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A Partnership in Treating Childhood Asthma
urticaria, angioedema, and join pain/swelling.
Zafirlukast and is a bronchodilator and may cause the following side effects: headache, dizziness, nausea, vomiting, infections, pain, asthenia, mylagia, fever, dyspepsia, and increased ALT (Skidmore-Roth, 2003).
Levalbuterol HCL is another bronchodilator and may cause the following side effects: tremors, anxiety, insomnia, headache, dizziness, stimulation, restlessness, hallucinations, flushing, irritability, dry nose and irritation of nose and throat, palpitations, tachycardia, angina, dysrhythmias, hypertension, hypotension, muscle cramps heartburn, nausea, and vomiting. Albuterol is a B2 bronchodilator used to relieve exercise-induced asthma with the same possible effects as Levalbuterol HCL (Skidmore-Roth, 2003).
Theophylline relaxes smooth muscle of the respiratory system and has the following possible side effects: restlessness, insomnia, dizziness, convulsions, headaches, light-headedness, muscle twitching, tremors, palpitations, sinus tachycardia, other dysrhythmias, fluid retention with tachycardia, hyperglycemia, nausea, vomiting, anorexia, diarrhea, bitter taste, dyspepsia, gastric distress, increased respiratory rate, flushing of the skin, and urticaria (Skidmore-Roth, 2003). In addition to other side effects, some parents are greatly concerned about the possible growth suppressive effects of inhaled corticosteroids.
The National Asthma Education and Prevention Program (NAEPP) issued an update stating inhaled corticosteroids are safe, effective, and preferred therapy for children and adults with persistent asthma or as a combination therapy for the treatment of moderate asthma. The statement also reaffirms that antibiotics should not be used to treat acute asthma attacks except in the presence of bacterial infection by another condition (“Updated Asthma”, 2002). If the growth suppressive effects of inhaled corticosteroids are present, they may be relatively short-lived, with the most pronounced effect during the first six weeks (Kelso, 1999). However, periodic efforts should be made to decrease systemic steroids and to maintain control with high-dose inhaled steroids alone (Gallagher, 2002).
Inhaled corticosteroids are an important part of asthma treatment in children. Yet continued evidence is being presented that corticosteroids may have some real but subtle effects on growth. Dosages for these agents should be minimized and switched to alternatives, such as nedocromil, when effective. However the benefit of inhaled steroids to maintain good asthma control still far outweighs the risk to growth in the vast majority of patients (Kelso, 1999).
For those who fear growth suppressive effects there may soon be an alternative to corticosteroid use. A recent study conducted by Berkhof, Parker, and Melnyk referenced the effectiveness of anti-leukotriene agents in childhood asthma. It was found that montelukast (Singular®) significantly improved FEV1 in 6 to 14 year old children. As a result the investigators concluded that long-term treatment of chronic asthma with Singular® can be effective in children in reducing asthma exacerbations. They also concluded that, since Singular® showed similar improvements in patients who were and were not on corticosteroids, Singular® would be an appropriate complementary therapy to inhaled corticosteroids in treatment of chronic asthma in children (2003).
Research studies have demonstrated that patients are more likely to comply with oral medication than with inhaled medication, and that adherence is improved by prescribing inhaled medication dosing of no more than twice per day. In many instances, children and families may be offered the choice of [next page]