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Published on: November 4, 2010
Asthma therapy for children under 5 years of age
Annemie L M Boehmer1, Peter J F M Merkus
1Division of Respiratory Medicine, Department of Paediatrics, Sophia Children's Hospital, Erasmus University and University Hospital, Rotterdam, The Netherlands.
Insights
Current asthma medications for young children
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Wheezing in infants and preschool children presents diagnostic challenges due to uncertain etiology.
- Transient symptoms and spontaneous resolution complicate therapeutic study designs.
- Defining distinct phenotypes and objective outcome measures remains difficult.
Purpose of the Study:
- To review the evidence for the effectiveness of current asthma medications in treating wheeze in young children.
- To explore recent therapeutic approaches and outcome measurements in pediatric wheezing.
Main Methods:
- Review of recent studies on pharmacotherapy for wheezing infants and preschool children.
- Analysis of studies focusing on phenotype definition, inflammation, and airway remodeling.
- Inclusion of studies utilizing lung function parameters and nitric oxide measurements.
Main Results:
- Therapeutic studies are confounded by diagnostic uncertainties and symptom variability.
- Recent research attempts to define homogeneous phenotypes and identify likely responders to medication.
- Lung function and nitric oxide are increasingly used as outcome measures.
Conclusions:
- No current evidence-based guidelines or consensus exist for pharmacological treatment of wheezing in this age group.
- Accurate diagnosis remains a primary challenge.
- Further research is needed on phenotype characterization, diagnostics, and early intervention effectiveness.
Purpose Of Review:
The evidence for effectiveness of currently used asthma medication for wheeze in young children is reviewed.
Recent Findings:
The management of the infant and preschool child with wheezing is complicated by the uncertainty with respect to the aetiology. Difficulties in defining phenotypes and objective outcome parameters combined with the transient nature of symptoms which often resolve spontaneously have confounded many therapeutic studies. Recent studies on the effect of pharmacotherapy in wheezing infants have tried to define a more homogeneous phenotype as well as make a selection of patients that are likely to respond to the studied drug. In addition, these studies have used lung function parameters and nitric oxide as one of the outcome measurements. Studies on the nature of inflammation and the development of airway remodelling in infants and young children are done to further define phenotypes.
Summary:
Currently, there are no evidence-based guidelines and not even consensus statements on the right approach in pharmacological treatment of wheezing in infants and preschool children. The main issue still is the difficulty in coming to a correct diagnosis. Further studies are needed on the nature and the diagnostics of phenotypes and on the effect of early intervention.
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