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Y àontroller medications for children include inhaled and systemic glucocorticosteroids, leukotriene modifiers, long
acting inhaled ɴ2-agonists, theophylline, cromones, and long-acting oral ɴ2-agonists

Y ×nhaled glucocorticosteroids are the most effective controller therapy, and are therefore the recommended treatment
for asthma for children of all ages
Y phe potential clinically relevant  

 of inhaled glucocorticosteroids on bones in children are osteoporosis

and fracture
Y ct higher doses, small changes in HPc axis function can be detected with sensitive methods
Y adrenal crisis has been reported in children treated with excessively high doses of inhaled glucocorticosteroids
Y the increased level of dental erosion reported in asthma is insufficiently controlled by medium doses
children with asthma may be due to a reduction in of inhaled glucocorticosteroids or as single-dose
oral pH that may result from inhalation of ɴ2-agonists therapy before vigorous exercise

àhildren older than 5 years: àhildren older than 5 years:
Y aeukotriene modifiers provide partial protection Y ×nhalation of a single dose of long-acting inhaled ɴ2-
against exercise-induced bronchoconstriction within agonist effectively blocks exercise-induced
hours after administration with no loss of bronchoconstriction for several hours
bronchoprotective effect Y ¦ith daily therapy the duration of the protection is
Y cs add-on treatment in children whose asthma is somewhat reduced, but is still longer than that
insufficiently controlled by low doses of inhaled provided by short-acting ɴ2-agonists
glucocorticosteroids, leukotriene modifiers provide
moderate clinical improvements, including a àhildren 5 years and younger:
significant reduction in exacerbations Y àombination therapy with budesonide and formoterol
Y àombination therapy is less effective in controlling used both as maintenance and rescue has been
asthma in children with moderate persistent asthma shown to
than increasing to moderate doses of inhaled reduce asthma exacerbations in children ages 4 years
glucocorticosteroids and older with moderate to severe asthma

àhildren 5 years and younger: Side effect:

Y aeukotriene modifiers reduce viral-induced asthma Y inconsistency of reports on their effects
exacerbations in children ages 2-5 with a history of
intermittent asthma   
Y aong-acting inhaled ɴ2-agonists are primarily used as Y pheophylline has been shown to be effective as
add-on therapy in children older than 5 years whose monotherapy and as add-on treatment to inhaled or
oral glucocorticosteroids in children older than 5 Y §ecause of the side effects of prolonged use, oral
years glucocorticosteroids in children with asthma
Y cdd-on treatment with theophylline has been found should be restricted to the treatment of acute
to improve asthma control and reduce the severe exacerbations, whether viral-induced or
maintenance glucocorticosteroid dose necessary in
children with severe asthma treated with inhaled or
oral glucocorticosteroids.
Y phe efficacy of theophylline is less than that of low-
dose inhaled glucocorticosteroids Õ   
Y Sustained-release products are preferable for Õ           
maintenance therapy, since they enable twice-daily   
dosing Y Õapid-acting inhaled ɴ2-agonists are the most
Y Sustained-release products with reliable absorption effective bronchodilators available and therefore the
profiles and complete bioavailability with and without preferred treatment for acute asthma in children of
concomitant food intake are preferred all ages
Y phe most common  

 of theophylline are Y phe inhaled route results in more rapid

anorexia, nausea, vomiting, and headache bronchodilation at a lower dose and with fewer side
Y ]ild central nervous stimulation, palpitations, effects than oral or intravenous administration
tachycardia, arrhythmias, abdominal pain, diarrhea, Y ×nhaled therapy offers significant protection against
and, rarely, gastric exercise-induced bronchoconstriction and other
bleeding may also occur (mainly seen at doses higher challenges for 0.5 to 2 hours (long acting ɴ2-agonists
than 10 mg/kg/day) offer longer protection)
Y phe risk of adverse effects is reduced if treatment is Y Side effect : skeletal muscle tremor, headache,
initiated with daily doses around 5 mg/kg/day and palpitations, and some agitation
then gradually increased to 10 mg/kg/day
`ot recommended for long-term management of asthma
               in children
Y àonflicting & not better than placebo
Side effect :
Y àough, throat irritation, and broncho-constriction
occur in a small proportion of patients treated
with sodium cromoglycate
Y c bad taste, headache, and nausea are the most
common side effects of nedocromi

Y preatment with long-acting oral ɴ2-agonist such
as slow release formulations of salbutamol,
terbutaline, and bambuterol reduces nocturnal
symptoms of asthma
Y wue to their potential side effects of
cardiovascular stimulation, anxiety, and skeletal
muscle tremor, their use is not encouraged