Choosing therapy for childhood asthma

Inhaled corticosteroids remain the primary long-term treatment for controlling childhood asthma. Sodium cromoglycate (cromolyn sodium) and nedocromil sodium are both well tolerated, but usually less effective, alternatives to corticosteroids. Long-acting beta(2)-agonists (beta(2)-adrenoceptor agonists) may be useful adjuncts in patients already receiving inhaled corticosteroids who require frequent use of short-acting bronchodilators or experience nocturnal exacerbations (i.e. overall asthma control suboptimal). Theophylline has bronchodilator and anti-inflammatory effects and may also be used as an adjunct to inhaled corticosteroids. Leukotriene receptor antagonists are now an alternative as monotherapy in young children with mild persistent asthma, or as adjunctive therapy with inhaled corticosteroids as well. Short-acting inhaled beta(2)-agonists or other short-acting bronchodilators should be used as needed for acute episodes. For inhaled delivery, metered-dose inhalers with spacer devices (holding chambers) may be used as the delivery system in many patients, but the choice of inhalation method must be individualised, based largely on patient acceptance and compliance. Systemic corticosteroids may be used to gain prompt control when initiating long-term therapy in patients with severe, persistent asthma that does not respond to inhaled medication or in patients who are unable to take inhaled medication. The anti-immunoglobulin E antibody, omalizumab, is a novel therapy that attacks a fundamental immunopathological process of asthma and has shown promising results in several clinical trials.