Longterm control medications 1 Corticosteroids

a. Glucocorticoids provide anti-inflammatory effects and reduce bronchial hyperactivity. Inhaled corticosteroids are first-line agents in patients who require daily asthma therapy. No specific inhaled corticosteroid preparation is superior to another. Primary adverse effects of these medications are cough, oral thrush and hoarseness. In high doses, a potential exists for significant systemic absorption. Patients with severe persistent asthma may require daily systemic steroid therapy when other medications have failed.

b. Prednisone, prednisolone or methylprednisolone (Solu-Medrol), 40 to 60 mg qd; for children, 1 to 2 mg/kg/day to a maximum of 60 mg/day. Therapy is continued for 3-10 days. The oral steroid dosage does not have to be tapered after short-course "burst" therapy if the patient is receiving inhaled steroid therapy.

Classification

Long-term control medications

Quick-relief medications

Mild intermittent

Short-acting beta2 agonist as needed

Mild persistent

Low-dose inhaled corticosteroid or cromolyn sodium (Intal) or nedocromil (Tilade); alternatively, a leukotriene modifier may be used

Short-acting beta2 agonist as needed

Moderate persistent

Medium-dose inhaled corticosteroid plus a long-acting bronchodilator (long-acting beta2 agonist) if needed

Short-acting beta2 agonist as needed

Severe persistent

High-dose inhaled corticosteroid plus a long-acting bronchodilator and systemic corticosteroid if needed

Short-acting beta2 agonist as needed

Inhaled Corticosteroids and Mast Cell Stabilizers

Dose range (total puffs/day)

Drug

Trali lami

lisi ^g/iuii)

Liw

Iitirmiliati

High

vent

Vanceril

Vanceril

Double

Strength

>20 >10

Triamciii-liii

Azmacort

100

4 to 10

10 to 20

>20

Fluiisilili

AeroBid

250

2 to 4

4 to 8

>8

Flovent 110

Flovent 220

110 220

2 to 6 2

2 to 6

>6 >3

Dose range (total puffs/day)

Drug

Trade

Dose

Low

Intermediate

High

name

¬ępuff)

Mast cell stabilizers

Cromolyn

Intal

800

Adults: 6

Adults: 9 to

Adults: 16

sodium MDI

mg/puff

puffs or 3

12 puffs in

puffs in three

nebulizer,

ampules in

three divided

divided doses

20 mg/2-

three di

doses

or 4 ampules

mL ampule

vided doses

Children: 6

in four divided

Children: 3

puffs in three

doses

puffs or 3

divided doses

Children: 8

ampules in

puffs or 4 am-

three di-

pules in four

vided doses

divided doses

Nedocromil

Tilade

1.75

Adults: 4 to

Adults: 9 to

Adults: 16

mg/puff

6 puffs in

12 puffs in

puffs in four

two to three

two to three

divided doses

divided

divided doses

Children: 8

doses

Children: 4 to

puffs in four

Children: 2

6 puffs in two

divided doses

to 3 puffs in

to three di-

two to three

vided doses

divided

doses

2. Cromolyn sodium (Intal, Nasalcrom) and nedocromil sodium (Tilade) are anti-inflammatory medications. They lack the systemic side effects associated with corticosteroids. Cromolyn, available in a metered-dose inhaler or as inhaler solution, requires dosing four times per day. Nedocromil is designed for twice-daily dosing. Maximal benefit may not be achieved for four to six weeks. Cromolyn and nedocromil are first-line agents in children.

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