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Asthma has become the most common chronic disease of childhood.
- What is responsible for its rise? See Hygiene Hypothesis
- What happens to recurrent wheezing conditions in childhood? See Natural History
- What is optimal management for childhood asthma?
A good starting place for asthma management is the U.S. National Guidelines, developed by the National Institutes of Health, through the National Heart, Lung and Blood Institute for the National Asthma Education & Prevention Program.
These guidelines describe 6 components to optimal management:
- Initial Assessment and Diagnosis of Asthma.
Includes:
- Spirometry
- Differential diagnosis
- Pharmacotherapy
Includes:
- Long-term Controllers
- Quick Relievers
- Control of Factors Contributing to Asthma Severity
Includes:
- Environmental exposures: allergens, tobacco smoke
- Co-morbid conditions: rhinosinusitis, gastroesophageal reflux, obesity
- Periodic Assessment and Monitoring
Includes:
- Self-monitoring
- Peak Flows
- Clinician follow-up
- Education for a Partnership in Asthma Care
Includes:
- Managing Asthma Exacerbations
Includes:
- Home management
- Emergency room management
- Hospital management
Complete NAEPP EPR2 1997 report
NAEPP EPR2 Practice Guidelines
The recent 2002 "Update" to the revised 1997 Guidelines is especially helpful for those managing children with asthma. In particular, it addresses pharmacotherapy in children with an evidence-based approach.
Complete NAEPP 2002 Update
Brief NAEPP 2002 Update
Together, the NIH Guidelines and Update serve as a current, evidence- and consensus-based approach to asthma management. They also provide a target for building a better understanding of optimal asthma management.
NIH also sponsors informative, collaborative research efforts to test and improve key parameters of childhood asthma management, including:
- Childhood Asthma Management Program (CAMP)
- Childhood Asthma Research and Education network (CARE)
- Inner City Asthma Consortium (ICAC)
With younger children, these two algorithms aid asthma management:
- "3 Strikes" rule: which children may benefit from persistent asthma management
- Asthma Predictive Index: which children are likely to have persistent asthma later in life
Helpful Resources for Optimal Management of Childhood Asthma
LiuLab publications
- Liu, AH, Spahn JD, Leung DYM. Chapter 134: "Childhood Asthma," Nelson's Textbook of Pediatrics, 17th Ed. Saunders, 2004; pp. 760-73.
Related
Coming
- Paper summarizing NIH Childhood Asthma Management collaborative studies
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HYGIENE
ENDOTOXIN
EARLY INTERVENTION 
CHILDHOOD
ASTHMA 
INNER CITY ASTHMA
RHINOSINUSITIS
NATURAL HISTORY
