Management of childhood asthma

Asthma is complex, often difficult to diagnose and likely to be the clinical manifestation of several disorders, the management of childhood asthma is quite straight-forward. Few non-pharmacological intervcntions have been proven to be effective. Avoidance of cigarette smoke is important as passive smoking results in reduce lung function early in life and an increase in incidence and severity of asthma in childhood. Allergen avoidance is commonly practiced, but there is little evidence for its effectiveness. Animals in or near the house during infancy has been associated with a reduction in asthma incidence, but controlled trials have not evaluated this. Pharmacological treatment of asthma has changed little recently, although an oral leukotriene receptor antagonists can be beneficial. Modern inhaled steroids have some advantages over older versions, but increased efficacy, higher doses and better delivery systems have raised concerns about steroid toxicity, particularly for preschool children. Inhaled beta2 adrenergic drugs can be administered without nebulisers even in acute asthma.