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Choosing the right controller for a child with asthma - not only the correct drug matters

Kalin Papochiev, Lili Goguleva, Penka Perenovska, Dimitrinka Miteva, Guergana Petrova


Introduction: Current clinical evidence suggests that although contemporary inhaled therapy (main­ly inhaled corticosteroids - ICS) for asthma has the potential to control disease in most patients, con­trol is often not achieved in practice. One prominent reason for poor control is poor inhaler tech­nique, because no matter how good a drug is, it cannot be effective if it does not reach the targeted airways.

Materials and methods: We present clinical cases of children with asthma who despite a proper dose and a good drug of choice (following Global Initiative for Asthma guidelines) have very bad control. One of them is a 15-year-old boy with combined ICS with Ellipta device once daily, the second child is a 3-year-old boy with pMDI (Metered Dose Inhaler `Puffer`) with improper use of spacer, the third one is a 5-year-old girl with nebulised ICS and the forth one is a 14 year old girl with pMDI. All 4 patients had a deterioration in their asthma symptoms and required multiple inpatient treatments. Changing the inhaler and a re-education of patients and mothers lead to better results.

Results: A year after the intervention all 4 kids have good control without need to be re-hospitalized. The result shows the importance of the right technique. This is why doctors should spend more time explaining to the patients how to properly use their medication to achieve the best possible results.

Conclusion: Inhaling medication into the lungs can be very effective - but frequently it is not. The most common reasons for patients not responding to treatment are: being given an inappropriate in­haler, not using the inhaler device properly or failing to take the medication as directed. Proper edu­cation and correct drug and inhaler choice are crucial for maintain perfect asthma control, which is the ultimate goal for all asthma specialists.


asthma; controllers; correct



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