Assessment of Controversial Pediatric Asthma Management Options Using GRADE

Abstract

We provide systematically and transparently developed recommendations about controversial asthma management options. Using GRADE for guideline development may change recommendations, enhance guideline implementation, and define remaining research gaps.

Classification and pharmacological treatment of preschool wheezing: changes since 2008

“…Using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, the Dutch Paediatric Respiratory Society recently recommended using ICS as the first choice of maintenance treatment in all preschool children, irrespective of phenotype [29]. A similar recommendation was issued by GINA (Global Initiative for Asthma) [30].…”

Long-term adherence to inhaled corticosteroids in children with asthma: Observational study

“…Inclusion criteria for this study were a diagnosis of asthma made by the attending pediatrician based on national Dutch guidelines for the diagnosis and management of asthma (which are comparable to international guidelines) [16], and use of ICS for at least three months. Exclusion criteria comprised limited knowledge of the Dutch language, severe comorbidity and a sibling participating in the study.…”

It's the adherence, stupid (that determines asthma control in preschool children)!

“…To enter our asthma management programme, children must be referred by their primary care practitioner because of troublesome, severe or frequent symptoms. After the diagnosis of persistent asthma had been made by the attending paediatrician, ICS by metered dose inhaler/spacer combination were prescribed as daily controller therapy, irrespective of the wheezing phenotype (episodic viral or multiple trigger wheeze), in accordance with the national paediatric asthma guidelines [14]. Details of the asthma management programme in our clinic have been published previously [13,15], and comprise extensive training of correct inhalation technique, home visits to assess and reduce exposure to relevant allergens and tobacco smoke, and treatment of relevant comorbidities.…”