Weighing the risks of treatment versus nontreatment in pediatric asthma.
During the past dozen years, great strides have been made in the understanding of asthma. In addition, an excellent choice of effective and safe medications has become available for use in both the acute and chronic manifestations of this disease. Unfortunately, asthma continues to affect society adversely in terms of cost and morbidity. Following the NHLBI guidelines for the management of persistent asthma could substantially reduce the health care expenditures associated with asthma and, more importantly could significantly reduce asthma exacerbations, emergent care visits, hospitalizations, and even asthma deaths. All who care for children with asthma must continue to relay the message that asthma is a chronic condition that is best treated with controller agents. Inhaled glucocorticoids are considered first-line agents for all patients with persistent asthma. They have been shown to improve asthma control, improve lung function, and reduce morbidity and mortality. Whether the leukotriene-modifying agents will be shown to reduce morbidity and mortality significantly remains an important and unanswered question at present. Another important question is whether combination therapy and which combination (inhaled glucocorticoid plus LABA or inhaled glucocorticoid plus leukotriene-modifying agent) will provide even further improvement in asthma control and further reductions in hospitalizations and mortality than seen with the use of inhaled glucocorticoids alone.
Spahn
Joseph D
JD
The Ira J. and Jacqueline Neimark Laboratory of Clinical Pharmacology and the Division of Allergy, and Clinical Immunology, Department of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson Street, Denver CO 80206, USA. spahnj@njc.org
Covar
Ronina A
RA
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage* / Q000009:adverse effects
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids; D020024:Leukotriene Antagonists