Current concepts in asthma treatment in children

Current concepts in asthma treatment in children
Stanley J. Szefler

Purpose of review The purpose of this review is to present current literature related to the management of childhood asthma. Recent findings Persistent asthma is now considered an inflammatory airways disease. Inhaled corticosteroids are recognized as the preferred long-term control medication. New classes of medications havebeen introduced during the last 5 years, including leukotriene modifiers, long-acting -adrenergic agonists, combination inhaled corticosteroids with long-acting -adrenergic agonists, and anti-IgE. Research is also being directed to understand the early onset of asthma. Summary Management of childhood asthma is now being directed to early recognition and early intervention. Recent updates in theasthma guidelines prompt clinicians to consider intervention with antiinflammatory therapy, preferably inhaled corticosteroids, in children who have frequent asthma exacerbations and a risk profile for persistent asthma. In children with persistent asthma, inhaled corticosteroids are recognized as the preferred antiinflammatory therapy. Health care systems that have adapted this approach haverecognized the benefits of reduced hospitalizations and urgent care visits. Continued research is needed to identify asthma at a very early stage so that interventions can be directed to interrupting the development of this disease. Keywords childhood asthma, asthma pharmacotherapy, corticosteroids, leukotriene receptor antagonists, immunomodulators
Curr Opin Pediatr 16:299–304. © 2004 by LippincottWilliams & Wilkins.

Introduction
Asthma management has advanced considerably during the last 20 years. This era of rapid development began with the recognition of an increasing trend in asthma mortality despite effective treatments. Once this concerning trend was identified, opinion leaders gathered to develop guidelines for asthma management to consolidate available information, assimilate keymessages, and recommend treatment strategies. Key messages that have emerged include chronic inflammation as a core feature of the pathogenesis of asthma and the benefits of inhaled corticosteroids (ICS) as a long-term control agent for the management of persistent asthma even in young children. The recent update to the national asthma guidelines [1] paid special attention to the topic of earlyintervention in young children and proposed that longterm control therapy also be considered for children with frequent episodes of asthma and a risk profile for persistent asthma. During the past year a number of publications have contributed information related to the management of asthma as well as the origins of asthma.

New developments in asthma management
The trend of increasing asthmamortality and morbidity has fortunately reached a plateau in recent years [2]. Recent trends in asthma management have prompted a more proactive approach to encourage clinicians to identify patients at risk for developing persistent asthma and to intervene earlier with long-term control therapy. Research is now directed to develop interventions that could effectively alter the natural history ofasthma and reduce deleterious outcomes related to asthma. ICS are now recognized as the preferred long-term control medication for managing persistent asthma even in children younger than 5 years of age [1,3,4]. New medications and delivery systems have been introduced to facilitate early intervention for asthma in young children including a nebulized inhaled corticosteroid and a leukotriene receptorantagonist for asthma therapy [5,6]. These initiatives have now made it possible to intervene at a very early age and thus improve the overall management of childhood asthma [7]. Therefore, current methods applied in the management of childhood asthma include early diagnosis and early intervention with either environmental control in allergen-sensitized patients or the use of long-term control...