Van Asperen PP

The Childrení»s Hospital at Westmead, Sydney Australia


There are a number of new medications as well as novel approaches to treatment which are being utilised in the management of children with asthma.  This presentation will focus on two aspects of childhood asthma management which demonstrate how evidence from controlled trials have led to changes in management approach. 

Although evidence for the efficacy of delivering bronchodilators via spacer devices compared to nebulisers in children with acute asthma has been accumulating for some time1, spacers have only recently been incorporated into guidelines for acute asthma management in children.  The comparative evidence for spacer and nebuliser delivery together with the practical issues of implementing guidelines incorporating spacer delivery will be discussed.

There has been considerable debate about the role of inhaled corticosteroids in the management of childhood asthma, with concerns raised about loss of lung function related to delays in commencing treatment at one extreme to concerns about side effects (particularly on growth) at the other.  The recent evidence for efficacy and safety of inhaled corticosteroids2, as well as the role of  í░steroid sparingí▒ medications such as long-acting beta agonists and theophylline, will be presented.  This has allowed a more evidence-based positioning of their use in the management of children with asthma.


1.      Cates CJ, Rowe BH. Holding chamber versus nebuliser for beta-agonist treatment of acute asthma (Cochrane Review) In: Cochrane Library Issue 1 2001. Oxford: Update software.

2.      The Childhood Asthma Management Program Research Group.  Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med 2000; 343: 1054-1063.