-Last few days of preparation for my Step 2 USMLE -Clinical Knowledge Exam
Wednesday, May 23, 2012
Regarding asthma treatment
Every patient with persistent asthma, regardless of disease severity, should use a daily controller medication.
Consider an inhaled corticosteroid (ICS) first when choosing controller medications for long-term treatment of mild, moderate, and severe persistent asthma in adults and children. Leukotriene modifiers, cromolyn, and nedocromil may be considered as alternative, not preferred, controller medications for patients with persistent asthma.
Long-acting β2-adrenergic agonists should not be used as monotherapy.
Long-term use of ICSs within labeled doses is safe for children in terms of growth, bone mineral density, and adrenal function; nonetheless, asthma should be monitored and ICS therapy stepped down to the lowest effective dose.
Low-to medium-dose ICSs are not associated with the development of cataracts or glaucoma in children, but high cumulative lifetime doses may slightly increase the prevalence of cataracts in adults and elderly patients.
ICSs are recommended for use in pregnant women with asthma; budesonide is the only ICS rated Pregnancy Category B.