Anti-inflammatory treatment of asthma: differentiation and trial-and-error.
The relative lack of evidence for anti-inflammatory treatment of some phenotypes of asthma in children has been highlighted in recent guidelines and consensus reports specifically aiming at the paediatric population. Consequently, we are left with a need for defining treatment strategies in the clinical setting. The decision to initiate antiinflammatory treatment should be based on assessments of the individual child's age, the type of asthma, severity, heredity and atopic condition, adherence factors and sensitivity to systemic adverse effects of treatment options. Inhaled corticosteroids are potent anti-inflammatory agents that are effective in the whole spectrum of asthma in school age children. In toddlers with viral wheeze and in children with mild asthma oral leukotriene receptor antagonists or inhaled corticosteroids may be given on a trial-and-error basis.


CONCLUSIONS
To treat all children with asthma equally effectively from infancy through adolescence does not mean that they should be treated identically and in some types of asthma a trial-and-error approach may be warranted.
Wolthers
Ole D
OD
Asthma and Allergy Clinic, Children's Clinic Randers, 8900 Randers, Denmark. bkr@boerneklinikkenranders.dk
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage; D055118:Medication Adherence; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012135:Respiratory Sounds; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D020024:Leukotriene Antagonists