Abstract
BackgroundGuidelines for the diagnosis and management of asthma have been published over the last 15 years; however, there has been little focus on issues relating to asthma in childhood. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies, particularly in children, have highlighted the need to incorporate new information into the asthma guidelines. The objectives of this article are to review the literature on asthma published between January 2000 and June 2003 and to evaluate the influence of new evidence on the recommendations made in the 1999 Canadian Asthma Consensus Report and its 2001 update, with a major focus on pediatric issues.MethodsThe diagnosis of asthma in young children and prevention strategies, pharmacotherapy, inhalation devices, immunotherapy, and asthma education were selected for review by small expert resource groups. The reviews were discussed in June 2003 at a meeting under the auspices of the Canadian Network For Asthma Care and the Canadian Thoracic Society. Data published through December 2004 were subsequently reviewed by the individual expert resource groups.ResultsThis report evaluates early-life prevention strategies and focuses on treatment of asthma in children, emphasizing the importance of early diagnosis and preventive therapy, the benefits of additional therapy, and the essential role of asthma education.ConclusionWe generally support previous recommendations and focus on new issues, particularly those relevant to children and their families. This document is a guide for asthma management based on the best available published data and the opinion of health care professionals, including asthma experts and educators.
Highlights
Guidelines for the diagnosis and management of asthma have been published over the last 15 years; there has been little focus on issues relating to asthma in childhood
If control is inadequate on low-dose Inhaled corticosteroids (ICSs), identify the reasons for poor control, and if indicated, consider additional therapy with Leukotriene receptor antagonists (LTRAs) or long-acting 2-agonists
The presence of atopy can be established by skin-prick testing[16] or by measurement of specific immunoglobulin E (IgE) antibodies[17,18] and is suggested by elevated peripheral total IgE and blood eosinophils.[18,19,20]
Summary
The definition of asthma is descriptive and has not changed since the publication of the 1999 Canadian Asthma Consensus Guidelines.[3] Asthma is characterized by paroxysmal or persistent symptoms such as dyspnea, chest tightness, wheezing, sputum production, and cough associated with variable airflow limitation and airway hyperresponsiveness to endogenous or exogenous stimuli.[3] Inflammation and its resultant effects on airway structure are considered the main mechanisms leading to the development and persistence of asthma. Optimal management of asthma requires adequate evaluation of the patient and the patient’s environment. Asthma control should be assessed with specific criteria (Table 2).[3] Severity is more difficult to assess and may be determined only after asthma control is achieved. Asthma control should be assessed at each visit
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