Dual Antithrombotic Therapy’s Increased Risks Not Always Offset by Benefit

Abstract

ily and community medicine at the University of Nevada in Reno, explained that patients need to be taught how to recognize when their symptoms are getting worse, what do when their symptoms worsen (such as proper use of their rescue inhaler), and when they need further medical assistance. For example, Stoloff suggested physicians have placebo inhalers on hand so patients can demonstrate during visits that they can properly use the device. Additionally, the guidelines recommend that families and school staff be included in asthma action plans and taught to recognize when a pediatric patient is in distress and how to help. PEDIATRIC PATIENTS Theguidelines’updatedtreatmentcharts highlightthespecialneedsofpediatricpatients with asthma. Prior to the revision, the charts contained step-by-step treatment instructions for 2 groups, children younger than 5 years and everyone else. However,recentdatathatsuggestchildren and adults respond differently to certain medications ledthepanel todividethe“5 years and older” category into 2 groups: childrenaged5to11yearsand individuals aged 12 years or older. Panel member Robert F. Lemanske, MD, professor of pediatrics and medicine at the University of Wisconsin, in Madison, explained that the evidence compiled to date suggests that inhaled corticosteroids are the most effective treatment for children, and that children may not derive any further benefit from the addition of long-acting -agonists. In contrast, individuals who are aged 12 years or older may benefit from such combination therapy. Additionally, stratifying patients into these 3 categories helps physicians deal with the specific treatment issues that may arise in each age category. Factors such as understanding instructions for medication use and compliance, for example, are going to differ for preschoolers compared with adolescents. “There are clearly developmental distinctions we need to be thinking about,” he said.