In the study, 51 children were randomized to the fluticasone group and 49 to the oral prednisone group. The mean age was nine years, with a range of five to 17 years. The FEV 1 increased from baseline to 240 minutes by a mean of 19 percent in the oral steroid group ( P <) compared with percent in the inhaled steroid group. Thirteen of the children in the oral prednisone group had an “excellent” response (an increase of FEV 1 greater than 25 percent) but only five in the inhaled fluticasone group had such a response. In contrast, 16 in the latter group had a “poor” response (an increase in FEV 1 of less than 5 percent) compared with just four children taking oral prednisone. Moreover, 25 percent of children in the inhalation therapy group actually had a reduction in baseline FEV 1 at 240 minutes, whereas no children in the oral prednisone group showed a decline in FEV 1 . The FVC and predicted peak expiratory flow rates were also significantly greater in the oral steroid group. Following the study, 16 children (31 percent) in the fluticasone group were admitted to the hospital compared with only five (10 percent) in the prednisone group.
Less common but sever conditions related to mould spores such as Acute Broncho Pulmonary Aspergillosis (ABPA is a chronic fungal infection plus allergy in the airways) and Extrinsic Allergic Alveolitis (called Farmer’s Lung) should be considered in patients with asthma like symptoms that do not respond to conventional asthma treatments. Occupational (work related) asthma may occur in bread bakers and alsoafter exposure to isocyanates in spray paint, carpentry wood dust, platinum salts in jewellery workers and animal allergens (in veterinary and animal laboratory workers and fish and shellfish factory workers)
May also consider . salbutamol . Limited evidence for benefit.
5 mcg/kg/min for one hour as a load, followed by 1-2 mcg/kg/min.
Beware salbutamol toxicity: tachycardia, tachypnoea, metabolic acidosis. Can occur with both IV and inhaled therapy. Lactate commonly high. Consider stopping/reducing salbutamol as a trial if you think this may be the problem.
Aminophylline, magnesium and salbutamol must be given via separate IV lines.
Intensive care admission for respiratory support (facemask CPAP, BiPAP, or intubation/IPPV) may be needed.