Title:Insights from Overviewing Selective International Guidelines for Pediatric
Asthma
Volume: 20
Author(s): Kam Lun Ellis Hon*, Daniel K.K. Ng, Wa Keung Chiu and Alexander K.C. Leung
Affiliation:
- Department of Pediatrics CUHKMC, The Chinese University of Hong Kong, China
Keywords:
Asthma, guidelines, beta agonists, inhaled corticosteroid, biologics, laboratory testing.
Abstract: Background: Asthma is a chronic atopic and inflammatory bronchial disease characterized by recurring symptoms and, episodic reversible bronchial obstruction and easily triggered
bronchospasms. Asthma often begins in childhood. International guidelines are widely accepted
and implemented; however, there are similarities and differences in the management approaches.
There is no national guideline in many cities in Asia. This review aims to provide a practical perspective on current recommendations in the management of childhood asthma, specifically in the
following aspects: diagnosis, classification of severity, treatment options, and asthma control, and
to provide physicians with up-to-date information for the management of asthma.
Methods: We used the PubMed function of Clinical Queries and searched keywords of “Asthma”,
“Pediatric,” AND “Guidelines” as the search engine. “Clinical Prediction Guides”, “Etiology”,
“Diagnosis”, “Therapy,” “Prognosis,” and “Narrow” scope were used as filters. The search was
conducted in November 2022. The information retrieved from this search was used in compiling
the present article.
Results: Diagnosis is clinically based on symptom pattern, response to therapy with bronchodilators and inhaled corticosteroids, and spirometric pulmonary function testing (PFT). Asthma is classified in accordance with symptom frequency, peak expiratory flow rate (PEFR), forced expiratory volume in one second (FEV1), atopic versus nonatopic etiology, where atopy means a predisposition toward a type 1 hypersensitivity reaction. Asthma is also classified as intermittent or persistent (mild to severe). Unfortunately, there is no disease cure for asthma. However, symptoms can
be prevented by trigger avoidance and suppressed with inhaled corticosteroids. Antileukotriene
agents or long-acting beta-agonists (LABA) may be used together with inhaled corticosteroids if
symptoms of asthma are not controlled. Rapidly worsening symptoms are usually treated with an
inhaled short-acting beta-2 agonist (SABA, e.g., salbutamol) and oral corticosteroids. Intravenous
corticosteroids and hospitalization are required in severe cases of asthma attacks. Some guidelines
also provide recommendations on the use of biologics and immunotherapy.
Conclusion: Asthma is diagnosed clinically, with supporting laboratory testing. Treatment is
based on severity classification, from intermittent to persistent. Inhaled bronchodilator and steroid
anti-inflammatory form the main stay of management.
