Alfin G. Vicencio, MD Attending in Pediatric Pulmonary - Steven and Alexandra Cohen Childrens Med Center
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Asthma Attack Prevention Medication Male: Asthma control in essence is like birth control. If you don’t take it you become pregnant. If you don’t take the control you're going to get attacks. What would be the ideal approach to prevent the attacks and what kind of medications are there available? Alfin G. Vivencio: There are a lot of different medications that are available. Probably the most effective is a little dose of inhaled corticosteroid and that’s something that helps to decrease the frequency of attacks and the severity of the attacks when they do come. Male: But people with inhaled steroid where they get a little bit nervous. And when it’s inhaled you don’t get all the complications if you’ve taken it by now. There are some concerns about it but not quite the same level of taking that prednisone tablet which is used all the time. That goes an expression steroid-dependent asthmatic, non- steroidal, you don’t even use that term anymore. So if you’re using control methods, what were the ones that you would prefer over others? Alfin G. Vivencio: There are a variety of different types of inhaled corticosteroids and again as you said I like to -- these medications are very safe to use. They do need to be monitored and there can be some potential problems if you're on high doses for a long time. One of them is called the desonide. It’s a medication that’s administered by nebulizer. It’s also administered by dry powder inhaler. There are other medications. Corticosone is one of them, beclomethasone, a variety of different inhaler and medications. Male: What would you be your prognosis to a young baby that got a lot of attacks and if any particular one you would go to first? Alfin G. Vivencio: The desonide is actually a good choice. It’s very easy to administer. Male: That is long what is the name-- Alfin G. Vivencio: The trade name is -- Male: So people prefer the nipple. Alfin G. Vivencio: Yes, it’s a medication that’s actually very easily administered and there is pretty good deposition into the lung. There are some practitioners who prefer metered-dose inhaler or asthma pumps. They also can be effectively use, if used correctly in very, very young children. Male: If we use an example, pulmo-- in your kid who’s had frequent attacks, how long would you say you would use that kind of medication? Alfin G. Vivencio: That medication, as you already mentioned before is a medication that needs to be used chronically. Male: Then it’s not a week, not a month, how long would that be? Alfin G. Vivencio: It can be several months or even up to a year depending on how poorly or how well the symptoms are controlled. The way that I decide whether or not somebody needs to be on medication very frequently is the frequency of the symptoms. I’ll give you an example. If there is a child who is having symptoms several days a week and not somebody who -- Male: With the symptoms, what are the things you're looking for? Alfin G. Vivencio: It could be as simple as a chronic cough. Male: Daytime, nighttime, which makes you more concerned? Alfin G. Vivencio: Both, to be honest with you. The nighttime cough is actually very, very frequent in fully controlled asthma. And if you're having frequent nighttime cough, then that’s a little bit more of a concern. Cough with asthma can actually be present both in the day and at night particularly with certain types of triggers including frequent activity. But if there are symptoms such as chronic cough or certainly wheezing that are present several days a week then already you have an indication for chronic therapy with a low dose inhaled steroid.
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