Monthly Triamcinolone Acetonide for Severe, Refractory, Life-Threatening Asthma in Children

Rationale: Treatment modalities for severe, therapy-resistant asthma in children are not well studied.  Triamcinolone acetonide has been described in adults, but pediatric data on its use is limited. At our institution, triamcinolone acetonide has been used recently for children who have demonstrated severe, life-threatening asthma refractory to NHLBI Guidelines step 6 therapy.

Methods: Retrospective chart review for children treated with intramuscular triamcinolone acetonide (TA) was performed.  The following data were extracted: medication history, hospitalizations per year before and during TA therapy, life threatening events (cardiac arrest, intubation, CPR, ECMO).

Results: Five children have been treated with intramuscular TA at our hospital beginning in March 2014.  Age at time of initiation of TA therapy ranged from 7.8 to 14.8 years.  Patient histories were notable for the following asthma-related events: Patient 1 – three cardiac arrests; Patient 2 - ECMO and multiple intubations; Patient 3 – multiple intubations; Patient 4 – ICU admissions monthly; Patient 5 – cardiorespiratory failure twice requiring CPR and emergent intubation. All had failed treatment with daily oral corticosteroids, and had either failed or were not candidates for omalizumab and/or theophylline.  Starting TA dose ranged from 60 to 120mg, was dosed monthly, and weaning was begun after 2-3 months of stability. In the year prior to intiation of TA therapy, the five patients combined for 28 hospital admissions. To date, after initiation of TA therapy none of the patients have been hospitalized.

Conclusions: Monthly injection of triamcinolone acetonide is a viable therapeutic modality for children with life-threatening severe refractory asthma.