Asthma and Medicines – Long-Term Side-Effects, Monitoring and Dose Titration
Asthma is a major pediatric respiratory morbidity requiring long-term management. A thorough knowledge of long-term medication side-effects in children is, thus, essential for every physician dealing with childhood asthma. Establishing diagnosis and initiating treatment is just a beginning of the journey. Ongoing monitoring is an essential component of comprehensive asthma management programme. Monitoring includes not only assessment of asthma control but also checking for adherence to treatment, technique of inhaler device use, associated co-morbities, if any, and potential environmental exposure. Various tools – both subjective and objective - are available for assessment of asthma control. However, evidence for their optimum use in different settings and patient groups is lacking and monitoring has to be customized depending on available resources and individual patient characteristics. Patient education is an important component of long-term asthma therapy. The ultimate aim is to achieve optimum asthma control i.e., achieve and maintain control of clinical symptoms, decrease future risk to patients (risk of exacerbations, progressive loss of lung function and development of fixed airflow obstruction, adverse effects of medications) and enabling the child to lead a life without restrictions, at lowest possible dose of drugs. This article reviews the side-effects of medications used for long-term management of asthma and discusses current literature on asthma monitoring and dose titration in pediatric population to help the asthma therapist not only prescribe the drugs rationally but also help the family make right choices for treatment.
KeywordsChildhood asthma Management Side-effects Monitoring Dose titration Step-down
Both authors reviewed the topic and contributed to manuscript preparation. VS will act as guarantor for the paper.
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- 11.Pruteanu AI, Chauhan BF, Zhang L, Prietsch SOM, Ducharme FM. Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth. Cochrane Database Syst Rev. 2014;7:CD009878.Google Scholar
- 14.Axelsson I, Prietsch SOM, Zhang L. Inhaled corticosteroids in children with persistent asthma: effects of different drugs and delivery devices on growth. Cochrane Database Syst Rev. 2012;10 https://doi.org/10.1002/14651858.CD010126.
- 23.Kelly HW, Van Natta ML, Covar RA, Tonascia J, Green RP, Strunk RC, and the CAMP Research Group. Effect of long-term corticosteroid use on bone mineral density in children: a prospective longitudinal assessment in the childhood Asthma Management Program (CAMP) study. Pediatrics. 2008;122:e53–61.Google Scholar
- 24.Tse SM, Kelly HW, Litonjua AA, Van Natta ML, Weiss ST, Tantisira KG, and the Childhood Asthma Management Program Research Group. Corticosteroid use and bone mineral accretion in children with asthma: effect modification by vitamin D. J Allergy Clin Immunol. 2012;130:53–60.e4.Google Scholar
- 26.Raissy HH, Sternberg AL, Williams P, Jacobs A, Kelly HW; CAMP Research Group. Risk of cataracts in the Childhood Asthma Management Program Cohort, J Allergy Clin Immunol. 2010;126:389–92. 92.e1–4Google Scholar
- 38.Chauhan BF, Chartrand C, Ni Chroinin M, Milan SJ, Ducharme FM. Addition of long-acting beta2-agonists to inhaled corticosteroids for chronic asthma in children. Cochrane Database Syst Rev. 2015;11:CD007949.Google Scholar
- 42.Sridhar AV, Mckean MC. Nedochromil sodium for chronic asthma in children. Cochrane Database Syst Rev. 2006;3:CD004108.Google Scholar