Symposium: respiratory disordersThe management of childhood asthma - what is new?

Childhood asthma is a common condition where there is no consensus on definition, no diagnostic test and no reliable test to monitor symptoms. Despite (or because of) these considerable clinical challenges, many national bodies produce guidelines for the diagnosis and management of childhood asthma. The British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN) published their first asthma guideline in 1995 and have updated regularly, and most recently in 2016. The present article will (i) summarise changes in the BTS/SIGN asthma guideline between 1995 and 2014 and (ii) highlight what has changed between 2014 and 2016. The guideline has evolved considerably over 21 years, but the core principles for diagnosis and management have remained constant. The major changes to the 2016 guideline include (i) the initial trial of treatment should be with inhaled corticosteroids (ICS) (ii) there is new terminology for the dose of ICS (iii) there are new recommendations for the traditional “steps” 1 to 3 and (iv) the 5-12 and less than 5 year old stepwise algorithms in the 2014 guideline are now unified. For acute severe asthma, the first choice intravenous treatment is magnesium sulphate. Childhood asthma remains a clinical diagnosis where management is symptom-based and patient-focussed.