Diagnosis and management of asthma in children

The bottom line

• In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment

• If diagnostic doubt still exists, including a failure to respond adequately to a low to medium dose of inhaled corticosteroids, referral should be made to a specialist team

• Asthma is a disease that kills, even in children with “mild” asthma, and care must be seen in that context

• Any emergency visit to hospital, regardless of whether admission occurs, is a marker of future risk, and should prompt a focused and urgent review of what trigger factors led to the attack and whether the attack was appropriately managed

• Non-adherence to treatment, overuse of bronchodilators, and underuse of inhaled corticosteroids are common problems that should be routinely tackled

• Failure of annual asthma review is a factor in asthma related deaths and for children a review should be routine at least every three months; these should be conducted by doctors or nurses with training in asthma and not seen as “tick box” exercises

• When specialist services are also involved, good communication is essential; this is particularly true after an acute asthma attack

Sources and selection criteria

We performed a search of PubMed using the terms “asthma” or “wheeze”, with the filters “clinical trial”, “published in the last 5 …