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Benefits and Risks of Long-Term Asthma Management in Children: Where Are We Heading?
Hengameh H Raissy1, H William Kelly2
1Department of Pediatrics, MSC10 5590, University of New Mexico, School of Medicine, 1 University of New Mexico, Albuquerque, NM, 87131, USA. HRaissy@salud.unm.edu.
Insights
This review examines asthma medications for children, focusing on inhaled corticosteroids (ICSs) and other controllers. It assesses benefits and risks to guide optimal treatment strategies for managing childhood asthma effectively.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Clinical Practice Guidelines
Background:
- International guidelines recommend stepwise asthma management for children aged 0-4, 5-11, and adolescents.
- Asthma control targets current impairment and future risk.
- Controller medications like inhaled corticosteroids (ICSs) have varying efficacies.
Purpose of the Study:
- To review the benefits and risks of asthma medications in children.
- To guide practitioners in the optimal use of pediatric asthma therapies.
- To assess the systemic activity of ICSs and minimize adverse effects on growth and adrenal function.
Main Methods:
- Review of current international asthma management guidelines.
- Analysis of the efficacy and risk:benefit profiles of long-term controller medications.
- Examination of potential adverse effects of inhaled corticosteroids (ICSs).
- Assessment of dosing strategies, including intermittent therapy.
Main Results:
- Controller medications, including ICSs, ICS/long-acting β2 agonists, leukotriene receptor antagonists, and immunomodulators, differ in their impact on asthma control domains.
- Careful assessment of the risk:benefit ratio is crucial for medication selection.
- Systemic effects of ICSs on growth and adrenal activity require careful monitoring and management strategies.
Conclusions:
- Optimal asthma management in children requires a thorough understanding of medication benefits and risks.
- Minimizing systemic ICS effects through appropriate dosing and monitoring is essential for pediatric asthma care.
- This review aids clinicians in making informed decisions for effective and safe childhood asthma treatment.
Abstract:
International guidelines provide recommendations for a stepwise approach to the management of asthma in children 0-4 years old, 5-11 years old, and adolescents who are treated as adults. Therapy is aimed at two domains of control: current impairment and future risk. The long-term controller medications, inhaled corticosteroids (ICSs), ICSs in combination with long-acting β2 agonists, leukotriene receptor antagonists, and immunomodulators, exhibit different efficacies for these domains. The risk:benefit ratios of the available medications need to be carefully assessed. This review briefly presents the benefits and the potential risks of available asthma medications in children to assist the practitioner in the optimal use of asthma medications. Specifically, the systemic activity of the ICSs and how to minimize their effects on growth and adrenal activity are reviewed as well as other potential adverse effects. Dosing strategies such as intermittent therapy are also assessed.
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