[Inhaled corticosteroids: Which regimens are appropriate?].

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Clinical Pharmacy

Background:

• Inhaled corticosteroids (ICS) are foundational in asthma management.
• Current guidelines emphasize continuous ICS treatment, titrated to the lowest effective dose.
• International asthma guidelines show minor variations in ICS regimens.

Purpose of the Study:

• To critically evaluate recent studies on preemptive or "pro re nata" (as needed) ICS regimens in pediatric asthma.
• To assess the implications of these findings for current asthma management practices, particularly in young children.
• To determine if a shift from continuous to discontinuous ICS treatment is warranted for specific pediatric populations.

Main Methods:

• Review and critical analysis of recent research on alternative ICS dosing strategies in children.
• Examination of the inclusion of these alternative regimens in international guidelines, such as GINA 2015.
• Assessment of the evidence supporting the efficacy and safety of preemptive ICS use in infants and children.

Main Results:

• Recent studies indicate potential benefits of "pro re nata" ICS regimens in infants and children.
• GINA 2015 incorporated discontinuous ICS treatment as a second-line option for children aged 5 years and younger.
• The evidence supporting these alternative regimens requires careful consideration.

Conclusions:

• The findings necessitate a critical review of established continuous ICS treatment protocols for pediatric asthma.
• The potential value of "pro re nata" ICS regimens, especially in younger children, warrants further investigation and discussion.
• Clinical practice may need to adapt based on evolving evidence regarding pediatric asthma management strategies.