Pharmaceutical treatment of asthma in children.

The present review article gives an overview of the present treatment modalities of asthma during childhood and discusses the existing controversies in asthma treatment. Present guidelines of asthma treatment concentrate on treatment for adults and only marginally concern treatment of childhood asthma. The few exceptions are the British Scottish guidelines and the Nordic guidelines, which have separate paragraphs on paediatric asthma management. The main controversy in paediatric asthma treatment is that how early (in age) and how soon (after diagnosis of asthma has been established) should inhaled steroids be instituted. Does treatment with early inhaled steroids influence lung development? Also possible side effects of inhaled steroids as possible impact upon growth and effect upon the hypothalamic adrenal axis are discussed. What is the place of leukotriene antagonists in childhood asthma treatment? Other issues discussed are prevention of asthma (primary, secondary and tertiary) in relationship to treatment of asthma. Primary prevention regards preventive measures to be taken to prevent initial allergic diseases; secondary prevention aims at preventing development of further allergic disease after the initial allergic disorder, as preventing debut of asthma after atopic eczema. Tertiary prevention aims at reducing already existing allergic illness and preventing further progression. For asthma, tertiary prevention regards treatment. During later years, there has been a focus on the respiratory tract as a continuum, and how allergic rhinitis and asthma should be treated when they are coexistent. Treating exercise induced asthma optimally is regarded as an important aim in the general treatment of asthma in childhood. Particularly in childhood asthma, compliance (concordance) with treatment is an important issue. Also some controversial aspects of acute asthma treatment in young children are discussed.