WHAT’S NEW IN THE MANGEMENT OF CHILDHOOD ASTHMA?
Van
Asperen PP
The
Children’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 “steroid sparing” 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.
References:
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.