Flovent side effects child

Flovent (Fluticasone)

Fluticasone (Flovent) is an inhaled corticosteroid generally used to prevent breathing difficulties, chest tightness, wheezing, and coughing caused by asthma. It works by decreasing any swelling and irritation in the airways making it easier to breathe. It is NOT used in cases of acute bronchospasm. Flovent is also used in the treatment of eosinophilic esophagitis (EoE) because it acts locally on the esophagus to heal the affected areas

How should it be used?

  • Flovent is inhaled by mouth, and can be used by patients aged 4 years and older.
  • It is usually inhaled twice a day around the same times each day.
  • Individuals will start to feel relief at different times. It may take 1 to 2 weeks or longer after starting treatment to feel the benefits of this medicine.
  • Continue to use Flovent even if you feel well. Do not stop using it without talking to your doctor.

Directions

  • Do not use a spacer.
  • Wait 30 minutes to eat or drink.
  • Rinse your mouth after taking the medication. DO NOT swallow the water. Spit it out. The medication needs to work on the esophagus and if you swallow water or juice directly after taking the medication, it will wash the medication away from the affected areas.
  • For younger child who cannot use the inhaler properly, you can spray the Flovent on the top of some juice (one teaspoon) and have the child swallow the juice. Do not eat or drink for 30 minutes.

Follow these directions:

  • Prime the inhaler as instructed by the manufacturer.
  • Shake Flovent canister for 5 seconds.
  • Remove cap from the mouthpiece.
  • Breathe out through your mouth.
  • Hold the inhaler facing you with the mouthpiece on the bottom. Place your thumb under the mouthpiece and your index finger on the top of the canister. Place the mouthpiece in your mouth and close lips around it.
  • Breathe in through your mouth. At the same time press down firmly on the top of the canister releasing one dose of the medication.
  • At the end of your breath, swallow so the medication will reach your esophagus.
  • If possible, hold your breath for up to 10 seconds.
  • Repeat steps to give a second dose.

Special Precautions / Instructions

Tell your doctor about all the medications (including over-the-counter), vitamins, herbal products, and supplements that you take before beginning this medication.

If you are taking any of the following medications, please tell you doctor before starting Flovent:

Contraindications

Before starting Flovent, tell you doctor if you have any of the following conditions:

  • Hypersensitivity to any of the ingredients of Flovent HFA.
  • Primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required.

The pharmaceutical company cannot assure the correct amount of medication in each inhalation after the counter reads “000” even though the canister is not completely empty. Once the inhaler counter reads “000,” it should be discarded.

Side Effects

Flovent may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • headache
  • stuffy or runny nose
  • difficulty speaking
  • sore or irritated throat
  • painful white patches in the mouth or throat

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

  • new or increased acne (pimples)
  • easy bruising
  • enlarged face and neck
  • growth of hair on the face
  • depression
  • anxiety
  • extreme tiredness
  • muscle weakness
  • irregular menstruation (periods)
  • pink or purple stretch marks on the skin
  • hives
  • rash
  • itching
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness
  • difficulty breathing or swallowing
  • chest pain or tightness
  • cough
  • shortness of breath
  • red or fluid filled bumps on skin
  • burning, tingling, numbness, or weakness in arms or legs

Local and systemic corticosteroid use may result in the following:

  • Candida albicans infection
  • Immumosuppression
  • Hypercorticism and adrenal suppression
  • Reduction in bone mineral density
  • Growth effects
  • Glaucoma and cataracts

Storage Conditions

Store medication with the mouthpiece down, at room temperature, away from heat, moisture (not in the bathroom), and direct light. Keep this medication, and all medications, out of reach of children.

Emergency / Overdose

Call the national poison control center 1-800-222-1222 or 9-1-1 in the event of an overdose. If the person is not breathing or has collapsed, contact local emergency services 911.

Pediatric Use

Safety and effectiveness has been evaluated and established in pediatric patients aged 4 – 11 years. The types of adverse reactions seen in children aged 4 – 11 years were similar to those in adolescent and adult patients.

Flovent Ingredients

Inactive ingredients are: microcrystalline suspension of fluticasone propionate (micronized) in a mixture of 2 chlorofluorocarbon propellants (trichlorofluoromethane and dichlorodifluoromethane) with soya lecithin.

Additional Information

Additional information may be found at: us.gsk.com/products/assets/us_flovent_hfa.pdf

Flovent

How does this medication work? What will it do for me?

Fluticasone belongs to the class of medications called inhaled corticosteroids, which reduce symptoms of asthma and prevent asthma attacks by decreasing inflammation in the lungs and thereby opening the airways. When used regularly every day, inhaled fluticasone decreases the number and severity of asthma attacks. However, it will not relieve an asthma attack that has already started.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Diskus

Each inhalation of the dry powder inhalation device delivers 100, 250, or 500 µg of fluticasone propionate. It also contains lactose (milk sugar), including milk protein, which acts as the “carrier”. FLOVENT DISKUS is a plastic inhaler device containing a foil strip with 60 blisters. Each blister contains 50, 100, 250, or 500 µg of the active ingredient fluticasone propionate.

Inhalation Aerosol

Each actuation of the pressurized metered-dose inhaler delivers: 50, 125, or 250 µg of fluticasone propionate suspended in propellant HFA-134a (1,1,1,2-tetrafluoroethane). This product does not contain chlorofluorocarbons (CFCs) as the propellant. The 50 µg strength of FLOVENT HFA inhalation aerosol is available in 120 dose containers. The 125 µg and 250 µg strengths of FLOVENT HFA inhalation aerosol are available in 60 and 120 dose containers. FLOVENT HFA inhalation aerosol is a pressurized metered-dose inhaler (MDI) consisting of an aluminum canister fitted with a metering valve. The 50 µg canister is fitted into the supplied peach actuator/adaptor. The 125 µg canister is fitted into the supplied orange actuator/adaptor. The 250 µg canister is fitted into the supplied red/brown actuator/adaptor. A dust cap is fitted over the actuator’s mouthpiece when not in use.

How should I use this medication?

The recommended regular daily dose of fluticasone inhalation is that which is the lowest required to control asthma symptoms. The full benefit of this medication may take 1 to 2 weeks or longer to achieve.

The usual dose for adults and adolescents over 16 years of age is 100 µg to 500 µg twice daily (the number of inhalations varies depending on strength of medication used). For people with very severe asthma, higher doses up to 1,000 µg twice daily may be needed. When using the HFA inhaler, each dose should be used as two inhalations (e.g., two inhalations of 50 µg should be used to get a 100 µg dose).

The usual dose for children between 4 and 16 years of age is 100 µg twice daily (the number of inhalations varies depending on strength of medication used). On occasion, a dose of 200 µg may be needed to control asthma symptoms. Your doctor may tell you to adjust the dose of this medication in order to find one that helps control your asthma symptoms.

Children 12 months to 4 years of age may be given 100 µg twice daily, using a spacer device. The dose should be given as a single 50 µg actuation of the HFA inhaler into the spacer device, inhaled, and then repeated. The Diskus form of this medication should not be used by children under the age of 4 years.

Inhaled fluticasone is used to prevent asthma attacks. It is not used to relieve an attack that has already started. For relief of an asthma attack that has already started, you should use another medication. If you do not have another medication to use for an attack or if you have any questions about this, check with your health care professional. If your doctor has asked you to use a “reliever” inhaler such as salbutamol or terbutaline with your fluticasone inhaler, you should use the reliever inhaler first, wait several minutes, and then use the fluticasone inhaler. The reliever medication will provide immediate relief of symptoms of asthma attack, while the fluticasone inhalation works to treat and control asthma regularly.

Shake the HFA inhaler well before use or before inserting the mouthpiece into the spacer device. In order to get the most medication into the lungs from the inhaled dose, ask your doctor or pharmacist about proper techniques for taking this medication.

Rinsing your mouth and gargling with water after each inhalation can help prevent hoarseness, throat irritation, and infection in the mouth caused by candidiasis (a type of yeast infection of the mouth; also known as “thrush”). If you have dentures, they should be cleaned after each dose.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important that this medication be used exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not administer a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store the diskus blisters in the sealed foil wrap that it is packaged in, until you are ready to put the disk in the device for use. Store this medication at room temperature, out of direct sunlight and out of reach of children. Protect the inhaler and diskus blisters from freezing. Do not store the diskus in a damp environment.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use fluticasone if you:

  • are allergic to fluticasone or any ingredients of the medication
  • are allergic to milk or lactose (in the case of the diskus only)
  • have active or inactive untreated pulmonary tuberculosis
  • have untreated fungal, bacterial, or viral infections
  • need treatment for status asthmaticus or other acute asthma conditions

Do not give this medication to children less than 12 months of age.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • cough
  • difficulty sleeping
  • fever
  • headache
  • hoarseness, voice change
  • nasal congestion
  • runny nose
  • sore mouth and tongue
  • sore throat

Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • anxiety
  • behaviour changes (e.g., hyperactivity, irritability)
  • fever
  • inability to speak
  • increased skin bruising
  • joint pain with limited motion
  • osteoporosis or bone fractures
  • pins and needles or numbness of arms or legs, sinus pain and congestion, worsening breathing problems (Churg-Strauss Syndrome)
  • signs of respiratory tract infection (e.g., fever or chills, shortness of breath, prolonged dizziness, headache, weight loss, tightness in chest, difficulty breathing, or wheezing)
  • signs of too much corticosteroid (e.g., round face, rapid weight gain, increased sweating, thinning of skin, muscle weakness)
  • signs of thrush (e.g., white patches in mouth and throat, sore throat)
  • slowed growth (children and adolescents)
  • swelling of face, lips, or eyelids
  • symptoms of glaucoma or cataracts (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
  • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • skin rash or hives
  • sudden shortness of breath and wheezing after using this medication
  • worsening asthma symptoms

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Asthma attacks: This medication is not a “reliever” medication. If you start developing asthma symptoms, be sure to use your reliever medication (such as salbutamol or terbutaline) for rapid relief of your asthma symptoms. It is very important that you have your reliever medication with you at all times. If you persistently use more of your reliever medication, contact your doctor.

Bone effects: Long-term use of corticosteroids such as fluticasone may affect bone density and increase the risk of fracture. Your doctor will monitor your bone health while you are taking this medication.

Diabetes: Fluticasone may cause an increase in blood sugar levels. If you have diabetes, you may find it necessary to monitor your blood sugar more frequently while using this medication.

Eye problems: If you have glaucoma or cataracts or are at risk of developing them, have your eyes checked by your doctor before starting long-term treatment with this medication. Have your eyes monitored at regular intervals while using this medication.

Growth effects: Long-term use of corticosteroids, including inhaled forms such as this medication, may slow the growth of children and adolescents. It is important to use the lowest effective dose for managing asthma symptoms. Talk to your doctor if you have any concerns.

Infection: This medication, like other corticosteroids, may prevent the early signs of a serious infection from being noticed. Try to limit the amount of time you spend around others who have recently had infections such as chickenpox or measles. If you do come into contact with someone who has one of these infections, contact your doctor for advice.

Oral hygiene: Adequate oral hygiene is very important in minimizing the overgrowth of microorganisms such as candidiasis (thrush). Proper oral hygiene includes rinsing your mouth with water after using the inhaler. Using a spacer device with the inhaler can greatly reduce how much medication stays in your mouth. Thrush infections, should they occur, may require treatment with appropriate antifungal therapy or the discontinuance of treatment with fluticasone, depending on the severity of the infections.

Stopping this medication: Do not stop this medication suddenly, as this may result in withdrawal symptoms associated with suppressed adrenal glands (e.g., stomach discomfort or pain, worsening of asthma). Your doctor will tell you to gradually lower the dose over a period of time in order to stop this medication properly.

Wheezing: This medication may cause the airways to spasm immediately after using the inhaler. If this happens, use your rescue inhaler as soon as possible to relieve the symptoms, then call your doctor as soon as possible.

Worsening of asthma: Increasing use of your bronchodilators (e.g., salbutamol) to control asthma symptoms is an indication that your asthma may be worsening. Sudden and progressive worsening in asthma control is potentially life-threatening, and consideration should be given to increasing the dose of fluticasone inhalation. Talk to your doctor or pharmacist to learn more about how to properly monitor for symptoms of worsening asthma.

Pregnancy: The safety of fluticasone for use during pregnancy has not been established. Potential benefits need to be weighed against risks, especially in the first trimester of pregnancy.

Breast-feeding: Corticosteroid medications such as fluticasone pass into breast milk. Although the amount that appears in breast milk would likely be low, the benefits of using this medication while breast-feeding need to be weighed against risk. If you are a breast-feeding mother and are using fluticasone it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: This medication is not recommended for use by children under 12 months of age.

What other drugs could interact with this medication?

There may be an interaction between fluticasone and any of the following:

  • aldesleukin
  • amiodarone
  • aprepitant
  • “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
  • beta-2 agonists (e.g., salbutamol, formoterol, terbutaline)
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • cobicistat
  • conivaptan
  • crizotinib
  • dasatinib
  • deferasirox
  • denosumab
  • desmopressin
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, rosiglitazone)
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, indapamide, metolazone)
  • dronedarone
  • echinacea
  • fingolimod
  • grapefruit juice
  • HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
  • hyaluronidase
  • idelalasib
  • imatinib
  • leflunomide
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • mifepristone
  • natalizumab
  • nefazodone
  • nivolumab
  • norfloxacin
  • pimecrolimus
  • stiripentol
  • tofacitinib
  • trastuzumab
  • vaccines

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Flovent

Flovent HFA

SIDE EFFECTS

Systemic and local corticosteroid use may result in the following:

  • Candida albicans infection
  • Immunosuppression
  • Hypercorticism and adrenal suppression
  • Reduction in bone mineral density
  • Growth effects
  • Glaucoma and cataracts

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The incidence of common adverse reactions in Table 2 is based upon 2 placebo-controlled US clinical trials in which 812 adult and adolescent subjects (457 females and 355 males) previously treated with as-needed bronchodilators and/or inhaled corticosteroids were treated twice daily for up to 12 weeks with 2 inhalations of FLOVENT HFA 44 mcg Inhalation Aerosol, FLOVENT HFA 110 mcg Inhalation Aerosol, FLOVENT HFA 220 mcg Inhalation Aerosol (dosages of 88, 220, or 440 mcg twice daily), or placebo.

Table 2: Adverse Reactions with FLOVENT HFA with > 3% Incidence and More Common than Placebo in Subjects Aged 12 Years and Older with Asthma

Adverse Event FLOVENT HFA88 mcg Twice Daily
(n=203)%
FLOVENT HFA 220 mcg Twice Daily
(n = 204)%
FLOVENT HFA 440 mcg Twice Daily
(n = 202)%
Placebo
(n = 203)%
Ear, nose, and throat
Upper respiratory tract infection 18 16 16 14
Throat irritation 8 8 10 5
Upper respiratory inflammation 2 5 5 1
Sinusitis/sinus infection 6 7 4 3
Hoarseness/dysphonia 2 3 6 < 1
Gastrointestinal
Candidiasis mouth/throat and non-site specific 4 2 5 < 1
Lower respiratory
Cough 4 6 4 5
Bronchitis 2 2 6 5
Neurological
Headache 11 7 5 6

Table 2 includes all events (whether considered drug-related or nondrug-related by the investigator) that occurred at a rate of over 3% in any of the groups treated with FLOVENT HFA and were more common than in the placebo group. Less than 2% of subjects discontinued from the trials because of adverse reactions. The average duration of exposure was 73 to 76 days in the active treatment groups compared with 60 days in the placebo group.

Additional Adverse Reactions

Other adverse reactions not previously listed, whether considered drugrelated or not by the investigators, that were reported more frequently by subjects with asthma treated with FLOVENT HFA compared with subjects treated with placebo include the following: rhinitis, rhinorrhea/post-nasal drip, nasal sinus disorders, laryngitis, diarrhea, viral gastrointestinal infections, dyspeptic symptoms, gastrointestinal discomfort and pain, hyposalivation, musculoskeletal pain, muscle pain, muscle stiffness/tightness/rigidity, dizziness, migraines, fever, viral infections, pain, chest symptoms, viral skin infections, muscle injuries, soft tissue injuries, urinary infections.

Fluticasone propionate inhalation aerosol (440 or 880 mcg twice daily) was administered for 16 weeks to 168 subjects with asthma requiring oral corticosteroids (Trial 3). Adverse reactions not included above, but reported by more than 3 subjects in either group treated with FLOVENT HFA and more commonly than in the placebo group included nausea and vomiting, arthralgia and articular rheumatism, and malaise and fatigue.

In 2 long-term trials (26 and 52 weeks), the pattern of adverse reactions in subjects treated with FLOVENT HFA at dosages up to 440 mcg twice daily was similar to that observed in the 12-week trials. There were no new and/or unexpected adverse reactions with long-term treatment.

Pediatric Subjects Aged 4 To 11 Years

FLOVENT HFA has been evaluated for safety in 56 pediatric subjects who received 88 mcg twice daily for 4 weeks. Types of adverse reactions in these pediatric subjects were generally similar to those observed in adults and adolescents.

Postmarketing Experience

In addition to adverse reactions reported from clinical trials, the following adverse reactions have been identified during postapproval use of fluticasone propionate. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion due to either their seriousness, frequency of reporting, or causal connection to fluticasone propionate or a combination of these factors.

Ear, Nose, and Throat: Aphonia, facial and oropharyngeal edema, and throat soreness and irritation.

Endocrine and Metabolic: Cushingoid features, growth velocity reduction in children/adolescents, hyperglycemia, osteoporosis, and weight gain.

Eye: Cataracts.

Gastrointestinal Disorders: Dental caries and tooth discoloration.

Immune System Disorders: Immediate and delayed hypersensitivity reactions, including urticaria, anaphylaxis, rash, and angioedema and bronchospasm, have been reported.

Infections and Infestations: Esophageal candidiasis.

Psychiatry: Agitation, aggression, anxiety, depression, and restlessness. Behavioral changes, including hyperactivity and irritability, have been reported very rarely and primarily in children.

Respiratory: Asthma exacerbation, chest tightness, cough, dyspnea, immediate and delayed bronchospasm, paradoxical bronchospasm, pneumonia, and wheeze.

Skin: Contusions, cutaneous hypersensitivity reactions, ecchymoses, and pruritus.

Read the entire FDA prescribing information for Flovent HFA (Fluticasone Propionate HFA)

A metered dose inhaler (or MDI) is designed for use with a valved holding chamber, or spacer.

Asthma is the most common chronic disease in childhood. It is often underdiagnosed and undertreated, and can cause unnecessary burden in a child’s life. It accounts for approximately 13 million missed school days a year, as well as many missed workdays for family members. Asthma is also the most common cause of recurrent pneumonia in children.

When treated appropriately, children with asthma can live full and active lives without limitation from their breathing.

Asthma has two components: bronchospasm and inflammation. The lungs are made up of many branching airway tubes — much like and upside-down tree — the larger tubes are called bronchi. When the muscles lining those bronchi squeeze, bronchospasm occurs. This narrows the airway from the outside in.

Various triggers in the environment can cause a bronchospasm, including:

  • Cold viruses
  • Allergens (from pollen, grasses, house dust mite, pet dander, mold)
  • Irritants in the air (cigarette smoke, air pollution, strong odors, perfumes)
  • Exercise
  • Certain weather conditions (hot/humid weather, cold air, abrupt changes in weather, thunderstorms)
  • Emotional stress

Inflammation of the airway results in swelling and excessive production of mucous. This narrows the airway from the inside out. Children with asthma can have varying degrees of bronchospasm and inflammation.

Bronchospasm can happen quickly, causing sudden shortness of breath, chest tightness, coughing, and/or wheezing. Medicines called bronchodilators treat bronchospasm by relaxing the muscles around the bronchi and help open up the airway. The most common bronchodilator is albuterol (Proventil, Ventolin and ProAir), which acts very quickly (within minutes) but the effect only lasts about four hours. Albuterol is described as a rescue medication because it is best used when a child has sudden symptoms, but needs to be taken again if a child is having ongoing symptoms or ongoing exposure to the trigger that caused the bronchospasm.

Inflammation is a slower process and generally takes months or years to develop. When a child has inflammation, the sudden symptoms from bronchospasm can be even worse. For this reason, many children with inflammation require a controller medication to reduce the inflammation over time. This way, when they are exposed to a trigger, the acute symptoms are not as bad. The best preventive medications are inhaled steroids, such as fluticasone (Flovent), budesonide (Pulmicort), or beclomethasone (QVAR).

There are many commonly held beliefs about asthma that can be confusing when making treatment decisions for your child. Some of the more common things we hear in our pediatric pulmonary medicine clinic at Doernbecher include:

Inhaled steroids are bad for my child and will cause side effects.

Inhaled steroids, given in appropriate doses, are very safe and effective in controlling asthma symptoms and allowing children to live active, full lives. When inhaled, they act directly on the airway to reduce swelling and mucous production. Only a tiny amount of the inhaled steroid will enter the bloodstream and they have very few (if any) side effects. The same cannot be said for oral steroids, which can cause increased appetite and behavior changes, as well as others. If your child has needed more than one course of oral steroids in the last 12 months, be sure to talk to their primary care doctor, as this can be a sign that they may do better on an inhaled steroid.

My child will outgrow their asthma.

Children do not outgrow their asthma. As they grow, they can have fewer and less severe symptoms. However, they still have the disease and will have a tendency to overreact to triggers in the environment.

My child does not need to use a spacer anymore because they are too old for one.

A metered dose inhaler (or MDI) is designed for use with a valved holding chamber, or spacer. Everyone (including adults) should use a spacer with their rescue and controller MDI’s. Without a spacer, most of the medicine from an MDI will end up in the back of the throat. This can actually cause more side effects and increase the amount absorbed into the bloodstream. A spacer helps the medicine reach the lungs where it needs be in order to work.

A nebulizer is better than an inhaler.

An MDI is as effective as a nebulizer and much quicker to use, provided you use a spacer! A nebulizer dose contains about the same amount of medicine as in four to six puffs of an MDI. Although it is a larger dose of medicine, it is not better than an MDI.

My child can’t participate in sports because they have asthma.

If asthma is well controlled, your child should be able to participate in any sport they wish. There are many elite athletes who have asthma and as long as they use their prescribed medications, they can participate without limitations.

I don’t have asthma so my child can’t have asthma

Most of the time, a parent or other relative of the child will have asthma or other conditions like allergies or eczema. However, this is not always true, and children can develop asthma without a family history.

My child does not really have any symptoms and thus does not need a daily preventive medication.

There are many levels of asthma and not all children will have symptoms on a day-to-day basis. They may only have symptoms when the narrowing of their airways suddenly gets worse, such as when they have a cold or are exposed to a trigger. However, they may still benefit from a daily controller medication to help prevent symptoms. Lung function testing can help determine whether your child has significant asthma and might benefit from an inhaled steroid. These tests can generally be performed once your child is around 6-7 years old.

The cough went away, so my child no longer needs the inhaled steroid.

The symptoms went away because the inhaled steroid is working and getting rid of the inflammation. If you stop taking the inhaled steroid, most likely the symptoms (and the inflammation) will come back. Remember that asthma is a chronic condition and can get worse if you stop a controller medication. If you have questions about whether your child really needs a medication, always talk to your child’s doctor before stopping that medication.

My child will need these medications for the rest of their life.

False!!! Asthma triggers can change over time. Experts recommend seeing your doctor regularly to determine if your child can start taking a lower dose of medication or maybe take medications just when they are sick. Children should have lung function testing when they are old enough to do them (typically around ages 6 or 7). Lung function tests should be done at least once a year and also when changes are made to their medications.

Inhaled steroids will stunt my child’s growth.

This is tricky. In the past, we would have said that this is not true, based on a lack of good evidence. However, a recent study suggests that there may be an effect on adult height, albeit very small (1 to 3 centimeters, or less than an inch). This effect is dose-dependent, meaning that higher doses are more likely to cause a decrease in height. This study confirms what we always try to do anyway, which is to keep your child on the smallest amount of medication possible in order to control their symptoms. Be sure to talk to your child’s doctor if you have concerns about this very important issue.

While we cannot cure asthma, we can treat it. The goal of treatment for any child with asthma is to control their symptoms and minimize any limitation they may have to reduce their risk of complications from asthma. We always tell parents, “No one should know your child has asthma unless they see them using their inhaler.”

For more information on asthma, including helpful videos on how to use an MDI with a spacer, see Healthychildren.org.

Alexandra Cornell, M.D.
Assistant Professor of Pediatrics, Division of Pediatric Pulmonology
OHSU Doernbecher Children’s Hospital

Upping Inhaler Use May Not Help Kids with Asthma, Could Stunt Growth

Traditional asthma treatments center around inhaled steroids to soothe bouts of wheezing and coughing, with the dosage going up as symptoms worsen.

But a new study found that high doses of inhaled steroids may not be effective at reducing asthmatic exacerbations in some children and could even stunt their growth.

Published this week in The New England Journal of Medicine, the study examined the impact of high doses of inhaled steroids on children with mild-to-moderate asthma.

Asthma exacerbations are common events for children. About 1 in 10 children has asthma and that rate is growing, according to the U.S. Centers for Disease Control and Prevention (CDC).

These exacerbations can be bad enough that children need to be hospitalized. In 2016, one in six children with asthma ended up in the emergency department due to the condition.

To prevent children from ending up in the ER, doctors look for signs that a child’s asthma symptoms have changed.

These symptomatic changes are seen as the child moving from the “green zone” of asthma symptoms to the “yellow zone,” where coughing, wheezing, chest tightness, shortness of breath, waking at night, and limitation of usual activities become more prevalent.

When children hit the “yellow zone,” doctors often increase the inhaled steroid dosage to keep children from having a severe or dangerous exacerbation.

While this practice is fairly common, there’s been little robust research to test the effectiveness of increasing doses of inhaled steroids in kids who have mild-to-moderate asthma.

Treating asthma in the “yellow zone”

But the new study funded by the U.S. National Heart, Lung, and Blood Institute (NHLBI) looked at this issue by enrolling 254 children between 5 and 11 years old with mild-to-moderate asthma.

The study was conducted at 17 facilities throughout the Unites States over a one-year study period.

All of the enrolled children were given low-dose steroids daily or two puffs of a popular asthma medication, fluticasone or Flovent, twice a day.

When children started to show “yellow zone” symptoms, half of the children were maintained on the low-dose inhaled steroids while the other half were put on the high-dose inhaled steroids. This was done for seven days during each exacerbation.

The study found there were no major differences between the low-dose and the high-dose groups.

Despite more medication, those in the high-dose group had the same number of severe asthma exacerbations as those children in the low-dose group.

Researchers also found that it took the same amount of time for the first severe exacerbation to occur in both groups. Additionally, the number of emergency department and urgent care visits remained the same between both groups. They also had the same rate of medication failure.

Study leader Dr. Daniel Jackson, associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin said in a statement that the findings suggest “a short-term increase to high-dose inhaled steroids should not be routinely included in asthma treatment plans” for kids without severe asthma and who were already using low-dose inhaled steroids.

Jackson clarified that low-dose inhaled steroids should continue as the cornerstone daily treatment for children with asthma.

Jackson and his team also found signs that all those steroids could be impacting children negatively by stunting their growth.

They found the high-dose group grew 0.09 inches less than those who were in the low-dose group. This is despite the fact that these children only used higher dose steroids somewhat sparingly, during the week of an exacerbation.

While study authors acknowledged that this growth disparity is seemingly small, they warn that high steroid doses could lead to larger health implications.

Adding to the asthma ‘arsenal’

Dr. Sherry Farzan, attending allergy and immunology physician at Northwell Health in New York, told Healthline that the study could help doctors tailor treatment for patients.

“I think it is an important piece of information that we can add to our arsenal, especially because many physicians, including pediatricians, use this as a strategy in terms of increasing the dose of inhaled steroids in order to prevent a severe exacerbation,” Farzan told Healthline.

“That strategy may now not be helpful and it may actually be harmful,” Farzan continued.

She said that these rules would mainly affect kids older than preschool age and younger than teens or adults with severe asthma.

“It is a well-designed study with a very specific group of patients age range of 5 to 11 with mild-to-moderate persistent asthma,” said Farzan. “It is not your preschool ‘wheezers’ that may benefit from this kind of strategy.”

Farzan also said more research needs to be done in order to truly understand how to best personalize treatment plans for patients.

“It’s not the end of this strategy, it’s just perhaps we need to figure out what strategy is the best for each type of asthma patient,” she said.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *