Inhaled corticosteroids are the mainstay for daily controller medications in children and toddlers. The choice of which inhaled corticosteroid often comes down to which medication delivery device is preferred by caretakers. Young children can use metered-dose inhalers with a spacer and face mask, as long as caregivers are trained and feel comfortable with the proper technique. Budesonide is available via nebulizer, and this may be easier for infants and younger toddlers. Some children may also feel comfortable with a dry powder inhaler. If used properly, all medication delivery devices are effective, so choice is usually individualized based on caregiver and child preference. Combination inhalers are also used in children, and health-care professionals caring for children with asthma may choose these for children with moderate to severe asthma.
Thank you(!), Annette, for posting a rational response. Obviously the only problem with MOST meds is that they gradually lose potency, and the printed expiration date is not a magical transition point into badness -- newer meds are generally more potent; that is a reason ordering them sent through the mail can be a good idea, if you can get them from someplace that ships the product straight out from the assembly line. As you point out, discoloration is something to watch for, in meds as for vitamins and foods, and proper storage makes a lot more difference than calendar time. Even fairly new stuff can go off if it hasn't been stored properly, especially with regard to temperature and humidity. However, in any specific case under consideration, one always has a nagging suspicion that any particular item might be an exception to the general guidelines insofar as it might undergo some chemical transformation other than just reduction of potency.
Inhaled Steroids (such as Flovent, Pulmicort, and Qvar): Inhaled steroids can be safely given daily for asthma maintenance control. Because the medication is only going to the lungs (where it is needed) and not to the rest of the body, none of the long-term side effects of oral steroids are experienced. There have been exhaustive studies demonstrating that inhaled steroids given daily are safe and effective, and are considered first line therapy for asthma maintenance. These medications generally take a week or more to reach maximal effectiveness. One should NEVER attempt to use these medications in place of a rescue inhaler for acute symptoms. Because these medications work slowly, we will often start patients on a 3-7 day oral steroid "burst." When the oral steroid is finished, we will often then start an inhaled steroid to safely continue daily anti-inflammatory maintenance therapy.