Pediatric asthma: Principles and treatment

Abstract

Approximately one-half of children with asthma present with symptoms before 3 years of age. The typical history describes recurrent episodes of wheezing and/or cough triggered by a viral upper respiratory infection (URI), activity, or changes in weather. When symptoms occur after a viral URI, children with asthma often take longer than the usual week to fully recover from their respiratory symptoms. Wheezing and coughing during exercise or during laughing or crying, and episodes triggered in the absence of infection suggest asthma. A trial of bronchodilator medication should show symptomatic improvement. The goal of asthma therapy is to keep children “symptom free” by preventing chronic symptoms, maintaining lung function, and allowing for normal daily activities. Avoidance of triggers identified by a history, such as second-hand cigarette smoke exposure, and allergens identified by skin-prick testing can significantly reduce symptoms. According to the 2007 National Asthma Education and Prevention Program (NAEPP) report, if impairment symptoms are present for >2 days/week or 2 nights/month, then the disease process is characterized as persistent, and, in all age groups, inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy. Montelukast is approved for children ages ≥ 12 months and is often used for its ease of daily oral dosing. Long-acting beta-2 adrenergic agonists should only be used in combination with an ICS. For more-severe or difficult-to-control phenotypes, biologic therapy has been developed, which targets the type of inflammation present.

Influence of Maternal Fish Oil Supplementation on the Risk of Asthma or Wheeze in Children: A Meta-Analysis of Randomized Controlled Trials

“…Asthma and wheeze (asthma/wheeze) is a respiratory syndrome which mainly occurs in early childhood (1)(2)(3). The pathogenesis of asthma/wheeze is complicated, which involves a variety of inflammatory cells and cytokines, leading to chronic airway inflammation, airway hypersensitivity, and bronchial airflow limitation (4,5). According to epidemiological studies, the incidence of asthma/wheeze is increasing in recent decades, which has become an important threat to the health of the global population, particularly for the children and adolescents (1,2).…”

AERD Associated Nasal Polyposis: Efficacy of Postoperative Antileukotriene Therapy in Comparison with Aspirin Desensitization. A Retrospective Study

“…montelukast) inhibit the pro-inflammatory and pro-fibrotic effect of leukotrienes and lead to a symptom relief in chronic respiratory disease, for example Asthma [18]. Antileukotrienes are well known in asthma therapy and constitute, due to minimal side effects, an important option in its therapy (e.g., for children or adolescents [19]). In addition, they seem to be an effective therapy for AERD [20][21][22].…”

Childhood chronic cough made easy: a simplified approach for the primary care setting

“…In this case, a 4-to 8-week treatment with an adequate dose of inhaled corticosteroid (ICS) followed by cessation and reassessment, is recommended. 22 The resolution of cough shortly after the initiation of ICS does not necessarily mean the patient has asthma; as already mentioned, the majority of these children would be spontaneously cough-free within the next weeks. 41 However, the diagnosis of asthma should be seriously considered if the cough recurs after the discontinuation of ICS.…”

“…41 However, the diagnosis of asthma should be seriously considered if the cough recurs after the discontinuation of ICS. 22 If an isolated chronic dry cough does not resolve after 4 weeks of watchful waiting or ICS administration, referral to a tertiary center for specific investigations and management is warranted. 37 raise the possibility of foreign body aspiration, especially in toddlers.…”