Options for bronchodilation in children: can we rely on adult data?

Bronchodilators, especially beta2-agonists, are effective in relieving asthma symptoms. Therefore, short-acting beta2-agonists are recommended in all guidelines on a p.r.n. basis, usually in combination with anti-inflammatory treatment, at least in moderate to severe asthma. Although for adult asthma some concerns have been raised about regular use of short-acting beta2-agonists, studies in children do not suggest that continuous use results in deterioration of asthma. This question is more relevant to the chronic use of the long-acting beta2-agonists, salmeterol and formoterol. These drugs may be used instead of antiinflammatory drugs, especially inhaled corticosteroids. Recent studies in adult asthmatics have supported the use of a long-acting beta2-agonist in combination with a lower dose of inhaled corticosteroid in preference to a higher dose of inhaled corticosteroid. So far, data in children are less convincing for this therapeutic strategy. It may be that differences in the disease process between adults and children are likely to account for these different responses in treatment regimens. Furthermore, it has to be determined whether treatment should primarily aim at symptom reduction or whether other disease parameters should also be taken into account.