For now, experts caution against corticosteroids for infants and toddlers with mild asthma and urge close monitoring especially for children under age 5 with severe asthma who are receiving high doses. However, researchers are continuing to investigate the safety and effectiveness of inhaled corticosteroid use in young children. A small 2005 study found that fluticasone, used twice daily for 6 months, improved lung function and clinical outcomes in children younger than 2 years. A retrospective review of combined inhaled corticosteroid/long-acting beta2-agonist treatment in children younger than 5 years concluded that combination therapy is safe and effective for this age group.
Long-Acting Beta2-Agonists
Long-acting beta2-agonists, including salmeterol (Serevent) and formoterol (Foradil) plus inhaled corticosteroids are now the preferred preventive treatment for adults and children with moderate to severe asthma. Long-acting beta2-agonists are used for preventing an asthma attack (not for treating symptoms). The effects of one dose of a long-acting beta2-agonist last for about 12 hours, so they are particularly effective during the night. These drugs also may be used for prevention of exercise-induced asthma in people and to protect against aspirin-induced asthma.
In comparison studies, salmeterol and formoterol appear to be equally beneficial. Formoterol has a much faster action, however, and may achieve better control of nighttime asthma. Formoterol works almost as fast as the short-acting albuterol and is sometimes used to treat asthma symptoms. Salmeterol should never be used for treatment of acute episodes. For this purpose, short-acting bronchodilators should be used.
Long-acting forms are not used alone on any regular basis, since they may reduce the effectiveness of the short-acting beta2-agonists (the mainstays for treating acute attacks). In patients with moderate to severe asthma, the long-acting beta2-agonists are best used in combination with anti-inflammatory drugs. Unlike short-acting forms, these beta2-agonists may even have anti-inflammatory properties. A single inhaler (Advair Diskus) that combines both long-acting beta2-agonists and corticosteroids is now available for children age 4 years and older. This inhaler appears to be safe and possibly more effective that either drug used alone for patients who do not respond well to other treatments.
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