Clinical Review

Management of asthma in children

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39255.692222.AE (Published 02 August 2007) Cite this as: BMJ 2007;335:253

This article has a correction. Please see:

  1. J Townshend, registrar in respiratory paediatrics,
  2. S Hails, paediatric respiratory nurse specialist,
  3. M Mckean, consultant in respiratory paediatrics
  1. Paediatric Respiratory Unit, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP
  1. Correspondence to: M Mckeanm.c.mckean{at}ncl.ac.uk
  • Accepted 19 June 2007

Summary points

  • Inhaled corticosteroids, although safe if given at the recommended dose, can have important adverse effects if given above it, including adrenal suppression

  • Long acting β2 antagonists can be used as add-on treatment to avoid further increases in the dose of inhaled corticosteroid but can be associated with increased risk of exacerbations and hospital admission

  • Long acting β2 antagonists should therefore be continued only if a demonstrable response to treatment occurs

  • Inhaled corticosteroids do not prevent the development of asthma

  • Low dose inhaled corticosteroid should not be used as preventive treatment for episodic viral wheeze

  • Referral to a specialist centre should be considered when a child reaches step 4 of the British Thoracic Society/Scottish Intercollegiate Guidelines Network guideline or earlier, depending on the expertise of the general practitioner and the resources available

This review on childhood asthma focuses on acute and chronic management in relation to the asthma phenotypes reviewed in our previous article.1 It includes when to refer to hospital services and updates on new and emerging treatments.

Managing asthma requires not only an understanding of specific treatments but also a commitment to supporting the child and family as they learn to deal with this long term illness. Key areas of management include acute asthma management plans, day to day “preventer” treatments, monitoring for side effects, and an emphasis on trying to achieve a normal level of functioning. For young children and those with atypical features, repeated review also provides an opportunity to revisit the diagnosis.

Searches and selection criteria

This review draws on the chapter on asthma and other wheezing disorders in children in Clinical Evidence, search date October 2006. We searched Medline in January 2007 with the terms asthma, viral induced wheeze, childhood, prevalence, symptoms, diagnosis, management, corticosteroids, and adrenal suppression. We also used the British Thoracic Society/Scottish …

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