[The practice guideline 'Asthma in children' (second revision) from the Dutch College of General Practitioners; a response from the perspective of paediatric pulmonology].
The second revised guideline 'Asthma in children' from the Dutch College of General Practitioners provides a well-documented and useful overview. Diagnostic recommendations depend heavily on the symptom 'wheezing', which may be difficult to detect in young children. A uniform therapeutic approach for the various asthma phenotypes is recommended, including a therapeutic trial with inhaled corticosteroids for persistent symptoms. Pitfalls include the fact that inhalation of corticosteroids is sometimes difficult in young children, and that the use of corticosteroids in children with transient virus-induced wheeze is not evidence-based. The guideline no longer recommends the use of cromoglycate. Children who are refractory to inhaled steroids should be referred to a paediatrician before trying long-acting beta2-sympathomimetics or leukotriene antagonists. The current challenge is to effectively incorporate this new guideline into a coherent system of care for the asthmatic child in cooperation with paediatricians, asthma nurses and others involved in the diagnosis and treatment of childhood asthma.
de Jongste
J C
JC
Erasmus MC-Sophia Kinderziekenhuis, afd. Kindergeneeskunde, Postbus 2060, 3000 CB Rotterdam. j.c.dejongste@erasmusmc.nl
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015272:Pulmonary Medicine / Q000592:standards*; D012129:Respiratory Function Tests; D012955:Societies, Medical
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents