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My guidelines for treating children's asthma

The BTS guideline out this year recommends ?2 agonist as step one and the addition of a steroid inhaler as step 2. If after four weeks adequate response is obtained, then maintain children on that steroid dose for six months and then maybe taper down.

I wish to make a suggestion to manage young children's asthma slightly differently. In the early I 1990s I set up an asthma clinic. I categorised children's asthma in to three trigger categories: allergic, emotional and upper respiratory tract infection.

While I found few children who had an allergic component to their asthma, most had upper respiratory infections as their trigger. I hardly had any child who had an emotional trigger.

To optimise treatment of children with asthma with URTI as their trigger ­ which is the majority ­ my suggestion is as follows:

Step 1 While extremely mild cases will be started on ?2 agonist alone, the majority will need to be started on ?2 agonist inhaler and appropriate dose of steroid inhaler, usually 200-400mcg per day. Bronchodilator should be taken 10 minutes before their steroid inhalation at every dose.

Step 2 Review after four weeks if all is well and their PFR is back to normal and URTI had gone. Then stop all treatment.

Step 3 Review when they next have an acute episode. If this is within one or two months then give a maintenance dose of steroid inhaler, especially if they have not encountered another episode of URTI.

But if the next episode is many months after the first, then give ?2 agonist and steroid inhaler together each time that child has URTI for one month and then stop.

In this way we can trim down steroid use in children and target use only at the most appropriate time.

Dr Archana Garg



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