Treatment of asthma in children and adolescents: the need for a different approach

To provide a concise, balanced summary of the principles of management of asthma in children and adolescents.

Current medical literature and the clinical experience considered during the deliberations of the Australian Paediatric Asthma Special Interest Group.

There is evidence of both under-treatment and over-treatment of childhood asthma in Australia. The spectrum of asthma severity is very broad, most children with asthma having mild infrequent episodes that do not require regular preventive therapy. The guidelines presented here provide a framework for accurately assessing the pattern and severity of asthma, identifying those children who require preventive therapy and making a rational decision about the appropriate preventive agent and delivery device.

When prescribing preventive therapy, a careful assessment of the relative risks and benefits should be made in the light of the underlying asthma severity. The level of therapy should be reconsidered regularly to ensure control is maintained with minimum dosages, particularly for inhaled corticosteroids. Recommendations are provided to ensure a normal quality of life for children with asthma, with guidelines to minimise adverse effects of therapy.