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Updates in the treatment of asthma in pediatrics: A review for pharmacists
Tara Smith1, Kimberly Mills2, M Petrea Cober3
1HCA Florida West Healthcare, Pensacola, FL, USA.
Insights
Pediatric asthma management is evolving, with guidelines from NAEPP and GINA offering stepwise approaches. This review highlights treatment gaps and emerging therapies for children, including biologics.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Guidelines
Background:
- Asthma is a prevalent chronic respiratory condition in children, necessitating individualized management strategies.
- Current asthma guidelines, including the National Asthma Education and Prevention Program (NAEPP) and the Global Initiative for Asthma (GINA), provide frameworks for diagnosis, assessment, and treatment.
- Recent updates from NAEPP (2020) and GINA (2023) offer distinct, stepwise approaches to asthma management in both adults and children.
Approach:
- This review synthesizes current literature on pediatric asthma management, focusing on guideline-based approaches.
- It critically examines key differences and identifies gaps within existing NAEPP and GINA guidelines.
- The review also explores treatment considerations for children under five and discusses emerging therapies, such as biologics, for difficult-to-treat cases.
Key Points:
- Gaps in current guidelines include the use of bronchodilators and inhaled corticosteroids with single maintenance and reliever therapy, and long-acting muscarinic antagonists in pediatric asthma.
- Evidence-based treatment recommendations for children under five years of age are limited.
- Emerging biologic agents offer new possibilities for managing severe or difficult-to-treat pediatric asthma.
Conclusions:
- Pediatric asthma management is increasingly patient-specific, with evolving treatment strategies and novel therapeutic agents.
- Pharmacists are integral to educating patients and caregivers, dispensing medications, and recommending evidence-based treatments for pediatric asthma.
- Addressing guideline gaps and exploring new treatments are crucial for optimizing outcomes in children with asthma.
Purpose:
The purpose of this review is to summarize the management of asthma in children and to highlight different guideline-based approaches. This review also discusses literature regarding the use of corticosteroids, both inhaled and systemic, as well as biologic agents, in asthma management.
Summary:
Asthma is a common chronic respiratory condition in the pediatric population and has evolved into a highly patient-specific disease. Of the 2 main asthma guidelines, one developed by the National Asthma Education and Prevention Program was recently published as a focused update in 2020. The other, from the Global Initiative for Asthma, focuses on a global strategy for management and prevention, with the most recent update in 2023. Both reports discuss diagnosis, assessment, and treatment of asthma in adults and children. Treatment is designed as a stepwise approach in both reports, although there are key differences. This article focuses on gaps in these guidelines, including the use of bronchodilators and inhaled corticosteroids with single maintenance and reliever therapy and long-acting muscarinic antagonists in children. It also reviews treatment in children under 5 years of age, although recommendations are limited due to a lack of evidence in this age group. Finally, this review discusses considerations for emerging treatments, including biologics, for patients who are difficult to treat.
Conclusion:
New treatment strategies and agents have emerged in the treatment of pediatric asthma. Pharmacists play a key role in providing education about, dispensing, and recommending the newest evidence-based treatment options for children.
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