Asthma treatment in children: A pragmatic approach

Abstract

Corresponding author: R Masekela (masekelar@ukzn.ac.za)Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. Objectives. To provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children. Methods. The South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ. Conclusions. To ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical.Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.

Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression

“…In a recently published approach to paediatric asthma management, [1] treatment modifications included a 3-day course of rescue oral corticosteroids, intermittent use of ICS, a single ICS dose in the morning if possible, and a more prominent role for non-steroid controller medication. All these measures will protect the hypothalamic-pituitary-adrenal axis from suppression.…”

“…In addition, cognisance needs to be taken of the child's BMI, adherence to therapy and the ICS route of administration, as lung deposition, and hence dose, varies between devices. [1,3]…”

He who refuses to obey cannot command: A guide to paediatric asthma management

“…Two CME articles in this issue of SAMJ address the management of mild-to-moderate asthma in children [2] and the place of the novel biological agents.…”

“…Two CME articles in this issue of SAMJ address the management of mild-to-moderate asthma in children [2] and the place of the novel biological agents. [3] Key to these issues is that childhood asthma can mainly be managed by primary healthcare providers and the appropriate use of inhaled corticosteroids via metered-dose inhalers with a spacer device, and the provision of reliever medication for acute exacerbations.…”

“…The CME article, ' Asthma treatment in children: A pragmatic approach' , [2] provides guidance on indications for the use of systemic steroids in preschoolers and for shorter courses of systemic corticosteroids in older children with exacerbations.The current recommendation is a short course of 3 days, which differs from the recommendation in the 2009 paediatric asthma guideline. [4] The injudicious use of macrolide antibiotics, over-the-counter bronchodilators, cough mixtures and mucolytics remains a widely prevalent problem in asthma management.…”