Management of paediatric asthma

Abstract

Paediatric asthma best practice not only includes prescribing the correct therapeutic mix based on consensus guidelines, but also reducing therapy once control has been achieved. Clinicians should also be aware that asthma in young children is a heterogeneous entity, and a beneficial response to bronchodilators and/or inhaled steroids is not inevitable. In general, preschool children and infants should not be prescribed inhaled corticosteroids above 200 μg beclometasone dipropionate equivalent twice a day, or regular oral steroids, or long acting β2-adrenoceptor agonists. New therapies such as anti-IgE antibodies are on the horizon, but these are unlikely to replace the established drug combinations. More likely is that the delivery of established drugs will become more convenient (for example, once a day inhaled corticosteroids, or season dependent prophylactic therapy).

Safety and tolerability of indacaterol in asthma: A randomized, placebo-controlled 28-day study

“…1 A selective b 2 -agonist that can provide safe and effective 24-h bronchodilation with once-daily dosing extends the treatment options for many patients with asthma, as well as potentially contributing to patient compliance, especially among adolescents and children. 11,12 The very low incidence of predictable pharmacological side effects such as tremor, headache, nervousness, nausea and tachycardia, together with negligible effects on QTc interval, blood glucose and serum potassium, over a wide range of doses suggests a favourable therapeutic index for indacaterol. Changes in heart rate, QTc interval and plasma potassium and glucose levels have been reported in patients and healthy volunteers receiving the long-acting b 2 -agonists salmeterol [13][14][15] and formoterol [16][17][18][19] at higher doses than indicated for clinical use.…”

Prescription of respiratory medication without an asthma diagnosis in children: a population based study

“…Despite this uncertainty in diagnosis, asthma medication is often prescribed to wheezing infants. Moreover, the response to asthma medication itself is widely used as a diagnostic tool to strengthen or reject the possible diagnosis of asthma [ 1 , 6 , 7 , 19 , 22 ].…”

Persistence of asthma medication use in preschool children

“…Moreover, the response to asthma medication itself is widely used as a diagnostic tool to strengthen or reject the possible diagnosis of asthma. 3,5,11,12 The GINA guidelines state that 'a trial of asthma medication is probably the most confident way to make a diagnosis on asthma in children'. 11 The rationale behind the trial treatment is that young children with wheezing but no underlying asthmatic disease are expected not to respond to treatment and will, therefore, discontinue treatment after evaluation of the effect.…”