Back to Treating Childhood Asthma
An international panel of experts are asked to discuss their own experiences of treating children with asthma, and to respond to the contention by Professor Ulrich Wahn's and colleagues that there be discrete guidelines for managing children with asthma, and that there be more specific research on children with asthma.
The prevalence of asthma among children continues to increase worldwide, even in countries where asthma prevalence appears to be levelling off among adults. Moreover, surveys indicate that asthma control is less than optimal for many children despite existing clinical practice guidelines for asthma.
Childhood asthma guidelines: the key issues
The Paediatric Consensus Working Group Conference on the Management of Paediatric Asthma, co-chaired by Professor Ulrich Wahn of Charité University Hospital Berlin and Dr. Erkka Valovirta of the Turku Allergy Centre in Finland, brought together 36 specialists in childhood asthma from 18 European and Eurasian countries for a 2-day meeting in Berlin, Germany, in September 2005. This expert group identified nine important issues in childhood asthma for further study and consideration for inclusion in future guidelines for childhood asthma:
- Recognition of the different age-related forms (phenotypes) of asthma with multiple triggers, such as the common cold/viruses, allergies, and childhood activities such as play and sport (exercise-induced asthma);
- The pathophysiology, and unique prevailing triggers of childhood asthma as distinct from those of adults with asthma;
- The varying treatment needs of children of different ages and need for flexibility to individualise therapy and manage airway inflammation and symptoms;
- The long-term safety profile and efficacy of currently available treatment options;
- The long-term monitoring of symptoms;
- The diagnosis of co-morbidities and their impact on childhood asthma;
- The importance of patient and physician education and empowerment;
- Diagnostic criteria; and
- Prevention strategies for overcoming potential environmental risk factors.
Professor Wahn explained, "Asthma in children is effectively a different disease from adult asthma. Children have a greater susceptibility to viral and allergic triggers than adults with asthma, and that may require different treatment approaches. It's time that these differences are recognised by the guidelines community."
The IPCRG perspective-experience of practising clinicians
Community and primary care settings are where most asthma is diagnosed and managed. Seeking to define the reality that any new guidance must address, the IPCRG interviewed 11 primary care practitioners and a patient representative to gather their reactions to these nine issues and the conference findings. The telephone interviews followed a structured Discussion Guide. Working in 12 countries on 5 continents, our interviewees painted a varied portrait of childhood asthma care around the world that helps explain much of the difficulty in achieving consistent and optimal asthma care.