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Combination Therapy in Children |
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The advantages of combination therapy apply equally to children.18 Clinical trials have demonstrated combination therapy to be as effective as component medications taken individually.19 However, before starting combination therapy, consider the indications for LABAs in children. Most children with persistent asthma should be adequately controlled on a dose of ICS equivalent to 250mcg/day of FP or BDP-hydrofluoro-alkanes (HFA) or less, and should not require LABAs. LABAs should only be prescribed for children with persistent asthma that is not adequately controlled on 200-250mcg/day of FP or BDP-HFA.
Other issues to consider are adequate adherence with previously prescribed ICS, and that the child has an appropriate delivery device and reasonable technique. If control has not been achieved on a combination of LABA and a dose of ICS equivalent to 500mcg/day of FP or BDP-HFA or 800-1000mcg/day BUD/BDP (chlorofluorocarbons (CFC)), seek a specialist paediatric respiratory physician opinion.
One further issue to consider in children is the variable natural history of asthma and the need to adjust the dose of ICS. During periods of adjustment it may be necessary to revert to single drug preparations to achieve appropriate flexibility of dosing.
There is no evidence to support dosage increases of combination therapy during acute exacerbations in children.
Content Updated March 2002
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Last Updated ( Saturday, 26 July 2008 )
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