Management of asthma in children

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Abstract
What is the acute management of asthma and episodic viral wheeze?An exacerbation of asthma can occur at any time and in childhood is most commonly precipitated by viral upper respiratory tract infections. The British Thoracic Society/Scottish Intercollegiate Guidelines Network guideline recommends that all patients with asthma should have a written, individualised asthma management plan that includes clear and easy to follow instructions on acute management and guidance on daily treatment and when to call emergency services (fig 1⇓).2View larger version: In this window In a new window Fig 1 Information to be incorporated into an individual asthma management plan. *Use of large volume spacer to deliver bronchodilator has been shown to be as effective as delivery through nebuliser,3 but adequate doses of bronchodilator must be administeredThe management of episodic viral wheeze is controversial. Many doctors still favour an acute wheeze management plan similar to that used in acute asthma, with the use of regular bronchodilators and corticosteroids. Little evidence exists in the literature to support this approach, however. A Cochrane review of short acting β2 agonists found eight studies involving 229 patients and found no benefit in episodic viral wheeze and persistent wheeze in children under the age of 2 years.4 The benefit of anticholinergics in the management of episodic viral wheeze is similarly unclear. A Cochrane review of six studies involving 321 infants under the age of 2 years showed no impact on symptoms or clinical course of the acute illness.5 The studies were heterogeneous, however, leaving the possibility of a subgroup that may benefit. Currently, the indiscriminate use of anticholinergics and short acting β2 agonists in the management of acute episodic viral wheeze is not recommended. Although these agents are still used for young children with wheeze, the doctor should ensure that a clear clinical benefit is achieved before they are regularly prescribed.A short course of systemic corticosteroids at the onset of symptoms of episodic viral wheeze has been shown to reduce the need for additional drugs in infants admitted to hospital,6 7 and the use of high dose (1.6-2.25 mg/day) inhaled corticosteroids may also have some benefit if given at the onset of symptoms of upper respiratory tract infection in children known to have episodic viral wheeze.8