III. PRACTALL Consensus

 The PRACTALL consensus statement for childhood asthma is just published and is available, together with a pocket guide, on the EAACI website (http://www.eaaci.net/webcasts.htm), plus as a published paper:
Bacharier LB, Boner A, Carlsen KH, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy. 2008;63:5-34 (free text).

This consensus report was prepared by the PRACTALL pediatric group and is based on available published literature (until June 2007) and on best current clinical practice. The PRACTALL initiative is endorsed by both the European Academy of Allergology and Clinical Immunology (EAACI) and the American Academy of Allergy, Asthma and Immunology (AAAAI), which nominated expert teams to formulate consensus for clinical practice in Europe and North America.

The paper includes the natural history & pathophysiology of childhood asthma and recommendations for diagnosis, management, and monitoring. In addition, specific recommendations for use of inhalers as well as management of the following are included:

  1. children 0-2 years
  2. children 3-5 years
  3. acute asthma episodes
  4. exercise-induced asthma
  5. difficult asthma.

What the PRACTALL consensus adds:

  • Complete focus on children (similar to GINA Pediatric Pocket Guide)
  • Breakdown into four age groups: 0-2, 3-5, 6-12, & adolescence
  • A discussion of asthma phenotypes in childhood and the heterogeneity of childhood asthma
  • Emphasis on allergy testing of children with suspected asthma
  • Definition of asthma control for children (adds to that in GINA & US Expert Panel [EPR] 3): “Children (particularly preschool children) may experience 1–2 exacerbations per year and their asthma can be considered controlled provided they have no symptoms outside the exacerbation.”
  • Sample questions for asthma monitoring
  • Exhaled nitric oxide proposed as useful adjunct to routine clinical assessment in asthma management
  • A greater role, as compared with GINA, for leukotriene receptor antagonists (LTRAs), which are listed as an alternative to inhaled corticosteroids (ICS) as first-line treatment for persistent asthma, particularly if the child has concomitant rhinitis (see treatment algorithm below)
  • Research recommendations

2008 PRACTALL childhood asthma guidelines: Algorithm of preventive pharmacologic treatment for asthma in children >2 years of age. Reprinted with permission.


  
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