Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

New Evidence-Based Guidelines Focus on Treatment of Children With Asthma

New Evidence-Based Guidelines Focus on Treatment of Children With Asthma While asthma is the most common chronic childhood disease in industrialized countries, evidence-based guidelines generated through consensus of experts and specifically focused on treating children with the condition have been lacking—until now. The first international guidelines specifically targeting pediatric asthma, published in January, were developed by about 40 international experts in pediatric allergy and asthma and have been endorsed by the American Academy of Allergy, Asthma, and Immunology and the European Academy of Allergology and Clinical Immunology (Bacharier LB et al. Allergy. 2008;63[1]:5-34). The guidelines come at an opportune time. In the United States, where more than 5 million children and adolescents younger than 18 years have asthma, prevalence of the disorder has increased from 3.6% of all children in 1980 to 8.9% in 2005. Low-income populations, minorities, and children living in inner cities experience disproportionately higher morbidity and mortality due to asthma. Guidelines gap Leonard B. Bacharier, MD, associate professor of pediatrics at the Washington University School of Medicine, in St Louis, and a coauthor of the consensus report, said the document was needed because existing asthma treatment guidelines, such as the National Asthma Education and Prevention Program and the Global Strategy for Asthma Management and Prevention 2006, focused on all age ranges and were not specifically written for children. “If you look at the current literature on treatment guidelines, there's an extreme paucity of data for pediatrics,” Bacharier said. “So we needed some form of direction for physicians to manage children.” Prior pediatric asthma guidelines were created from unsystematically compiled opinions of experts, the report authors noted. Bacharier said the consensus report writers based the new guidelines on the most rigorous clinical trials available. “We tried very hard to make these recommendations evidence-based and tried to avoid expert opinion as the basis for recommendations.” The cornerstone of the pediatric asthma guidelines is a treatment algorithm that stresses disease control for children older than 2 years. The algorithm recommends starting a child on either inhaled corticosteroids or leukotriene receptor antagonists to gain control of the disease before instituting management therapy. If control of the asthma is not achieved, the algorithm indicates that a physician should increase the dosage of inhaled corticosteroids, try combinations of the medications, or add other drugs to the regimen, such as long-acting β2-agonists. The report also offers specific guidance on treating acute asthma episodes. The evidence for the guidelines' recommendations has less rigor in children aged 2 years or younger. “We have very little data to guide the treatment of asthma in young children,” Bacharier said. “We do not have a good idea of identifying which patients respond best to certain therapies. We rely on data on older children.” To that end, the consensus report, while noting conflicting evidence, recommends intermittent β2-agonists as the initial medications of choice when treating asthma in children aged 2 years or younger. Maintenance therapy Another area in which the evidence is limited concerns maintenance therapy after a child's asthma is brought under control, said Bacharier. “What do we do when kids are doing well? What are the indications for reducing medication levels to allow the patient to maintain disease control?” he asked. The report recommends that once a patient's asthma is controlled, the physician should then reduce medication levels in a step-down process to the lowest dose at which good control can be maintained. Beyond the algorithm, the consensus report discusses causes of childhood asthma and techniques for making a diagnosis, determining whether the asthma is caused by a virus, exercise, allergen, or unknown source. The report then suggests strategies for helping susceptible children avoid allergens and other triggers that produce asthma episodes. Also recommended is asthma education for children, parents, clinicians, public health officials, and government leaders. For parents of children younger than 5 years, the primary education focus should be on the use of inhaler devices and strategies for managing asthma episodes. Education for children aged 5 to 13 years should involve teaching both the patient and parent about asthma drugs and how they work, using colors and symbols to depict different types of medications. Adolescent patients should be directly engaged in all aspects of managing their condition to ensure optimal outcomes. Throughout the report, the authors call for research in areas that need more rigorous study. Still, Bacharier said, the document should provide physicians a working template for treating pediatric asthma. “We did not try to generate an exhaustive document, but rather, one that is practical,” he said. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

New Evidence-Based Guidelines Focus on Treatment of Children With Asthma

Mitka, Mike
JAMA , Volume 299 (10) – Mar 12, 2008
Download PDF
2 pages

Loading next page...
 
/lp/american-medical-association/new-evidence-based-guidelines-focus-on-treatment-of-children-with-dXIPQpXMT6

References (0)

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.299.10.1122
Publisher site
See Article on Publisher Site

Abstract

While asthma is the most common chronic childhood disease in industrialized countries, evidence-based guidelines generated through consensus of experts and specifically focused on treating children with the condition have been lacking—until now. The first international guidelines specifically targeting pediatric asthma, published in January, were developed by about 40 international experts in pediatric allergy and asthma and have been endorsed by the American Academy of Allergy, Asthma, and Immunology and the European Academy of Allergology and Clinical Immunology (Bacharier LB et al. Allergy. 2008;63[1]:5-34). The guidelines come at an opportune time. In the United States, where more than 5 million children and adolescents younger than 18 years have asthma, prevalence of the disorder has increased from 3.6% of all children in 1980 to 8.9% in 2005. Low-income populations, minorities, and children living in inner cities experience disproportionately higher morbidity and mortality due to asthma. Guidelines gap Leonard B. Bacharier, MD, associate professor of pediatrics at the Washington University School of Medicine, in St Louis, and a coauthor of the consensus report, said the document was needed because existing asthma treatment guidelines, such as the National Asthma Education and Prevention Program and the Global Strategy for Asthma Management and Prevention 2006, focused on all age ranges and were not specifically written for children. “If you look at the current literature on treatment guidelines, there's an extreme paucity of data for pediatrics,” Bacharier said. “So we needed some form of direction for physicians to manage children.” Prior pediatric asthma guidelines were created from unsystematically compiled opinions of experts, the report authors noted. Bacharier said the consensus report writers based the new guidelines on the most rigorous clinical trials available. “We tried very hard to make these recommendations evidence-based and tried to avoid expert opinion as the basis for recommendations.” The cornerstone of the pediatric asthma guidelines is a treatment algorithm that stresses disease control for children older than 2 years. The algorithm recommends starting a child on either inhaled corticosteroids or leukotriene receptor antagonists to gain control of the disease before instituting management therapy. If control of the asthma is not achieved, the algorithm indicates that a physician should increase the dosage of inhaled corticosteroids, try combinations of the medications, or add other drugs to the regimen, such as long-acting β2-agonists. The report also offers specific guidance on treating acute asthma episodes. The evidence for the guidelines' recommendations has less rigor in children aged 2 years or younger. “We have very little data to guide the treatment of asthma in young children,” Bacharier said. “We do not have a good idea of identifying which patients respond best to certain therapies. We rely on data on older children.” To that end, the consensus report, while noting conflicting evidence, recommends intermittent β2-agonists as the initial medications of choice when treating asthma in children aged 2 years or younger. Maintenance therapy Another area in which the evidence is limited concerns maintenance therapy after a child's asthma is brought under control, said Bacharier. “What do we do when kids are doing well? What are the indications for reducing medication levels to allow the patient to maintain disease control?” he asked. The report recommends that once a patient's asthma is controlled, the physician should then reduce medication levels in a step-down process to the lowest dose at which good control can be maintained. Beyond the algorithm, the consensus report discusses causes of childhood asthma and techniques for making a diagnosis, determining whether the asthma is caused by a virus, exercise, allergen, or unknown source. The report then suggests strategies for helping susceptible children avoid allergens and other triggers that produce asthma episodes. Also recommended is asthma education for children, parents, clinicians, public health officials, and government leaders. For parents of children younger than 5 years, the primary education focus should be on the use of inhaler devices and strategies for managing asthma episodes. Education for children aged 5 to 13 years should involve teaching both the patient and parent about asthma drugs and how they work, using colors and symbols to depict different types of medications. Adolescent patients should be directly engaged in all aspects of managing their condition to ensure optimal outcomes. Throughout the report, the authors call for research in areas that need more rigorous study. Still, Bacharier said, the document should provide physicians a working template for treating pediatric asthma. “We did not try to generate an exhaustive document, but rather, one that is practical,” he said.

Journal

JAMA – American Medical Association

Published: Mar 12, 2008

Keywords: asthma,guidelines,evidence-based practice,asthma, childhood

There are no references for this article.