|
.................................... Search the net .................................... |
Paediatric Pulmonology and Allergology
2008 April, Vol. XI, No. 1 (3766-3774)
CURRENT VIEW ON ASTHMA TREATMENT IN CHILDREN – BACK TO ANTIINFLAMMATORY THERAPY?
Dalia Steponaviciene1, Arunas Valiulis2
1Kaunas 2nd Clinical Hospital, Dept of Paediatric Pulmonology, 2Vilnius City University Hospital, Dept of Paediatric Pulmonology, Antakalnio Str. 57, LT-10207 Vilnius, Lithuania
The review article focusses on various aspects of the treatment of paediatric asthma and current controversial issues of efficacy and safety of long term treatment. Inhaled glucocorticosteroids are effective anti-inflammatory medications for the treatment of persistent asthma, but balance between safety and efficacy is doubtful. Clinical studies are demonstrated efficacy of inhaled glucocorticosteroids in reducing asthma symptoms, improving quality of life, improving lung function, decreasing airway hyperresponsiveness, controling airway inflammation, reducing frequency and severity of exacerbations. Inhaled glucocorticosteroids are effective controller therapy for persistent paediatric asthma. The clinical benefits of inhaled glucocorticosteroids for children with intermittent, virus-induced wheezing remain controversial. There is no evidence to support the use of maintenance low-dose inhaled glucocorticosteroids for preventing of wheezing in children of first 2–3 years of age. The studies evaluating the systemic effects of inhaled glucocorticosteroids are disscussed in this article. Leukotriene modifiers provide clinical benefit in children at all steps of severity, including intermittent asthma. Leukotriene modifiers provide protection against exercise-induced bronchoconstriction. As add-on treatment in children whose asthma is insufficiently controlled by low-to-high dose of inhaled glucocorticosteroids, leukotriene modifiers provide moderate clinical improvements, including a significant reduction in exacerbations. The article analyses aspects of different response to anti-inflammatory therapy in preschool children as well as treatment alternatives of overuse of long acting β2-agonists in moderate-to-severe asthma.