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I just came off of a pulmonary rotation and our pulmonologists are using
Singulair (actually, they even had a 2 year old on it) in several scenarios:
 
1.  Mild asthmatic:  those with some attacks despite compliance with
Tylade or Intal, used before going to steroid MDI.
 
2.  Mild asthmatic:  Non-compliant with Intal/Tylade.  They have a few
patients on Singulair alone with PRN Ventolin for wheezing.
 
3. Moderate asthmatic:  Reduce or eliminate need for steroid MDI.
 
4.  Severe asthmatic:  Reduce or eliminate need for oral coritcosteroids.
 
Still, I would shy away from prescribing it in the ED.  I believe such things
are long-term care issues best dealt with by the primary MD or
pulmonologist.  Technically approved for children 6 and over...but is used
younger at times.
 
Dave Smith
Children's of Akron
 
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