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Feature Article

Current issues in childhood asthma. Part 2: questions and answers

Alan F Isles, Claire Wainwright, Elizabeth Banks, Nicholas J Freezer, Craig Mellis, Colin F Robertson, Peter D Sly

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Abstract

Most childhood asthma can be managed by general practitioners. Last month, Part 1 of this article presented current concepts in the diagnosis and management of childhood asthma; here, in Part 2, specific clinical issues and situations are discussed in a user-friendly question and answer format.

Key Points

  • Not all persistent coughs in childhood are caused by asthma. In fact, a cough that does not respond within a week to appropriate asthma therapy is unlikely to be due to asthma.
  • If a patient remains symptomatic on therapy, increasing the prescribed dose of medication may not be the most appropriate course of action. Review the diagnosis and whether medication has been taken correctly or at all.
  • In general, inhaled corticosteroids should be reserved for children with frequent episodic asthma inadequately controlled by a nonsteroid medication or with persistent asthma. The risk of adverse effects from inhaled steroids can be rescued by back-titrating the dose to the lowest dose that maintains good control.
  • Long acting beta-2 agonists are useful as ‘symptom controllers’ in some children with asthma; Leukotriene antagonists may be useful as first line ‘preventer’ treatment for children with frequent episodic asthma and in some children with exercise-induced asthma.
  • Referral to a specialist should be considered when children with asthma require increasing or continued treatment with oral or high doses of inhaled corticosteroids and when there is a failure to respond to appropriate therapy.

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