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Current management of allergic asthma in children
1Pediatric Allergy and Respiratory Pathophysiology Unit, V. Buzzi Children's Hospital, Istituti Clinici di Perfezionamento Milan, Italy. gualtiero.leo@icp.mi.it
Insights
Childhood asthma management focuses on controlling symptoms with inhaled corticosteroids (ICS) and other therapies. Low-dose ICS are effective and safe for mild persistent asthma, with immunotherapy options for allergic triggers.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Childhood asthma involves recurrent symptoms like wheezing and cough, linked to inflammation and airflow obstruction.
- Allergic sensitization, especially allergic rhinitis, is a significant risk factor for pediatric asthma.
- Effective asthma management aims to control clinical manifestations through medication, education, and allergen-specific strategies.
Purpose of the Study:
- To outline current management strategies for pediatric asthma.
- To discuss the role of inhaled corticosteroids (ICS) and other controller medications.
- To review allergen avoidance and specific immunotherapy options for allergic asthma in children.
Main Methods:
- Review of asthma pathophysiology and clinical presentation in children.
- Analysis of drug classifications: controllers (ICS, leukotriene receptor antagonists) and relievers (bronchodilators).
- Evaluation of evidence for inhaled corticosteroids (ICS) efficacy, dosing, and safety.
- Consideration of specific immunotherapy (subcutaneous and sublingual) for allergic asthma.
Main Results:
- Inhaled corticosteroids (ICS) are the most effective anti-inflammatory controllers for persistent childhood asthma.
- Low doses of ICS demonstrate significant clinical and lung function improvements with good safety in mild asthma.
- If initial low-dose ICS are insufficient, dose escalation or additional therapies (leukotriene receptor antagonists, long-acting beta-agonists) are recommended.
- Specific immunotherapy, particularly sublingual immunotherapy, offers a safer and more accepted alternative for allergic asthma.
Conclusions:
- Low-dose inhaled corticosteroids (ICS) are the cornerstone of persistent asthma management in children.
- Treatment adjustments, including increased ICS dosage or combination therapy, are indicated for suboptimal response.
- Specific immunotherapy is a valuable option for children with aeroallergen-induced asthma, with sublingual administration preferred for safety and adherence.
Abstract:
Asthma in children is characterized by recurring symptoms such as wheezing, breathlessness, and cough, by airflow obstruction and bronchial hyperresponsiveness, and by underlying inflammation. The presence of allergic sensitization, and allergic rhinitis in particular, is strongly associated with asthma. The goal of management of asthma is to achieve and maintain control of the clinical manifestations of the disease. This can be obtained by drug treatment, education of patients and care givers, and, in allergic asthma, by allergen avoidance and specific immunotherapy. The drugs used in asthma can be classified as controllers - such as inhaled corticosteroids (ICS) and leukotriene receptor antagonists - or relievers (bronchodilators to be used during acute exacerbations of asthma). ICS are the most effective anti-inflammatory controllers for the management of persistent asthma in children of all ages, but there is no consensus about the optimal starting dose. Dose-response studies reported marked and rapid improvement in clinical symptoms and lung function at low doses of ICS, and mild asthma is well controlled by such doses in most children, this ensuring good safety. If there is no improvement with the initial low dose of ICS, an increased ICS dose or additional therapy with leukotriene receptor antagonists or long-acting inhaled β2-agonists should be considered. When asthma is caused by allergy to aeroallergens, specific immunotherapy must be taken into account, in its two forms of subcutaneous or sublingual immunotherapy. The former has complete evidence of efficacy, but the sublingual route is safer and more easily accepted by children.
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