Management

Modern guidelines for treating childhood asthma distinguish between controlling and relieving treatment. Among the controlling treatments, inhaled corticosteroids are the most important drugs and enable most children and adolescents with asthma to lead a normal life. In most cases, inhaled corticosteroids also control exercise-induced asthma, allowing participation in physical activity and sports. High doses of inhaled steroids may impair growth but only to a small extent (1–2 cm in height at most), and usually in the early phase of treatment. Adrenal suppression can occur with high doses, and hypoglycaemic convulsions have been reported. Recently, an inhaled corticosteroid has been introduced as a pro-drug, which depends for its effect on enzymatic activation in the respiratory epithelium. The lack of systemic side-effects makes such agents particularly suitable for childhood asthma.

Inhaled β2-agonists are important reliever medication, for both acute and chronic asthma. Combination treatment consisting of an inhaled corticosteroid and an inhaled long-acting β2-agonist has proved to be very effective in adult asthma care, but in childhood asthma and especially in pre-school children, the treatment response has not been as good. Children should be monitored carefully to assess the response to treatment, and treatment that proves to be ineffective should be stopped. This also applies to leukotriene antagonists, which are remarkably effective in some patients, both as controller and reliever treatment, but there is a high percentage of non-responders. Anticholinergic therapy, in particular ipratropium bromide, is also effective as a bronchodilator in children and may have an additive effect to inhaled β2-agonists. Anticholinergic treatment seems to have a special place as pre-medication before exercise in children with exercise-induced asthma and in treatment of asthmatic adolescents with an athletic career. The anti-immunoglobulin (Ig)E monoclonal antibody omalizumab has proved effective for some patients with severe allergic asthma, but, again, some fail to respond, emphasising the need for careful follow-up. Other novel treatments are currently being investigated.

Asthma care involves much more than just pharmacological treatment, although this is a very important part of the treatment plan. Participation in physical activity is of prime importance in childhood asthma and should be encouraged.

See the entire Childhood asthma Chapter