[Guideline "Treatment of asthma in children": 3 controversial approaches to treatment]

Area of Science:

• Pediatric Pulmonology
• Evidence-Based Medicine
• Clinical Guideline Development

Background:

• Asthma management in children presents treatment controversies.
• Developing evidence-based guidelines requires rigorous evaluation of available evidence.

Purpose of the Study:

• To systematically review and assess evidence for key controversies in pediatric asthma treatment.
• To formulate recommendations based on the GRADE approach for Dutch Paediatric Society guidelines.

Main Methods:

• Systematic literature review of three major asthma treatment controversies in children.
• Quality assessment of evidence using the GRADE framework.
• Development of recommendations considering the strength of evidence.

Main Results:

• Low quality of evidence necessitates cautious recommendations.
• Inhaled corticosteroids (ICS) are recommended for young children with severe/recurrent wheezing.
• Leukotriene receptor antagonists (LTRA) are an alternative for poor inhalation technique; ultrafine particle ICS not first-line.
• For uncontrolled asthma on ICS, dose increase is advised after excluding environmental factors; combination therapy with long-acting bronchodilators for older children (4-6 years).

Conclusions:

• Despite low evidence quality, clear, albeit weak, recommendations for pediatric asthma management were established.
• The GRADE approach facilitated transparent decision-making for guideline development.
• Recommendations provide a framework for optimizing asthma control in children based on current evidence.