Experts Provide New Consensus On Childhood Asthma

New international guidelines from the PRACTALL Pediatric Asthma Group have emphasized the importance of asthma management strategies that are specifically tailored for children. The guidelines, which will be presented on 10 June 2007 at the XXVI Congress of the European Academy of Allergology and Clinical Immunology (EAACI), recommend strategies that include not only pharmacological treatment, but also allergen and trigger avoidance and asthma education. Professor Ulrich Wahn, PRACTALL Chairman and Head of the Department of Paediatric Pneumology and Immunology, at Charité-Humboldt University, Berlin, Germany said: "Children with asthma are fundamentally different from adults with asthma. Their lungs are still developing, their immune systems are immature and they have smaller airways that get obstructed more easily. The new PRACTALL guidelines address these issues and offer clinicians practical recommendations for diagnosis, management and monitoring of asthma in children." The guidelines include a new treatment algorithm for asthmatic children over 2 years of age that recommends either inhaled corticosteroids (ICS) or leukotriene receptor antagonists (LTRAs) as first-line treatment. If the child's asthma is not sufficiently controlled, the ICS dose can be increased or LTRA can be combined with ICS. Treatment can be stepped up further to achieve control by adjusting ICS doses and adding other medications, such as long-acting β2 agonists. The guidelines recommend that treatment should subsequently be stepped down to the lowest dose at which good control can be maintained. Treatment of children 2 years of age and under is addressed in a separate section in the new guidelines. Professor Wahn commented: "The 0-2 year age group is the most difficult to diagnose and treat because so few studies have been done. Persistent asthma often begins at this age and any changes in lung structure and function that occur will likely have a major effect on asthma status throughout childhood." In addition to pharmacological treatment, the guidelines recommend that children avoid allergens and other potential triggers of an asthma attack. These include pets, house-dust mites, food allergens and, most importantly, passive tobacco smoke. Although exercise will trigger an asthma attack in many asthmatic children, the guidelines highlight the need for children to be well controlled so that they can participate fully in exercise and sporting activity. Education should be a key aspect of the asthma management strategy. Ideally, the guidelines recommend a three-tier education program that considers disease severity, stage of development, and the need for information. Education should target not only children, but also parents, caregivers and healthcare professionals including primary care physicians, nurses and pharmacists. Professor Wahn commented: "A good asthma education programme should increase knowledge of the disease, allay any fears about medication and increase communication between children, caregivers and healthcare providers. Parents need to be aware of the benefits as well as the potential risks of all therapies so that they can make informed choices for their children." The new PRACTALL guidelines were developed to address the lack of up-to-date international guidelines that focus exclusively on paediatric asthma. They were developed by the PRACTALL Paediatric Asthma Group, which consists of approximately 40 international experts in paediatric allergy and asthma. The guidelines are part of the PRACTALL initiative, which is endorsed by EAACI and the American Academy of Allergy, Asthma and Immunology (AAAAI). They will be published in both Europe and North America in future issues of journals published by the two academies.

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