Some patients with asthma have frequent exacerbations and persistent airflow obstruction despite treatment with inhaled glucocorticoids and long-acting beta-agonists (LABAs).
In patients with poorly controlled asthma despite the use of inhaled glucocorticoids and LABAs, the addition of tiotropium significantly increased the time to the first severe exacerbation and provided modest sustained bronchodilation.
Anticholinergic agents have been available for the treatment of airways obstruction for many decades. For patients with chronic obstructive pulmonary disease (COPD), many practitioners believe that these drugs have become the bronchodilator of choice. For patients with asthma, anticholinergic agents are less popular, probably because of their slower onset of action as a reliever medication and their generally inferior effect on lung function and symptoms, as compared with inhaled beta-agonists.
Acute bacterial sinusitis is diagnosed in children with persistent rhinorrhea and cough, severe symptoms, or worsening of symptoms after initial improvement. Antibiotic therapy is recommended, and amoxicillin–clavulanate is generally the first-line treatment.
The use of inhaled glucocorticoids for persistent asthma causes a temporary reduction in growth velocity in prepubertal children. The resulting decrease in attained height 1 to 4 years after the initiation of inhaled glucocorticoids is thought not to decrease attained adult height.
For egg allergy, dietary avoidance is the only currently approved treatment. We evaluated oral immunotherapy using egg-white powder for the treatment of children with egg allergy.