Update on the pathogenesis and management of childhood asthma.
OBJECTIVE
To review and summarize trends in the current literature in childhood asthma with implications for current management and future research.


RESULTS
There have been several articles in the last year that address the pathogenesis and pharmacogenomics of asthma. Recent consensus guidelines have been published that emphasize a stepwise approach to management, which will be briefly reviewed here. Several publications have proposed novel treatments to attempt to attenuate asthmatic lower airway inflammation. In terms of measuring this inflammation, a portable exhaled nitric oxide analyzer has been developed.


CONCLUSIONS
Evidence shows that various early life exposures (high house dust mite levels, early antibiotic use) may predispose susceptible individuals to the development of asthma, but the early introduction of solid foods, even so-called allergenic foods, does not appear to be one of these factors. Newly identified pharmacogenomic markers may be the first step in tailoring each asthmatic patient's therapy on the basis of genotype, and management tailored specifically toward each patient's level of airway inflammation is already coming into wider clinical use. Several novel treatments for asthma have shown promise in early studies. On the basis of the most recent evidence, the National Education and Prevention Program's Guidelines for the Diagnosis and Management of Asthma is a comprehensive, stepwise management guide for asthma.
Cornell
Alexandra
A
Dartmouth Hitchcock Medical Center/Children's Hospital at Dartmouth, Lebanon, New Hampshire 03756, USA.
Shaker
Marcus
M
Woodmansee
Donald P
DP
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000485:Allergens; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy*; D016535:Bronchial Hyperreactivity / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D012882:Skin Tests; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000485:Allergens; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents