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Updated: Apr 26, 2026
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
[Dutch College of General Practitioners' practice guideline 'Asthma in children']
Patrick J E Bindels1, Erik-Jonas van de Griendt, Mariska K Tuut
1Huisartsenpraktijk Buitenhof, Amsterdam.
Insights
Diagnosing and managing childhood asthma requires age-specific strategies. Early intervention with short-acting beta-agonists (SABAs) and inhaled corticosteroids (ICS) can help achieve asthma control in children.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Allergy and Immunology
Background:
- Diagnosing asthma in young children (< 6 years) is challenging due to atypical symptom patterns, often leading to the diagnosis of 'episodic expiratory wheezing'.
- In older children (≥ 6 years), asthma diagnosis relies on symptoms, with spirometry used for confirmation when necessary.
- Complete asthma control is the treatment objective, defined by specific symptom frequency, activity levels, rescue medication use, and normal spirometry.
Purpose of the Study:
- To outline age-appropriate diagnostic criteria for asthma in children.
- To provide guidance on asthma management strategies tailored to different pediatric age groups.
- To define goals for achieving complete asthma control and criteria for referral.
Main Methods:
- Review of current diagnostic approaches for childhood asthma based on age.
- Recommendations for pharmacologic interventions, including short-acting beta-agonists (SABAs) and inhaled corticosteroids (ICS), stratified by age.
- Guidelines for monitoring treatment effectiveness and determining the need for specialist referral.
Main Results:
- For children < 1 year, a monitored trial of SABA is advised; ICS are not recommended.
- In children aged 1–6 years, SABA is the initial treatment, with ICS added if symptoms persist.
- For children ≥ 6 years, ICS are recommended for incompletely controlled asthma, with referral if control is not achieved with standard ICS dosages.
Conclusions:
- Age-specific approaches are crucial for accurate asthma diagnosis and effective management in children.
- Early and appropriate use of SABAs and ICS, guided by symptom control, is essential for managing childhood asthma.
- Regular monitoring and timely referral are key components of optimal asthma care in pediatric patients.
Abstract:
In children < 6 years characteristic asthma patterns are often lacking and the diagnosis cannot be objectified. For this reason 'episodic expiratory wheezing' is the preferred diagnosis. In children ≥ 6 years asthma is diagnosed on the basis of symptoms; if there is doubt spirometry may be helpful. The treatment goal is complete asthma control, i.e. daytime symptoms < 2/week, no nocturnal symptoms, no limitation of activities, rescue treatment ≤ 2/week, normal spirometry. Smoking by children or relatives is strongly discouraged. In children < 1 year, a monitored trial with short-acting beta-agonist (SABA) is recommended. Controller medication (inhaled corticosteroids (ICS)) is not recommended. In children aged 1 to 6 years, a SABA is recommended, with additional ICS if symptoms persist. Incompletely controlled asthma is an indication for referral. In children ≥ 6 years ICS are recommended in incomplete asthma control. If the normal daily dosage of ICS and adequate coping fail to achieve complete control of the asthma, then referral is recommended. Patients on ICS should be monitored regularly.
