Current guidelines for the management of asthma in young children

Abstract

The diagnosis and management of asthma in young children is difficult, since there are many different wheezy phenotypes with varying underlying aetiologies and outcomes. This review discusses the different approaches to managing young children with wheezy illnesses presented in recently published global guidelines. Four major guidelines published since 2007 are considered. Helpful approaches are presented to assist the clinician to decide whether a clinical diagnosis of asthma can, or should be made in a young child with a recurrent wheezy illness and which treatments would be appropriate, dependent on risk factors, age of presentation, response to initial treatment and safety considerations. Each of the guidelines provide useful information for clinicians assessing young children with recurrent wheezy illnesses. There are differences in classification of the disease and treatment protocols. Although a firm diagnosis of asthma may only be made retrospectively in some cases and there are several effective guidelines to initiating treatment. Consistent review of the need for ongoing treatment with a particular pharmacological modality is essential, since many children with recurrent wheezing in infancy go into spontaneous remission. It is probable that newer biomarkers of airway inflammation will assist the clinician as to when to initiate and when to continue pharmacological treatment in the future.

The challenges of diagnosing bronchial asthma in very young infants in Calabar, Nigeria

“…The reasons vary from difficulties in making a confident diagnosis, lack of objective diagnostic criteria, logistical and ethical issues and the variable expression of wheezy illness in this group of children. 6 Also, studies are difficult to conduct in these infants and young children leading to a paucity of data. Available studies show asthma-like inflammation are present at very early age and reduced lung function at 6years of age in those who had persistent wheezing since infancy.…”

“…10 For over 24 years, asthma guidelines have been developing globally to increase awareness of asthma among the health problems, improve asthma management, evaluate published reports on asthma and to promote international collaboration in asthma research. 6 Lack of familiarity with guidelines is a common problem among doctors. 6 The available guidelines do not adequately address the management of asthma in children under the age of 5 in the underdeveloped world where resources are lacking and studies on asthma management are absent.…”

“…6 Lack of familiarity with guidelines is a common problem among doctors. 6 The available guidelines do not adequately address the management of asthma in children under the age of 5 in the underdeveloped world where resources are lacking and studies on asthma management are absent. 6 Geopolitical peculiarities should also be considered.…”

“…6 The available guidelines do not adequately address the management of asthma in children under the age of 5 in the underdeveloped world where resources are lacking and studies on asthma management are absent. 6 Geopolitical peculiarities should also be considered. 7 It is therefore necessary for regions and countries to consider all the available guidelines and adapt them in their contexts so that the recommendations are in line with available resources in a particular region.…”

“…This would facilitate their implementation and thus improve the management of asthma in young children around the world. 6 Reports of three cases whose initial presentations started in the neonatal period, 6 weeks and 2 months of age respectively. The diagnosis of asthma was initially missed because of their young ages but with a high index of suspicion, prompt diagnosis and correct treatment, all of them are doing well.…”