Asthma Management Handbook

Considering other regular treatments in children 0–5 years

Recommendations

Regular treatment with a theophyllines (aminophylline or theophylline) is not recommended for children aged 0–5 years.

How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Brand et al. 2008 1

Ipratropium is not recommended for the regular management of asthma in children.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available), with particular reference to the following source(s):

  • Brand et al. 20081
  • McDonald et al. 20032

More information

Ipratropium for children

Cochrane systematic reviews concluded that, overall, clinical trial evidence does not support the regular use of muscarinic antagonists (anticholinergic bronchodilators) in the maintenance treatment of asthma in children (i.e. outside the context of acute asthma).2

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Inhaled corticosteroid/long-acting beta-2 agonist combinations for children: 0–5 years

The combination of salmeterol plus fluticasone propionate in a single inhaler is registered for use in children 4 years and older.3 The use of long-acting beta2 agonists in combination with inhaled corticosteroids has not been studied in children under 4 years old.4 Australian5 and international6 guidelines recommend against the use of long-acting beta2 agonists in children aged 5 years or less.

In children aged 5 years or less with asthma that is not adequately controlled by low-dose inhaled corticosteroid alone, adding montelukast is preferable to adding a long-acting beta2 agonist or increasing the dose of inhaled corticosteroids when the safety profiles of these options are compared.7

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References

  1. Brand PL, Baraldi E, Bisgaard H, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J. 2008; 32: 1096-1110. Available from: http://erj.ersjournals.com/content/32/4/1096.full
  2. McDonald N, Bara A, McKean MC. Anticholinergic therapy for chronic asthma in children over two years of age. Cochrane Database Syst Rev. 2003; Issue 1: CD003535. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003535/full
  3. GlaxoSmithKline Australia Pty Ltd. Product Information: Seretide (fluticasone propionate; salmeterol xinafoate) Accuhaler and MDI. Therapeutic Goods Administration, Canberra, 2013. Available from: https://www.ebs.tga.gov.au/
  4. Ni Chroinin M, Lasserson TJ, Greenstone I, Ducharme FM. Addition of long-acting beta-agonists to inhaled corticosteroids for chronic asthma in children. Cochrane Database Syst Rev. 2009; Issue 3: CD007949. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007949/full
  5. van Asperen PP, Mellis CM, Sly PD, Robertson C. The role of corticosteroids in the management of childhood asthma. The Thoracic Society of Australia and New Zealand, 2010. Available from: http://www.thoracic.org.au/clinical-documents/area?command=record&id=14
  6. Global Initiative for Asthma (GINA). Global strategy for the diagnosis and management of asthma in children 5 years and younger. GINA, 2009. Available from: http://www.ginasthma.org/
  7. van Asperen PP. Long-acting beta agonists for childhood asthma. Aust Prescr. 2012; 35: 111-3. Available from: http://www.australianprescriber.com/magazine/35/4/111/3