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A Partnership in Treating Childhood Asthma
include anti-inflammatory treatment with an inhaled corticosteroid at a low dose, cromolyn (1 or 2 puffs three of four times daily), or nedocromil (1 or 2 puffs three times daily). Leukotriene receptor antagonists (such as zafirlukast) may be an option for treatment of mild-to-moderate persistent asthma in some children. According to the Food and Drug Administration (FDA), zafirlukast is safe and effective for prophylaxis and ongoing treatment of asthma in patients as young as five years old (Gallagher, 2002).
In moderate persistent asthma the child’s symptoms occur daily, nightly at least five times per month, or both. Daily medication should include an anti-inflammatory drug (an inhaled corticosteroid at either medium or low-to-medium dosage), and a long acting inhaled bronchodilator (a long acting B2 agonist, 1 or 2 puffs every twelve hours; long acting B2 agonist tablets; or sustained-release theophylline), especially for nighttime symptoms. If necessary the inhaled corticosteroid can be increased to a medium-to-high dose (Gallagher, 2002).
In severe persistent asthma the child has continual daytime symptoms each week, or nighttime symptoms seven or more times a month, or both. Daily medication should include an anti-inflammatory drug (an inhaled corticosteroid at a high dose), a long-acting bronchodilator (a long-acting inhaled B2 agonist, 1 or 2 puffs every twelve hours), and corticosteroid tablets or syrup administered over the long term (three months or longer). Emergency or quick relief of an asthma episode is attained by administering a short-acting bronchodilator (an inhaled B2 agonist, 2 to 4 puffs as needed) until symptoms have abated. Sepracor’s Xopenex (Levalbuterol HCL solution used as an albuterol variant) has been proved by the FDA for the treatment or prevention of bronchospasm in children six to eleven years old who have reversible airway disease. In children ages four to eleven who have mild-to-moderate persistent asthma, Levalbuterol inhalation solution at 0.31 mg via nebulizer – should not exceed 0.63 mg three times a day – has demonstrated clinical efficacy comparable to racemic albuterol given at four-to-eightfold higher dosages (1.25 mg to 2.5 mg) as well as a more favorable safety profile (Gallagher, 2002; “New asthma”, 2002). At any stage of the asthma classification level of treatment, the nurse should inform the parents that if the child may need higher dosages of anti-inflammatory medications, referral to a pediatric asthma specialist, or both, if symptoms aren’t controlled or if goals aren’t being attained (Gallagher, 2002).
It may be easy for a parent or child to confuse symptoms of an illness with those associated with medication side effects. It is the responsibility of the nurse to ensure that the parents and child are properly educated on all possible side effects. Early notification by the parents concerning the following side effects can assist the health care team in determining whether a dosage needs modification or substitution.
Cromolyn and Nedocromil are antiasthmatics with the following possible side effects: throat irritation, cough, nasal congestion, burning eyes, nasal stinging, sneezing, headache, dizziness, neuritis, urinary frequency, dysuria, nausea, vomiting, anorexia, dry mouth, bitter taste, rash, urticaria, [next page]