preschoolers
Indication for
Beclomethasone
dipropionate HFA
(QVAR)
200
Low dose QVAR in Children, Adolescents and Adults
Indication for
Beclomethasone
dipropionate HFA
(QVAR)
≤200
Medium dose QVAR in Children
Indication for
Beclomethasone
dipropionate HFA
(QVAR)
201 - 400
