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Asthma in children and adolescents - Highlights

Description

An in-depth report on how asthma is diagnosed, treated, and managed in children and adolescents.

Highlights:

FDA Panel Votes to Ban Two Asthma Drugs

In December 2008, an FDA advisory panel voted to ban two long-acting beta2-agonists drugs, salmeterol (Serevent) and formoterol (Foradil), for treatment of asthma in children and adults. These drugs can increase the risk of asthma death unless used in combination with an inhaled steroid. The FDA panel decided that salmeterol-fluticasone (Advair) and formoterol-budesonide (Symbicort), which combine two drugs in a single inhaler, can remain on the market. Advair is approved for children ages 4 years and older, and Symbicort is approved for children ages 12 years and older.

FDA Advisory: Montelukast (Singulair)

In 2008, the FDA recommended that patients who take montelukast (Singulair), or other leukotriene antagonist drugs, be monitored for signs of behavioral and mood changes, and signs of suicidal thoughts.

Asthma Guidelines

The U.S. National Asthma Education and Prevention Program (NAEPP) guidelines for the diagnosis and management of asthma recommend:

Assessment and Monitoring. Doctors should use multiple measures to determine a patient� ' s current condition and future risk for worsening of condition. Even patients who show few daily effects of asthma may be in danger of sudden worsening of symptoms.
Patient Education. Patients should be taught skills to self-monitor and manage asthma. Doctors should give patients a written asthma action plan, which includes information on daily treatment and ways to recognize worsening asthma.
Control of Environmental Factors and Other Asthma Triggers. The guidelines outline new approaches for reducing exposure to allergens. They also address how treating co-existing chronic conditions (rhinitis, sinusitis, gastroesophageal reflux, and obesity) can help improve asthma control.
Medications. The NAEPP specifies different treatment plans for children based on three age groups: 0 - 4 years, 5 - 11 years, and 12 years and older. A stepwise approach is recommended where medication types and doses are increased or decreased based on the level of asthma control.

Resources

www.lungusa.org -- The American Lung Association
www.acaai.org -- American College of Allergy, Asthma & Immunology
www.aaaai.org -- American Academy of Allergy, Asthma, and Immunology
www.nhlbi.nih.gov -- National Heart, Lung, and Blood Institute
www.aafa.org -- Asthma and Allergy Foundation of America
www.aanma.org -- Allergy and Asthma Network, Mothers of Asthmatics

References

American Lung Association Asthma Clinical Research Centers, Peters SP, Anthonisen N, Castro M, Holbrook JT, Irvin CG, et al. Randomized comparison of strategies for reducing treatment in mild persistent asthma. N Engl J Med. 2007 May 17;356(20):2027-39.

Bateman E, Nelson H, Bousquet J, Kral K, Sutton L, Ortega H, Yancey S. Meta-analysis: effects of adding salmeterol to inhaled corticosteroids on serious asthma-related events. Ann Intern Med. 2008 Jul 1;149(1):33-42. Epub 2008 Jun 3.

Castro-Rodriguez JA, Rodrigo GJ. Efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing and asthma: a systematic review with meta-analysis. Pediatrics. 2009 Mar;123(3):e519-25.

Fanta CH. Asthma. N Engl J Med. 2009 Mar 5;360(10):1002-14.

Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008 Jan;121(1):183-91.

Kukkonen K, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2007 Jan;119(1):192-8. Epub 2006 Oct 23.

National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publications 08-4051.

Stern DA, Morgan WJ, Halonen M, Wright AL, Martinez FD. Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study. Lancet. 2008 Sep 20;372(9643):1058-64.

Vliagoftis H, Kouranos VD, Betsi GI, Falagas ME. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Ann Allergy Asthma Immunol. 2008 Dec;101(6):570-9.

Reviewed last on: 6/1/2009
Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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