Controversies in the treatment of mild asthma. What novelties and practical implications?

Abstract

Mild asthma is prevalent in childhood and causes as many as 30%–40% asthma exacerbations requiring emergency visits. The management of "intermittent" and "mild persistent" asthma phenotypes is still a matter of debate, even if the role of inhaled corticosteroids, both continuous and intermittent, is a cornerstone in this field. Recent updates of the guidelines on the strategies to manage these patients are coming, since the role of inflammation in these asthma phenotypes is crucial, as well as the potential side effect and risks of short‐acting beta 2 agonists overuse, prescribed as the only "as‐needed" treatments. In this paper, we overview the new (r)evolution regarding intermittent and mild persistent asthma management.

Applying the new guidelines to asthma management in children

“…In general, mild asthma is associated with a nonnegligible risk of even severe and potentially fatal acute attacks, as reported by the 2014 British National Review of Asthma Deaths report [17]. There is evidence that the low frequency and generally unproblematic nature of symptoms in patients with mild asthma are associated not only with unsatisfactory adherence to controller therapy, particularly inhaled corticosteroids (ICS), but also with overuse of short-acting β2 agonists (SABA), resulting in adverse events (frequently tachycardia, tremors and headache) [15,16].…”

“…The 'intermittent' and 'mild persistent' asthma phenotypes represent the great majority in the paediatric age group [13][14][15][16]. In general, mild asthma is associated with a nonnegligible risk of even severe and potentially fatal acute attacks, as reported by the 2014 British National Review of Asthma Deaths report [17].…”

“…The 2022 updated GINA document recommends concomitant low-dose ICS use with SABA for children 6–11 years with intermittent disease (step 1) and daily low dose of ICS in mild persistent disease (step 2) (Table 1) [1 ▪▪ ,15,16]. Intermittent, symptom-based use of ICS represents an effective patient-centred strategy in children with mild asthma, especially those who have difficulty adhering to daily therapy, as Sumino et al [22] recently demonstrated in the primary care setting.…”

New approaches in childhood asthma treatment

“…In the pediatric age group, 'intermittent' and 'mildpersistent' account for the vast majority of asthma phenotypes [5][6][7][8][9][10]. As described in the British National Review of Asthma Deaths report in 2014, mild asthma is associated with a considerable risk of severe and, potentially, fatal acute attacks [11].…”

Effect of Budesonide Inhalation on Asthmatic Child: A Randomized Controlled Trial

“…ICS are the basis of all asthma treatment recommendations. They minimize asthma manifestations in children, increase the quality of life (QoL) for asthmatic children and their families, decline school/work absences for cases and their parents, decrease airway inflammation, and enhance lung function, bronchial reactivity, and exercise-induced asthma [7,8].…”