Chapter 10: Pediatric asthma: principles and treatment

Approximately one-half of children with asthma present with symptoms before 3 years of age. The typical history describes recurrent episodes of wheezing and/or cough triggered by a viral upper respiratory infection, activity, or changes in weather or seasons. When symptoms occur after a viral respiratory infection, children with asthma often take longer than the usual week to recover fully from their respiratory symptoms. Wheezing and coughing during exercise or during laughing or crying and episodes triggered in the absence of infection suggest asthma. A trial of bronchodilator medication should show symptomatic improvement. The goal of asthma therapy is to keep children "symptom free" by preventing chronic symptoms, maintaining lung function, and allowing for normal daily activities. Avoidance of triggers identified by history, such as second-hand cigarette smoke exposure and allergens identified by skin-prick testing, can significantly reduce symptoms. According to the National Asthma Education and Prevention Program 2007 report (Expert Panel Report 3 [EPR-3]. Guidelines for the diagnosis and management of asthma: Summary report 2007. J Allergy Clin Immunol 120:S94-S138, 2007.), if impairment symptoms are present >2 days/week or 2 nights/mo, the disease process is characterized as persistent, and in all age groupings, inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy. Other controller medications such as cromolyn must be given three to four times a day and provides less efficacy than ICS. Montelukast is approved for children ≥12 months old and is often used for its ease of daily oral dosing. Long-acting beta(2)-adrenergic agonists should not be used as monotherapy (i.e., should only be used with ICS).