Current Allergy and Asthma Reports

, Volume 2, Issue 6, pp 453–459 | Cite as

Management of asthma in young children

  • Marianna Sockrider


Asthma and recurrent airway symptoms in a young child can result in significant morbidity and reduced quality of life. There is significant variability in asthma severity. Even for those who will “outgrow” asthma, regular problems can be minimized with appropriate pharmacotherapy, education, and environmental control. Success with primary prevention through environmental control for children at high risk for asthma has been limited. Avoidance of passive tobacco smoke exposure has primary and secondary prevention benefits. An inhaled short-acting bronchodilator should be available for use as needed. Patients with regular symptoms should receive maintenance anti-inflammatory medication. Add-on therapy can be considered for those with inadequate control on inhaled corticosteroid. Physicians should regularly review drug delivery technique and compliance and provide all patients with a written asthma action plan to guide symptom monitoring and medication use. Physicians should also establish a partnership with the child and family, providing self-management training to enhance skills and confidence.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Wasilewski Y, Clark NM, Evans D, et al.: Factors associated with emergency department visits by children with asthma: implications for health education. Am J Pub Health 1996, 86:1410–1415.PubMedGoogle Scholar
  2. 2.
    Eggleston PA, Malveaux FJ, Butz AM, et al.: Medications used by children with asthma living in the inner city. Pediatrics 1998, 103:349–354.CrossRefGoogle Scholar
  3. 3.
    Zeiger RS, Dawson C, Weiss S: Relationships between duration of asthma and asthma severity among children in the Childhood Asthma Management Program. J Allergy Clin Immunol 1999, 103:376–387.PubMedCrossRefGoogle Scholar
  4. 4.
    Lemanske RF: Inflammation in childhood asthma and other wheezing disorders. Pediatrics 2002, 109:368–372. Overview of measures of inflammation and recent research on inflammation in pediatric asthma and wheezing disorders. Part of a special issue supplement, Asthma in the Preschooler.PubMedGoogle Scholar
  5. 5.
    Duff AL, Pomeranz ES, Gelber LE, et al.: Risk factors for acute wheezing in infants and children: viruses, passive smoke and IgE antibodies to inhalant allergens. Pediatrics 1993, 92:535–540.PubMedGoogle Scholar
  6. 6.
    Martinez FD, Helms PJ: Types of asthma and wheezing. Eur Respir J Suppl 1998, 27:3s-8s.PubMedGoogle Scholar
  7. 7.
    Martinez FD: Development of wheezing disorders and asthma in preschool children. Pediatrics 2002, 109:362–367. Summary of the data from longitudinal studies of wheezing and childhood asthma describing different asthma phenotypes. Highlights heterogeneity of asthma. Part of a special issue supplement, Asthma in the Preschooler.PubMedGoogle Scholar
  8. 8.
    Martinez FD, Wright AL, Taussig LM, et al.: Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995, 332:133–138.PubMedCrossRefGoogle Scholar
  9. 9.
    Martinez FD: Role of respiratory infection in onset of asthma and chronic obstructive pulmonary disease. Clin Exp Allergy 1999, 29:53–58.PubMedGoogle Scholar
  10. 10.
    Stevenson EC, Turner G, Heaney LG, et al.: Bronchoalveolar lavage findings suggest two different forms of childhood asthma. Clin Exp Allergy 1997, 27:1027–1035.PubMedCrossRefGoogle Scholar
  11. 11.
    Stein RT, Holberg CJ, Morgan WJ, et al.: Peak flow variability and methacholine responsiveness as markers of different wheezing phenotypes in children: a prospective study. Thorax 1997, 5:946–952.Google Scholar
  12. 12.
    Sears MR: Consequences of long-term inflammation: the natural history of asthma. Clin Chest Med 2000, 21:315–329.PubMedCrossRefGoogle Scholar
  13. 13.
    National Asthma Education and Prevention Program. Expert Panel Report 2. In Clinical Practice Guidelines. Guidelines for the Diagnosis and Management of Asthma. Rockville, MD: US Department of Health and Human Services, National Institutes of Health; 1997. Publication #97-4051.Google Scholar
  14. 14.
    American Academy of Allergy, Asthma, and Immunology: Pediatric Asthma: Promoting Best Practice. In Guideline for Managing Asthma in Children. Milwaukee, WI: American Academy of Allergy, Asthma, and Immunology; 1999.Google Scholar
  15. 15.
    Skoner DP: Balancing safety and efficacy in pediatric asthma management. Pediatrics 2002, 109:381–392.PubMedGoogle Scholar
  16. 16.
    Tasche MJ, van der Wouden JC, Uijen JH, et al.: Randomized placebo-controlled trial of inhaled sodium cromoglycate in 1–4 year old children with moderate asthma. Lancet 1997, 350:1060–1064.PubMedCrossRefGoogle Scholar
  17. 17.
    Tasche MJ, Uijen JH, Bernsen RM, et al.: Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: a systematic review. Thorax 2000, 55:913–920.PubMedCrossRefGoogle Scholar
  18. 18.
    The Childhood Asthma Management Program Research Group: Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med 2000, 343:1054–1063. Presents key results of the largest long-term clinical trial of pediatric asthma in the United States. Compares maintenance therapy with budesonide, nedocromil, or placebo. Includes disease control and potential risk outcomes with five-year follow-up.CrossRefGoogle Scholar
  19. 19.
    Knorr B, Franchi LM, Bisgaard H, et al.: Montelukast, a leukotriene receptor antagonist, for the treatment of persistent asthma in children aged 2 to 5 years. Pediatrics, 2001, 108:E48. One of the first studies in preschool children addressing the effects of a leukotriene receptor antagonist. Multicenter, double-blind, randomized trial with 589 patients observed over 12 weeks of treatment.PubMedCrossRefGoogle Scholar
  20. 20.
    Simons FE, Villa JR, Lee BW, et al.: Montelukast added to budesonide in children with persistent asthma: a randomized, double-blind cross-over study. J Pediatr 2001, 138:694–698.PubMedCrossRefGoogle Scholar
  21. 21.
    Nielsen KG, Bisgaard H: The effect of inhaled budesonide on symptoms, lung function, and cold air and methacholine responsiveness in 2- to 5-year-old asthmatic children. Am J Respir Crit Care Med 2000, 162:1500–1506. Trial of inhaled budesonide in 38 children ages 2 to 5 years with asthma. Includes lung function and bronchial hyperresponsiveness measures in addition to disease control outcomes. Randomized, placebo-controlled, double-blind study with follow-up over 8 weeks.PubMedGoogle Scholar
  22. 22.
    Selroos O, Pietinalho A, Lofroos AB, Riska H: Effect of early vs. late intervention with inhaled corticosteroids in asthma. Chest 1995, 108:1228–1234.PubMedGoogle Scholar
  23. 23.
    Agertoft L, Pedersen S: Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med 1994, 88:373–381.PubMedCrossRefGoogle Scholar
  24. 24.
    Baker JW, Mellon M, Wald J, et al.: A multiple-dosing, placebocontrolled study of budesonide inhalation suspension given once or twice daily for treatment of persistent asthma in young children and infants. Pediatrics 1999, 103:414–421.PubMedCrossRefGoogle Scholar
  25. 25.
    Kemp JP, Skoner DP, Szefler SJ, et al.: Once-daily budesonide inhalation suspension for the treatment of persistent asthma in infants and young children. Ann Allergy Asthma Immunol 1999, 83:231–239.PubMedCrossRefGoogle Scholar
  26. 26.
    Bisgaard H, Gillies J, Groenewald M, Maden C: The effect of inhaled fluticasone propionate in the treatment of young asthmatic children: a dose comparison study. Am J Respir Crit Care Med 1999, 160:126–131.PubMedGoogle Scholar
  27. 27.
    Allen DB: Inhaled corticosteroid therapy for asthma in preschool children: growth issues. Pediatrics 2002, 109:373–380.PubMedGoogle Scholar
  28. 28.
    Reid A, Murphy C, Steen HJ, et al.: Linear growth of very young asthmatic children treated with high-dose nebulized budesonide. Acta Paediatr 1996, 85:421–424.PubMedGoogle Scholar
  29. 29.
    Allen DB: Safety of inhaled corticosteroids in children. Pediatr Pulmonol 2002, 33:208–220.PubMedCrossRefGoogle Scholar
  30. 30.
    Iles R, Lister P, Edmunds AT: Crying significantly reduces absorption of aerosolised drug in infants. Arch Dis Child 1999, 81:163–165.PubMedGoogle Scholar
  31. 31.
    Wildhaber JH, Dore ND, Wilson JM, et al.: Inhalation therapy in asthma: nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. J Pediatr 1999, 135:28–33.PubMedCrossRefGoogle Scholar
  32. 32.
    Everard ML: Aerosol delivery in infants and young children. J Aerosol Med 1996, 9:71–77.PubMedGoogle Scholar
  33. 33.
    O’Callaghan C: Delivery systems: the science. Pediatr Pulmonol 1997, 15:51–54.CrossRefGoogle Scholar
  34. 34.
    Rubin BK, Fink JB: Aerosol therapy for children. Respir Care Clin North Am 2001, 7:175–213.CrossRefGoogle Scholar
  35. 35.
    Fink JB: Aerosol device selection: evidence to practice. Respir Care 2000, 45:874–885.PubMedGoogle Scholar
  36. 36.
    Newman SP, Newhouse MT: Effect of add-on devices for aerosol drug delivery: deposition studies and clinical aspects. J Aerosol Med 1996, 9:55–70.PubMedGoogle Scholar
  37. 37.
    Konig P: Spacer devices used with metered-dose inhalers: breakthrough or gimmick? Chest 1985, 88:276–284.PubMedGoogle Scholar
  38. 38.
    Pedersen S: Aerosol treatment of bronchoconstriction in children, with or without a tube spacer. N Engl J Med 1983, 308:1328–1330.PubMedCrossRefGoogle Scholar
  39. 39.
    Cunningham SJ, Crain EF: Reduction of morbidity in asthmatic children given a spacer device. Chest 1994, 106:753–757.PubMedGoogle Scholar
  40. 40.
    Toogood JH, Baskerville J, Jennings B, et al.: Use of spacers to facilitate inhaled corticosteroid treatment of asthma. Am Rev Respir Dis 1984, 129:723–729.PubMedGoogle Scholar
  41. 41.
    Kim CS, Eldridge MA, Sackner MA: Oropharyngeal deposition and delivery aspects of metered-dose inhaler aerosols. Am Rev Respir Dis 1987, 135:157–164.PubMedGoogle Scholar
  42. 42.
    Amirav I, Newhouse MT: Aerosol therapy with valved holding chambers in young children: importance of the facemask seal. Pediatrics 2001, 108:389–394.PubMedCrossRefGoogle Scholar
  43. 43.
    Fok TF, Lam K, Chan CK, et al.: Aerosol delivery to non-ventilated infants by metered dose inhaler: should a valved spacer be used? Pediatr Pulmonol 1997, 24:204–212.PubMedCrossRefGoogle Scholar
  44. 44.
    Wildhaber JH, Janssens HM, Pierart F, et al.: High-percentage lung delivery in children from detergent-treated spacers. Pediatr Pulmonol 2000, 29:389–393.PubMedCrossRefGoogle Scholar
  45. 45.
    Leversha AM, Campanella SG, Aickin RP, Asher MI: Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma. J Pediatr 2000, 136:497–502. Randomized trial comparing costs and effectiveness of albuterol delivered by metered dose inhaler with spacer versus nebulizer in the emergency center for acute therapy of moderate to severe asthma among children 1 to 4 years of age. The trial demonstrated similar effectiveness with reduced cost and increased patient/parent satisfaction with metered dose inhaler and spacer.PubMedCrossRefGoogle Scholar
  46. 46.
    Rubilar L, Castro-Rodriguez JA, Girardi G: Randomized trial of salbutamol via metered-dose inhaler with spacer versus nebulizer for acute wheezing in children less than 2 years of age. Pediatr Pulmonol 2000, 29:264–269.PubMedCrossRefGoogle Scholar
  47. 47.
    Schuh S, Johnson DW, Stephens D, et al.: Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma. J Pediatr 1999, 135:22–27.PubMedCrossRefGoogle Scholar
  48. 48.
    Wildhaber JH, Devadason SG, Hayden MJ, et al.: Aerosol delivery to wheezy infants: a comparison between a nebulizer and two small volume spacers. Pediatr Pulmonol 1997, 23:212–216.PubMedCrossRefGoogle Scholar
  49. 49.
    Peat JK, Li J: Reversing the trend: reducing the prevalence of asthma. J Allergy Clin Immunol 1999, 103:1–10.PubMedCrossRefGoogle Scholar
  50. 50.
    Chan-Yeung M, Manfreda J, Dimich-Ward H, et al.: A randomized controlled study on the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants. Arch Pediatr Adolesc Med 2000, 154:657–663.PubMedGoogle Scholar
  51. 51.
    Foucard T: Is prevention of allergy and asthma possible? Acta Paediatr 2000, 89:71–75.CrossRefGoogle Scholar
  52. 52.
    Hide DW, Matthews S, Tariq S, Arshad SH: Allergen avoidance in infancy and allergy at 4 years of age. Allergy 1996, 51:89–3.PubMedCrossRefGoogle Scholar
  53. 53.
    Hesselmar B, Aberg N, Aberg B, et al.: Does early exposure to cat or dog protect against later allergy development. Clin Exp Allergy 1999, 29:611–617.PubMedCrossRefGoogle Scholar
  54. 54.
    Platts-Mills TA, Vaughan J, Squillace SP, et al.: Sensitization, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based cross-sectional study. Lancet 2001, 357:752–756.PubMedCrossRefGoogle Scholar
  55. 55.
    Stein RT, Holberg CJ, Sherrill D, et al.: Influence of parental smoking on respiratory symptoms during the first decade of life: the Tucson Children’s Respiratory Study. Am J Epidemiol 1999, 149:1030–1037.PubMedGoogle Scholar
  56. 56.
    Soyseth V, Kongerud J, Boe J: Postnatal maternal smoking increases the prevalence of asthma but not of bronchial hyperresponsiveness or atopy in their children. Chest 1995, 107:389–394.PubMedGoogle Scholar
  57. 57.
    Institute of Medicine: Exposure to environmental tobacco smoke. In Clearing the Air: Asthma and Indoor Air Exposures. Washington, DC: National Academy Press; 2000:263–297. This chapter is a comprehensive review of environmental tobacco smoke. This book is an excellent resource reviewing evidence on all major indoor triggers for asthma and the information on control strategies, ventilation, and research needs.Google Scholar
  58. 58.
    Ball TM, Castro-Rodriguez JA, Griffith KA, et al.: Siblings, daycare attendance, and the risk of asthma and wheezing during childhood. N Engl J Med 2000, 343:538–543.PubMedCrossRefGoogle Scholar
  59. 59.
    Wilson SR, Latini D, Starr NJ, et al.: Education of parents of infants and very young children with asthma: a developmental evaluation of the wee wheezers program. J Asthma 1996, 33:239–254.PubMedGoogle Scholar
  60. 60.
    McGill KA, Sorkness CA, Decker CA, et al.: Improved asthma outcomes in head start children using pharmacist asthma counselors. Am J Respir Crit Care Med 1997, 155:A202.Google Scholar
  61. 61.
    Holzheimer L, Mohay H, Masters IB: Educating young children about asthma: comparing the effectiveness of a developmentally appropriate asthma education videotape and picture book. Child Care Health Dev 1998, 24:85–99.PubMedCrossRefGoogle Scholar
  62. 62.
    Fish L, Wilson SR, Austin DM, Starr-Schneidkraut NJ: An education program for parents of children with asthma: differences in attendance between smoking and nonsmoking parents. Am J Public Health 1996, 86:246–248.PubMedCrossRefGoogle Scholar
  63. 63.
    Dawson KP, Van Asperen P, Higgins C, et al.: An evaluation of the action plans of children with asthma. J Paediatr Child Health 1995, 31:21–23.PubMedGoogle Scholar
  64. 64.
    Lieu TA, Quesenberry CP, Capra AM, et al.: Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits. Pediatrics 1997, 100:334–341.PubMedCrossRefGoogle Scholar
  65. 65.
    Gillies J, Barry D, Crane J, et al.: A community trial of a written self management plan for children with asthma. Asthma Foundation of NZ Children’s Action. N Z Med J 1996, 10:30–33.Google Scholar
  66. 66.
    Written asthma plans cut hospitalizations in half. Healthc Benchmarks 1997, 4:180-181.Google Scholar

Copyright information

© Current Science Inc. 2002

Authors and Affiliations

  • Marianna Sockrider
    • 1
  1. 1.Pediatric PulmonologyBaylor College of MedicineHoustonUSA

Personalised recommendations