Advances in the management of asthma

Exciting new data are increasing the evidence base for the management of paediatric asthma. To inform the treatment of preschool wheeze, the best current classification is into episodic (viral) and multitrigger wheeze, rather than according to epidemiological pattern (transient versus persistent) and the presence or absence of atopy. Episodic (viral) wheeze is treated intermittently, with either inhaled bronchodilators or oral montelukast at the time of viral colds. If this approach fails, intermittent high-dose inhaled corticosteroids may be tried. Oral prednisolone is ineffective in the treatment of all but the severest attacks of preschool episodic (viral) wheeze, and is not a primary-care medication in this context. In older children the role of long-acting β2 agonists has been explored. They are not indicated as first-line prophylactic therapy. In children with more severe symptoms, a single-inhaler strategy using budesonide/formoterol should be considered. In children who do not respond to conventional asthma therapy, the diagnosis and the way in which the prescribed treatment is being used should be reviewed rather than more treatment being blindly given. Most cases will improve with conventional management which is properly undertaken, and will not require novel therapies.