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Maintenance Therapy for Children and Adolescents with Asthma: Guidelines and Recommendations from the Emilia-Romagna
Valentina Fainardi1, Carlo Caffarelli1, Michela Deolmi1
1Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Insights
Pediatric asthma management requires personalized treatment plans based on severity, phenotype, and individual factors. Further research is needed for tailored therapies in young children, as current guidelines often extrapolate from adult studies.
Area of Science:
- Pediatric Pulmonology
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- Asthma is a leading chronic childhood illness, impacting up to 20% globally.
- Current pediatric asthma maintenance therapy guidelines offer varied approaches and staging.
- A need exists for updated evidence synthesis on pediatric asthma treatment.
Purpose of the Study:
- To summarize the latest evidence on maintenance therapy for pediatric asthma.
- To address key clinical questions concerning asthma treatment in children and adolescents.
- To develop expert-driven recommendations for pediatric asthma management.
Main Methods:
- A multidisciplinary expert panel addressed 10 clinical questions.
- Searches included electronic databases and gray literature from the past 25 years.
- Recommendations formulated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology.
Main Results:
- Medication choice is influenced by asthma severity, phenotype, age, and individual patient factors.
- Effective asthma control necessitates identifying comorbidities and modifiable risk factors.
- Pediatric asthma is recognized as a heterogeneous condition with variable progression.
Conclusions:
- Asthma treatment in children demands a personalized approach beyond general guidelines.
- Current pediatric asthma recommendations often rely on adult-derived data.
- There is a critical need for pediatric-specific clinical trials in asthma management.
Abstract:
Asthma is the most frequent chronic disease of childhood, affecting up to 20% of children worldwide. The main guidelines on asthma maintenance therapy in pediatrics suggest different approaches and describe different stages of asthma to determine the most appropriate treatment. This project aims to summarize the most recent evidence regarding maintenance therapy for asthma in children and adolescents. A multidisciplinary panel of experts was asked clinical questions regarding the treatment of children and adolescents with asthma. Overall, 10 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results showed that the choice of medication depends on the severity of the child's asthma, phenotype, age, preference, and individual factors. In addition to medications, the identification of comorbidities and modifiable factors is crucial to obtaining good control. Asthma in children is heterogeneous, and its evolution varies over time. Since most recommendations for asthma management in childhood are extrapolated from clinical studies performed in adults, more clinical trials specifically designed for young children should be conducted.
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