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Pharmaceutical treatment of asthma in children
1Voksentoppen BKL, Rikshospitalet University Hospital, Ullveien 14, N-0791 Oslo, Norway. k.h.carlsen@medisin.uio.no
Insights
This review examines current childhood asthma treatments, focusing on inhaled steroid timing, side effects, and leukotriene antagonists. It also addresses asthma prevention and managing coexisting conditions like allergic rhinitis.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Current asthma treatment guidelines primarily focus on adults, with limited specific recommendations for childhood asthma.
- Existing pediatric guidelines, such as British/Scottish and Nordic, offer some specific advice on managing asthma in children.
- Key controversies include the optimal timing for initiating inhaled corticosteroids (ICS) and their impact on lung development and potential side effects.
Purpose of the Study:
- To provide a comprehensive overview of current childhood asthma treatment modalities.
- To discuss existing controversies and gaps in pediatric asthma management guidelines.
- To explore the role of inhaled steroids, leukotriene antagonists, asthma prevention strategies, and management of comorbid conditions.
Main Methods:
- Review of existing literature and current treatment guidelines for childhood asthma.
- Analysis of controversies surrounding the early use of inhaled corticosteroids and their potential impact on growth and the hypothalamic-adrenal axis.
- Discussion of the place of leukotriene antagonists and the continuum of respiratory health, including allergic rhinitis.
Main Results:
- Significant debate exists regarding the early initiation of inhaled steroids in children and their long-term effects.
- The efficacy and safety profile of leukotriene antagonists in pediatric asthma require further clarification.
- Asthma prevention strategies (primary, secondary, tertiary) and management of exercise-induced asthma and comorbid allergic rhinitis are crucial aspects of holistic care.
Conclusions:
- There is a need for more specific guidelines for childhood asthma management, particularly concerning the early use of inhaled corticosteroids.
- Further research is required to understand the long-term effects of inhaled steroids and the optimal role of alternative therapies like leukotriene antagonists.
- Addressing compliance, exercise-induced asthma, and comorbid conditions is essential for effective asthma management in children.
Abstract:
The present review article gives an overview of the present treatment modalities of asthma during childhood and discusses the existing controversies in asthma treatment. Present guidelines of asthma treatment concentrate on treatment for adults and only marginally concern treatment of childhood asthma. The few exceptions are the British Scottish guidelines and the Nordic guidelines, which have separate paragraphs on paediatric asthma management. The main controversy in paediatric asthma treatment is that how early (in age) and how soon (after diagnosis of asthma has been established) should inhaled steroids be instituted. Does treatment with early inhaled steroids influence lung development? Also possible side effects of inhaled steroids as possible impact upon growth and effect upon the hypothalamic adrenal axis are discussed. What is the place of leukotriene antagonists in childhood asthma treatment? Other issues discussed are prevention of asthma (primary, secondary and tertiary) in relationship to treatment of asthma. Primary prevention regards preventive measures to be taken to prevent initial allergic diseases; secondary prevention aims at preventing development of further allergic disease after the initial allergic disorder, as preventing debut of asthma after atopic eczema. Tertiary prevention aims at reducing already existing allergic illness and preventing further progression. For asthma, tertiary prevention regards treatment. During later years, there has been a focus on the respiratory tract as a continuum, and how allergic rhinitis and asthma should be treated when they are coexistent. Treating exercise induced asthma optimally is regarded as an important aim in the general treatment of asthma in childhood. Particularly in childhood asthma, compliance (concordance) with treatment is an important issue. Also some controversial aspects of acute asthma treatment in young children are discussed.
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