Special considerations in pediatric asthma

Asthma is the most common chronic illness in childhood with challenges that revolve around interventions that can potentially alter the course of the disease and concerns regarding the safety of regular use of controller medications. Recent studies suggest that the use of inhaled corticosteroids in very young children with frequent wheezing episodes and at high risk for asthma, while effective, does not alter the eventual progression to asthma. As a controller medication, the safety of inhaled corticosteroids as regards efficacy and risk are reviewed. The use of as-needed ICS as a strategy to reduce risk of adverse events can be explored in children with mild persistent asthma. The key to risk reduction is to titrate the dose of steroids to the lowest dose needed to achieve asthma control. Aside from inhaled corticosteroids, other controller medications are described within the framework of the updated asthma guidelines released by the NIH-National Asthma Education and Prevention Program in 2007. Other interventions that may attenuate asthma risk and severity include environmental measures towards allergen avoidance and attention to the increasing prevalence of obesity. The use of age-appropriate delivery systems for inhaled medications is also important for asthma control.