Expert: Marc Rubin, RPh Asthma Educator - 7/11/2008

Question
my 4 yr old is taking 4 mg. Singulair, .25 pulmicort  twice daily, 1 tsp. loratadine and Albuterol as needed for wheezing.  Are there any substitutes for any of this, as my insurance has been cancelled?  Also, does this much medication seem approiate.  He has had asthma since 10 mos of age

Answer
Hi Ashley,

Asthma therapy can be complicated like this. Are you taking your child to a allergist, or is the treatment being guided by a pediatrician?

Typically, persistent asthma (where albuterol is required more than twice a week during the day time, or more than two awakenings/month from nighttime sleep)requires controller therapy, not just rescue. For children through 4 years of age, the controller of choice would be Pulmicort, but Singulair can be used as an alternative. Generally, the preferred product would be Pulmicort. With that said, if the patient is not controlled with a low dose inhaled steroid, the next step in the therapy would be to increase the steroid to a medium-dose level. The next step up from this would be to add either Singulair OR a long-acting version of albuterol. Antihistamines may be of help as an add-on, but if no improvement, probably no point. The MD would assess this.

Cost...would your child be qualified for a state program? If not, the drug companies have patient assistance programs for those who do not have insurance. Try calling 1(800)762-4636 or through the internet at https://www.pparx.org/Intro.php

Hope this helps you!

Sincerely,

Marc