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August 16, 2022
Albuterol–Budesonide Combination for Asthma Exacerbation: Asthma exacerbations are increasing in prevalence and result in serious complications such as hospitalizations and death. For acute treatment of flare-ups, the benefit of short-acting β2-agonists may be limited because they do not address the underlying airway inflammation compared to inhaled corticosteroids. A Phase 3, multinational, randomized, double-blinded trial demonstrated an albuterol-budesonide combination at higher and lower doses was effective compared to albuterol monotherapy for patients aged 4 years and older with uncontrolled moderate to severe asthma. The frequency of adverse events was similar among the three treatment groups. With these positive results, the first-in-class combination was recently submitted to the U.S. Food and Drug Administration for approval and may provide better access and outcomes for patients.
Upon completion of the chapter, the reader will be able to:
Define different age groups within the pediatric population.
Identify factors that affect selection of safe and effective drug therapy in pediatric patients.
Explain general pharmacokinetic and pharmacodynamic differences in pediatric versus adult patients.
Develop strategies for appropriate and effective medication administration to infants and young children.
Determine approaches to effectively communicate with patients and caregivers about appropriate medication use including expected outcomes, possible adverse effects, and appropriate administration.
Pediatric clinical practice involves care of infants, children, and adolescents with the goal of optimizing health, growth, and development toward adulthood. Clinicians serve as advocates for this unique and vulnerable patient population to optimize their well-being. Care for pediatric patients is relevant in both inpatient and outpatient settings and requires additional considerations with regard to selection and monitoring of drug therapy.
Despite the common misconception of pediatric patients as “smaller adults” where doses are scaled only for their smaller size, there are multiple factors to consider when selecting and providing drug therapy for patients in this specific population. Pediatric patients significantly differ within their age groups and from adults regarding drug administration, psychosocial development, and organ function development, which affect the efficacy and safety of pharmacotherapy.
FUNDAMENTALS OF PEDIATRIC PATIENTS
Classification of Pediatric Patients
Pediatric patients are those younger than 18 years, although some pediatric clinicians may care for patients up to age 21. Unlike an adult patient, whose age is commonly measured in years, a pediatric patient’s age can be expressed in days, weeks, months, and years. Patients are classified based on age and may be further described based on other factors, including birth weight and prematurity status (Table 2–1).1–3
Table 2–1Pediatric Age Groups, Age Terminology, and Weight Classification1-3