The 2002 Japanese Pediatric Guideline for the Treatment and Management of Asthma

The Japanese Pediatric Asthma Guideline was revised in November of 2002. The guideline, the JPGL2002, has several characteristics different from other asthma guidelines. One of the important differences is the classification of asthma severity ; the frequencies of asthma symptoms in Steps 2, 3 and 4 of the JPGL2002 are similar to those of Steps 1, 2 and 3, respectively, of the Global Initiative for Asthma (GINA). In the JPGL2002, infantile asthma is classified separately, considering the necessity of special concern due to the characteristic features, and three different protocols for long-term management are provided according to the patients' ages : younger than 2 years, 2 to 5 years, and older than 5 years. For patients older than 5 years, inhaled glucocorti- costeroid (ICS) is recommended for asthma with symptoms more than once a month but less than once a week (Step 2). The GlNA classifies this as Step 1 and does not recommend the use of ICS. The recommended dosages of ICS for Steps 3 and 4 of the JPGL2002 are, however, smaller than those for Steps 2 and 3, respectively, of the GINA. It should be clarified in future studies whether or not such a use of ICS can lead to earlier and more frequent remission of asthma, hopefully resulting in the asthma being outgrown.