SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

10/12/05

Management of childhood asthma

Summary
Background - Most childhood asthma can be controlled by treatment following national/international guidelines such as those promulgated by the NAEPP (NIH) and The Global Initiative for asthma (GINA). However, in some cases, asthma control is not satisfactory.

Findings - Dozor of the New York Medical College in Valhalla, NY discussed his approaches when childhood asthma is not adequately controlled. He stated these principles: 1) make sure the diagnosis is correct and that there are no complicating issues that interfere with asthma control; 2) the child should be evaluated at least once every 3-6 months during which asthma status is carefully evaluated and asthma action plans are updated, as needed; 3) carry out periodic spirometric evaluation of lung function in children who can perform studies; 4) daily treatment with inhaled corticosteroids (ICS) is indicated in all cases of persistent asthma (PA) using reasonably low doses whenever possible; 5) when asthma control is not achieved when low dose ICS are prescribed, first question carefully whether there is parental compliance with this treatment approach. If there is good compliance, then add inhaled long-acting beta agonists or leukotriene antagonists; 6) inhaled short-acting beta agonists appear to be best for rescue treatment or for occasional intermittent asthma (assuming that the patient is truly free of asthma symptoms between these occasional episodes). 7) For most children, the best route for inhaled medications is a metered dose inhaler with spacer or valved holding chamber; 8) short courses of oral corticosteroids may be needed for severe asthma exacerbations occurring despite adequate inhaled corticosteroids therapy.

Reference
J Respir Dis 2005;26:348-58

Editor's Comments
The treatment philosophy summarized above is in general agreement with that proposed by most asthma experts. However, some comments are worth consideration: 1) A recent large study concluded that as needed (prn) use of ICS may control mild PA as well as daily ICS treatment, with less overall use of ICS by the prn treatment approach; 2) there is currently considerable debate whether periodic spirometry adds significantly to careful clinical evaluation in predicting which childhood asthma is worsening.

 

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