Asthma Options for Young Children

Key Messages

1. The goal of asthma treatment, to achieve and maintain control of the disease, can be reached in a majority of children 5 years and younger with a pharmacologic intervention strategy developed in partnership between the family/caregiver and the healthcare practitioner.
2. Maternal smoking during pregnancy and exposure to environmental tobacco smoke early in life are associated with a greater risk of developing wheezing illnesses in childhood, as well as with reduced lung function later in life. Therefore, every effort should be made to avoid exposing children to tobacco smoke.
3. Making a diagnosis of asthma in children 5 years and younger may be difficult because episodic respiratory symptoms such as wheezing and cough are also common in children who do not have asthma, particularly in those younger than 3 years.
4. A diagnosis of asthma in young children can often be made based largely on symptom patterns and on a careful clinical assessment of family history and physical findings. The presence of atopy or allergic sensitization provides additional predictive support, as early allergic sensitization increases the likelihood that a wheezing child will have asthma.
5. Asthma education should be provided to family members and caregivers of wheezy children 5 years and younger when wheeze is suspected to be caused by asthma.
6. For all patients with a confirmed diagnosis of asthma, the goal of treatment is to achieve control of the clinical manifestations of the disease and maintain this control for prolonged periods, with appropriate regard to the safety and cost of the treatment required to achieve this goal.
7. The prolonged use of high doses of inhaled or systemic glucocorticosteroids must be avoided by ensuring that treatment is appropriate and reduced to the lowest level that maintains satisfactory current clinical control.
8. A pressurized metered dose inhaler (MDI) with a valved spacer (with or without a face mask, depending on the child's age) is the preferred delivery system.
9. Several placebo-controlled studies of inhaled glucocorticosteroids in children 5 years and younger with asthma have found statistically significant clinical effects on a variety of outcomes, including increased lung function and number of symptom-free days, and reduced symptoms, need for additional medication, caregiver burden, systemic glucocorticosteroid use, and exacerbations.
10. Because of the side-effects associated with prolonged use, oral glucocorticosteroids in young children with asthma should be restricted to the treatment of acute severe exacerbations, whether viral-induced or otherwise.
11. Rapid-acting inhaled beta₂-agonists are the most effective bronchodilators available and therefore the preferred reliever treatment for asthma in children 5 years and younger.
12. A low-dose inhaled glucocorticosteroid is recommended as the preferred initial treatment to control asthma in children 5 years and younger.
13. If low dose of inhaled glucocorticosteroid does not control symptoms, and the child is using optimal technique and is adherent to therapy, doubling the initial dose of glucocorticosteroid may be the best option.
14. When doubling the initial dose of inhaled glucocorticosteroids fails to achieve and maintain asthma control, the child's inhalation technique and compliance with the medication regimen should be carefully assessed and monitored, as these are common problems in this age group.
15. Continued need for asthma treatment in children under age 5 should be regularly assessed (e.g., every 3 to 6 months).