Abstract
Asthma still causes considerable morbidity and mortality globally and minimal improvement has been seen in key outcomes over the last decade despite increasing treatment costs. This review summarizes recent advances in the management of asthma in children and adolescents. It focuses on the need for personalized treatment plans based on heterogenous asthma pathophysiology, the use of the terminology ‘asthma attack’ over exacerbation to instill widespread understanding of severity, and the need for every attack to trigger a structured review and focused strategy. The authors discuss difficulties in diagnosing asthma, accuracy and use of Fractional exhaled nitric oxide both as second line test and as a method to monitor treatment adherence or guide the choice of pharmacotherapy. The authors discuss acute and long-term management of asthma. Asthma treatment goals are to minimize symptom burden, prevent attacks and (where possible) reduce risk and impact of progressive pathophysiology and adverse outcomes. The authors discuss pharmacological management; optimal use of short acting β2 agonists, long acting muscarinic antagonist (tiotropium), use of which is relatively new in pediatrics, allergen specific immunotherapy, biological monoclonal antibody treatment, azalide antibiotic azithromycin, and the use of vitamin D. They also discuss electronic monitoring and adherence devices, direct observation of therapy via mobile device, temperature controlled laminar airflow device, and the importance of considering when symptoms may actually result from dysfunctional breathing rather than asthma.
Highlights
Asthma still causes considerable morbidity and mortality globally [1]
Every asthma attack that a clinician encounters may be viewed as treatment failure and should trigger a structured review and focused strategy to reduce the risk of further attacks [18]
It is very well known that children do not want to and/or do not remember to take inhalers or medicines if they are feeling well, and so exacerbations on a background of poor adherence can be even more severe
Summary
Asthma still causes considerable morbidity and mortality globally [1]. The recent Lancet commission [2] highlighted that our concept of the asthma is too simplified i.e., that all asthma is considered the same and should be treated the same way. The Lancet commission suggested the importance of recognizing and defining the pathophysiology for an individual patient, e.g., eosinophilic airway inflammation and airway obstruction, with a focus on personalizing diagnosis and targeting care for treatable traits or pathology [2]. A recent systematic review with meta-analyses evaluated the diagnostic accuracy of FeNO testing in children with suspected asthma [5]. They evaluated 43 observational studies addressing this question and concluded the FeNO concentration has moderate accuracy to diagnose asthma in individuals aged 5 y and older. The first diagnostic test in patients with suspected asthma should be spirometry with an assessment of bronchodilator response If this test does not confirm the diagnosis, second-line tests (measurement of FeNO and bronchoprovocation studies) are recommended. FeNO is sensitive to corticosteroid treatment and can be used as a method to monitor treatment adherence or to guide choice(s) of pharmacotherapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
