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Preventive treatment in children |
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In a child with persistent asthma, initial therapy options include low-dose ICS, montelukast or cromones (Figure 2). If the initial choice is a cromone or montelukast, and adequate asthma control is not achieved after a trial period of 4– 8 weeks, cease the medication and initiate low-dose ICS.
As with any asthma therapy, commence LTRAs for a trial period of 4–8 weeks then reassess whether the treatment is effective, well tolerated and necessary.
Oral corticosteroids should not be abruptly replaced by montelukast. In patients taking montelukast, the dose of concomitant ICS may be reduced gradually to the lowest dose then ceased.9 Table 1 gives recommendations on commencing or ceasing LTRAs depending on the child’s current asthma severity and drug regimen. Oral montelukast should not be relied on to manage acute asthma.9
Figure 2. Approach to preventive therapy in children
Table 1. Recommendations for starting and stopping LTRA treatment in children with frequent intermittent or mild persistent asthma
| Current status |
Action recommended |
If poor response |
| Starting LTRA |
| Frequent reliever use, no preventer therapy |
Start LTRA
Trial for 4-8 weeks†
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Start low-dose‡ICS |
| Sodium cromoglycate or nedocromil sodium |
Start LTRA and cease cromone abruptly
Trial for 4-8 weeks†
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| Asthma well controlled on lowest ICS dose for 3 months |
Start LTRA and cease ICS abruptly.
Trial for 4-8 weeks†
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Recommence ICS |
| Stopping LTRA |
| Good control on LTRA for 3 months or end of winter season of frequent intermittent asthma |
Cease LTRA |
Recommence LTRA or other preventer |
| † Trial period depends on pattern and severity, e.g. 4 weeks may be sufficient in mild persistent asthma. In frequent intermittent asthma, a longer period may be needed to evaluate the effect on symptoms.
‡ Low-dose ICS: total daily dose of beclomethasone dipropionate-HFA 100–200 mcg or fluticasone propionate 100–200 mcg or budesonide 200–400 mcg.1
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Content Updated June 2007
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Last Updated ( Friday, 24 April 2009 )
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