Long-term maintenance of pediatric asthma: focus on budesonide/formoterol inhalation aerosol

Abstract

Current national and international asthma guidelines recommend treatment of children with asthma towards achieving and maintaining asthma control. These guidelines provide more stringent recommendations to increase therapy for patients with uncontrolled asthma in order to reduce asthma-related morbidity and mortality. Newer combination agents such as budesonide and formoterol have been shown to be safe and effective in treatment of asthma in children. Use of long-term controller agents like this in combination with improved compliance and treatment of co-morbid conditions have been successful in this endeavor. This review discusses control of pediatric asthma with focus on the use of budesonide in combination with formoterol.

Keywords: asthma; budesonide; children; control; formoterol; long-term.

Figure 1

Asthma Predictive Index. History of early wheezing in a child with at least one major criteria or two minor criteria had a positive predictive index of 76% in children. Copyright © 2008, American Thoracic Society. Adapted from Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med. 2000;162:1403–1406.

Figure 2

Assessing asthma control in children aged 5–11 years. Refer to NAEPP guidelines for other age groups. Adapted from National Asthma Education and Prevention Program. Guidelines for the Diagnosis and Management of Asthma: Expert Panel Report 3. Bethesda, MD: National Institutes of Health, National Heart, Lung and Blood Institute; 2007. Abbreviations: FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; SABA, short-acting β₂-agonists.

Figure 3

Degree of asthma control during year 1 was associated with probability of asthma exacerbation during year 2 in inner city children with asthma living in Los Angeles. Degree of asthma control was defined as the percentage of clinic visits during year 1 when asthma was rated as controlled based upon NAEPP ERP 2 asthma guidelines. Copyright © 2008, Elsevier. Adapted from Kwong KY, Morphew T, Scott L, Guterman J, Jones CA. Asthma control and future asthma-related morbidity in inner-city asthmatic children. Ann Allergy Asthma Immunol. 2008;101(2):144–152.

Figure 4

Stepwise Approach for managing asthma in children aged 5–11 years. Refer to NAEPP guidelines for other age groups. Adapted from National Asthma Education and Prevention Program. Guidelines for the Diagnosis and Management of Asthma: Expert Panel Report 3. Bethesda, MD: National Institutes of Health, National Heart, Lung and Blood Institute; 2007. Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting β₂-agonists; LTRA, leukotriene receptor agonists; SABA, short-acting β₂-agonists.