bronchial asthma

Often children are difficult cases to achieve asthma cobtrol. in such situation compliance, device and technique used should be evaluated. 3 ICS are commonly used.
1- Beclomethazoneis -can increase up to 400mcg OD
2- Budesonide -- (Pulmicort / Easyhaler), up to 800
3- fluticasone - - 400 (is twice stronger than other w/w)
use spacer for better cordination and avoiding local adherance and side effects (dysphonia, candidiasis, local irritation, cough, reflax bronchospasm).
steroids also cause systemic SE like depresion of hypothalamo-pitiutary-adrenal axis, osteoprosis, growth retardation, skin thinning, easy bruising, etc)
seretide (salmetrol, fluticasonea) is the onlyone that we can use spacer.
symbicort (budesonide/fomoterol)
steroids are used in persistant asthma, step up approach is used, 400 to 800 increase - think of adding 3rd drug LT, theophyllione, if has to increase to 800 refer to llllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllll