The pediatric asthma yardstick

Abstract

Current asthma guidelines recommend a control-based approach to management involving assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient's needs and preferences. However, for children with asthma, achieving control can be elusive. Although tools are available to help children (and families) track and manage day-to-day symptoms, when and how to implement a longer-term step-up in care is less clear. Furthermore, treatment is challenged by the 3 age groups of childhood-adolescence (12-18 years old), school age (6-11 years old), and young children (≤5 years old)-and what works for 1 age group might not be the best approach for another. The Pediatric Asthma Yardstick provides an in-depth assessment of when and how to step-up therapy for the child with not well or poorly controlled asthma. Development of this tool follows others in the Yardstick series, presenting patient profiles and step-up strategies based on current guidance documents, but modified according to newer data and the authors' combined clinical experience. The objective is to provide clinicians who treat children with asthma practical and clinically relevant recommendations for each step-up and each intervention, with the intent of helping practitioners better treat their pediatric patients with asthma, particularly those who do not always respond to recommended therapies.

Disease burden and treatment adherence among children and adolescent patients with asthma

“…Childhood asthma is characterized by periods with little, if any, impairment and fluctuations in severity (10,19); this may make it hard for parents to be convinced that their child needs a daily medication and difficult for the child/adolescent who feels fine when well. Parents and patients may believe that the medication does not help if it does not have an immediate effect, or mistakenly think that maintenance medication can be taken intermittently when symptoms are noticeable (22). Difficulties using inhalers, burdensome regimens, having to use multiple different inhalers, unaffordable medication co-payments, advice to stop treatment from healthcare providers, and lack of education on the importance of continuous adherence are also factors that may lead to poor adherence (8).…”

The treatment of allergic rhinitis in asthmatic children and adolescents: practical outcomes from the real-world “ControL’Asma” study

“…Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation (3). To define clinical, functional, and immunopathological patterns allows identifying asthma phenotypes and endotypes (5). In this regard, the allergic asthma phenotype is the most common in childhood and is defined when asthma symptoms and airway eosinophilic inflammation are associated with inhalation of the sensitizing allergen (3).…”

Application of aerosol therapy in respiratory diseases in children: A Saudi expert consensus

“…[ 35 ] Table 5 includes the recommendations for ICS aerosol delivery devices. [ 63 ]…”

“…Nebulizers and pMDIs with VHC are recommended for use with preschool children, and drug delivery with both aerosol devices is similar. [ 63 ] However, longer treatment time and less portability make the nebulizer less desirable than the pMDI when drug administration is PRN (i.e. as needed).…”