Treatment of Asthma in Children

  • Frank S. Virant
  • Gail G. Shapiro


Asthma is a pulmonary disorder characterized by reversible periods of airway obstruction, bronchial hyperresponsiveness, and associated airway inflammation (1). Although these features have important implications for the type of medications used in treatment, a comprehensive approach to asthma therapy in children should include assessment of disease severity and scrutiny for exacerbating factors as well as pharmacotherapy. Long-term successful management is clearly linked to education of patients and their parents about asthma, appropriate use of medications, and a plan of action for periods of exacerbation.


Allergic Rhinitis Peak Expiratory Flow Rate Ipratropium Bromide Chronic Asthma Bronchial Hyperresponsiveness 
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  1. 1.
    American Thoracic Society. Chronic bronchitis, asthma and pulmonary emphysema. Am. Rev. Resp. Dis. 1987; 136:224–225.Google Scholar
  2. 2.
    Bleecker ER. Airways reactivity and asthma: significance and treatment. J. Allergy Clin. Immunol. 1985; 75:21–24.PubMedCrossRefGoogle Scholar
  3. 3.
    Cockroft DW. Airway hyperresponsiveness: therapeutic implications. Ann. Allergy 1987; 59:405–414.Google Scholar
  4. 4.
    Berdon WE and Baker DN. Vascular anomalies and the infant lungs: rings, slings and other things. Semin. Roentgenol. 1972; 7:39.PubMedCrossRefGoogle Scholar
  5. 5.
    Weissberg D and Schwartz I. Foreign bodies in the tracheobronchial tree. Chest 1987; 91:730.PubMedCrossRefGoogle Scholar
  6. 6.
    Berquist WE, Rachelefsky GS, Kadden M, Siegel SC, Katz RM, Fonkzlsrud EW, and Ament ME. Gastroesophageal reflux associated recurrent pneumonia and chronic asthma in children. Pediatrics 1981; 68:29.PubMedGoogle Scholar
  7. 7.
    Shapiro GG and Christie D. Gastroesophageal reflux and asthma. Clin. Rev. Allergy 1983; 1:39.PubMedGoogle Scholar
  8. 8.
    Zimmerman B, Feanny S, Reisman J, Hak H, Rashed N, McLaughlin FJ, and Levison H. Allergy in asthma I. The dose relationship of allergy to severity of childhood asthma. J. Allergy Clin. Immunol. 1988; 81:63.PubMedCrossRefGoogle Scholar
  9. 9.
    Zimmerman B, Chambers C, and Forsyth L. Allergy in asthma II. The highly atopic infant and chronic asthma. J. Allergy Clin. Immunol. 1988; 81:71.PubMedCrossRefGoogle Scholar
  10. 10.
    Fergusson DM, Horwood LJ, and Shannon FT. Parental asthma, parental eczema, and asthma, and eczema in early childhood. J. Chronic Dis. 1983; 36:517.PubMedCrossRefGoogle Scholar
  11. 11.
    Davis JB and Bulpitt CJ. Atopy and wheeze in children according to parental atopy and family size. Thorax 1980; 35:671.CrossRefGoogle Scholar
  12. 12.
    Ellis EF. Adverse effects of corticosteroid therapy. J. Allergy Clin. Immunol. 1987; 80:515.PubMedCrossRefGoogle Scholar
  13. 13.
    Balfour-Lynn L. Growth and childhood asthma. Arch. Dis. Child. 1986; 61:1049.PubMedCrossRefGoogle Scholar
  14. 14.
    Shohat M, Shohat T, Kedem R, et al. Childhood asthma and growth outline. Arch. Dis. Child. 1987; 62:63.PubMedCrossRefGoogle Scholar
  15. 15.
    Waring WW. The history and physical exam, in Disorders of the Respiratory Tract in Children (Kendig EL and Cherniak R, eds.), W. B. Saunders, Philadelphia, PA, 1983; p. 63.Google Scholar
  16. 16.
    Commey JOO and Levison H. Physical signs in childhood asthma. Pediatrics 1976; 58:537–541.PubMedGoogle Scholar
  17. 17.
    Darman HR. Pulmonary function testing: use of the peak expiratory flow rate in an outpatient or office setting. J. Asthma 1984; 21(5):331–337.CrossRefGoogle Scholar
  18. 18.
    Harm DL, Kotses H, and Creer TL. Improving the ability of peak expiratory flow rates to predict asthma. J. Allergy Clin. Immunol. 1985; 76:688–694.PubMedCrossRefGoogle Scholar
  19. 19.
    Nowak RM, Pensler MI, Sarkar DD, et al. Comparison of peak expiratory flow and FEV1 admission criteria for acute bronchial asthma. Ann. Emerg. Med. 1982; 11:64–69.PubMedCrossRefGoogle Scholar
  20. 20.
    Barnes PJ. A new approach to the treatment of asthma. N. Engl. J. Med. 1989; 321:1517–1527.PubMedCrossRefGoogle Scholar
  21. 21.
    Webb-Johnson DC and Andrews JL. Bronchodilatory therapy (two parts). N. Engl. J. Med. 1977; 297(9):476–482.Google Scholar
  22. 22.
    Nelson HS. Adrenergic therapy of bronchial asthma. J. Allergy Clin. Immunol. 1986; 77:771–785.PubMedCrossRefGoogle Scholar
  23. 23.
    Robertson CF, Smith F, Beck R, and Levison H. Response to frequent low doses of nebulized salbutamol in acute asthma. J. Pediatr. 1985; 106:672–674.PubMedCrossRefGoogle Scholar
  24. 24.
    Schuh S, Parkin P, Rajan A, Canny G, Healy R, Rieder M, Tan YK, Levison H, and Soldin SJ. High-versus low-dose, frequently administered, nebulized albuterol in children with severe, acute asthma. Pediatrics 1989; 83:513–518.PubMedGoogle Scholar
  25. 25.
    Schuh S, Reider MJ, Canny G, Pender E, Forbes T, Tan YK, Bailey D, and Levison H. Nebulized albuterol in acute childhood asthma: comparison of two doses. Pediatrics 1990; 86:509–513.PubMedGoogle Scholar
  26. 26.
    Nussbaum E, Eyzaguirre M, and Galant SP. Dose-response relationship of inhaled metaproterenol sulfate in preschool children with mild asthma. Pediatrics 1990; 85:1072–1075.PubMedGoogle Scholar
  27. 27.
    Shapiro GG, Furukawa CT, Pierson WE, et al. Double-blind, dose-response study of metaproterenol inhalant solution in children with acute asthma. J. Allergy Clin. Immunol. 1987; 79:378–386.PubMedCrossRefGoogle Scholar
  28. 28.
    Portnoy J and Aggarwal J. Continuous terbutaline nebulization for the treatment of severe exacerbations of asthma in children. Ann. Allergy 1988; 60:368–371.PubMedGoogle Scholar
  29. 29.
    Moler FW, Hurwitz ME, and Custer JR. Improvement in clinical asthma score and PaCO2 in children with severe asthma treated with continuously nebulized terbutaline. J. Allergy Clin. Immunol. 1988; 81:1101–1109.PubMedCrossRefGoogle Scholar
  30. 30.
    Bernstein IL. Cromolyn sodium. Chest 1985; 87:68S–73S.PubMedGoogle Scholar
  31. 31.
    Bernstein IL, Siegel SC, Brandon ML, et al. A controlled study of cromolyn sodium sponsored by the drug committee of the American Academy of Allergy. J. Allergy Clin. Immunol. 1972; 50:235–245.PubMedCrossRefGoogle Scholar
  32. 32.
    Eigen H, Reid JJ, Dahl R, et al. Evaluation of the addition of cromolyn sodium to bronchodilatory maintenance therapy in the long-term management of asthma. J. Allergy Clin. Immunol. 1987; 80:612–621.PubMedCrossRefGoogle Scholar
  33. 33.
    Konig P. Inhaled corticosteroids: their present and future role in the management of asthma. J. Allergy Clin. Immunol. 1988; 82:297–306.PubMedCrossRefGoogle Scholar
  34. 34.
    Kerrebijn KF, van Ess-Zanvliet EM, and Neijens HJ. Effect of long-term treatment with inhaled corticosteroids and β-agonists on the bronchial responsiveness in children with asthma. J. Allergy Clin. Immunol. 1987; 79:653–659.PubMedCrossRefGoogle Scholar
  35. 35.
    Juniper EF, Kline PA, Vanzielehgem MA, Ramsdale EH, O’Byrne PM, and Hargreave FE. Effect of long-term treatment with an inhaled corticosteroid on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. Am. Rev. Resp. Dis. 1990; 142:632–636.Google Scholar
  36. 36.
    Salmeron S, Guerin JC, Godard P, et al. High doses of inhaled corticosteroids in unstable chronic asthma. Am. Rev. Resp. Dis. 1989; 140:167–171.PubMedCrossRefGoogle Scholar
  37. 37.
    Toogood JH. High-dose inhaled steroid therapy for asthma. J. Allergy Clin. Immunol. 1989; 83:528–536.PubMedCrossRefGoogle Scholar
  38. 38.
    Toogood JH. Complications of topical steroid therapy for asthma. Am. Rev. Resp. Dis. 1990; 141:S89–S96.PubMedCrossRefGoogle Scholar
  39. 39.
    Pouw EM, Prummel MF, Oosting H, Roos CM, and Endert E. Beclomethasone inhalation decreases serum osteocalcin concentrations. Br. Med. J. 1991; 302:627–628.CrossRefGoogle Scholar
  40. 40.
    Ali NJ, Capewell S, and Ward MJ. Bone turnover during high dose inhaled corticosteroid treatment. Thorax 1991; 46:160–164.PubMedCrossRefGoogle Scholar
  41. 41.
    Tabachnik E and Zadik Z. Diurnal cortisol excretion during therapy with inhaled beclomethasone dipropionate in children with asthma. J. Pediatr. 1991; 118: 294–2PubMedCrossRefGoogle Scholar
  42. 42.
    Pederson S and Fuglsang G. Urine cortisol excretion in children treated with high doses of inhaled corticosteroids: a comparison of budesonide and beclomethasone. Eur. J. Resp. Dis. 1988; 1:433–435.Google Scholar
  43. 43.
    Hollman GA and Allen DB. Overt glucocorticoid excess due to inhaled corticosteroid therapy. Pediatrics 1988; 81:452–455.PubMedGoogle Scholar
  44. 44.
    Littlewood JM, Johnson AW, Edwards PD, and Littlewood AE. Growth retardation in asthmatic children treated with inhaled beclomethasone dipropionate. Lancet 1988; i:115–116.CrossRefGoogle Scholar
  45. 45.
    Wolthers OD and Pedersen S. Growth of asthmatic children during treatment with budesonide: a double-blind trial. Br. Med. J. 1991; 303:163–165.CrossRefGoogle Scholar
  46. 46.
    Grant JA and Ellis EF. Update on theophylline: symposium proceedings. J. Allergy Clin. Immunol. 1986; 78:669–824.CrossRefGoogle Scholar
  47. 47.
    Murciano D, Aubier M, Lecocguic Y, and Pariente R. Effects of theophylline on diaphragmatic strength and fatigue in patients with chronic obstructive pulmonary disease. N. Engl. J. Med. 1984; 311:349–353.PubMedCrossRefGoogle Scholar
  48. 48.
    Pauwels RA. New aspects of the therapeutic potential of theophylline in asthma J. Allergy Clin. Immunol. 1989; 83:548–553.PubMedCrossRefGoogle Scholar
  49. 49.
    Dutoit JI, Salome CM, and Woolcock AJ. Inhaled corticosteroids reduce the severity of bronchial hyperresponsiveness in asthma but oral theophylline does not. Am. Rev. Resp. Dis. 1987; 136:1174–1178.PubMedCrossRefGoogle Scholar
  50. 50.
    Weinberger M. The pharmacology and therapeutic use of theophylline. J. Allergy Clin. Immunol. 1984; 73:525.CrossRefGoogle Scholar
  51. 51.
    Weinberger M and Hendeles L. Slow-release theophylline: rational and basis for product selection. N. Engl. J. Med. 1983; 308:760–764.CrossRefGoogle Scholar
  52. 52.
    Rogers R, Owens G, and Pennock B. The pendulum swings again towards rational use of theophylline. Chest 1985; 87:280–282.CrossRefGoogle Scholar
  53. 53.
    Ellis EF. Theophylline toxicity. J. Allergy Clin. Immunol. 1985; 76:297–301.CrossRefGoogle Scholar
  54. 54.
    Tsiu SJ, Self TH, and Burns R. Theophylline toxicity: update. Am. Allergy 1990; 64:241–257.Google Scholar
  55. 55.
    Gross NJ. Ipratropium bromide. N. Engl. J. Med. 1988; 319:486–494.PubMedCrossRefGoogle Scholar
  56. 56.
    Rebuck AS, Gent M, and Chapman KR. Anticholinergic and sympathomimetic combination therapy of asthma. J. Allergy Clin. Immunol. 1983; 71:317–323.PubMedCrossRefGoogle Scholar
  57. 57.
    Tashkin DP, Ashutosh K, Bleecker ER, et al. Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease. Am. J. Med. 1986; 81(Suppl. 5A):59–68.Google Scholar
  58. 58.
    Storms WW, Bodman SF, Nathan RA, et al. Use of ipratropium bromide in asthma. Am. J. Med. 1986; 81:61–66.PubMedCrossRefGoogle Scholar
  59. 59.
    Zeiger RS, Schatz M, Sperling W, Simon RA, and Stevenson DD. Efficacy of troleandomycin in outpatients with severe, corticosteroid-dependent asthma. J. Allergy Clin. Immunol. 1980; 66:438–446.PubMedCrossRefGoogle Scholar
  60. 60.
    Szefler SJ, Rose JQ, Ellis EF, Spector SL, Green AW, and Jusko WJ. The effect of troleandomycin on methylprednisolone elimination. J. Allergy Clin. Immunol. 1990; 66:447–451.CrossRefGoogle Scholar
  61. 61.
    Eitches RW, Rachelefsky GS, Katz RM, Mendoza GR, and Siegel SC. Methyl-prednisolone and troleandomycin in treatment of steroid-dependent asthmatic children. Am. J. Dis. Child. 1985; 139:264–268.PubMedGoogle Scholar
  62. 62.
    Mullarkey MF, Blumenstein BA, Andrade WP, Bailey GA, Olason I, and Wetzel CE. Methotrexate in the treatment of corticosteroid-dependent asthma. N. Engl. J. Med. 1988; 318:603–607.PubMedCrossRefGoogle Scholar
  63. 63.
    Mullarkey MF, Lammert JK, and Blumenstein BA. Long-term methotrexate treatment in corticosteroid-dependent asthma. Ann. Intern. Med. 1990; 112:577–581.PubMedCrossRefGoogle Scholar
  64. 64.
    Herman JJ, Noah ZL, and Moody RR. Use of isoproterenol for status asthmaticus in children. Crit. Care Med. 1983; 11:716–719.PubMedCrossRefGoogle Scholar
  65. 65.
    Fuglsang G, Pedersen S, and Bortstrom L. Dose-response relationships of intravenously administered terbutaline in children with asthma. J. Pediatr. 1989; 114:315–320.PubMedCrossRefGoogle Scholar
  66. 66.
    Bohn D, Kalloghlian A, Jenkins J, Edmonds J, and Barker G. Intravenous albuterol in the treatment of status asthmaticus in children. Crit. Care Med. 1985; 12:892–895.CrossRefGoogle Scholar
  67. 67.
    Virant FS. Chronic sinus disease in children. Pediatr. Asthma Allergy Immunol. 1988; 2:185–190.CrossRefGoogle Scholar
  68. 68.
    Towbin R and Dunbar JS. The paranasal sinuses in childhood. Radiographics 1982; 2:253.Google Scholar
  69. 69.
    Swischuk LE, Harden CK, and Dillard RA. Sinusitis in children. Radiographics 1982; 2:241.Google Scholar
  70. 70.
    Tinkelman DG and Silk H. Clinical and bacteriologie features of chronic sinusitis in children. Am. J. Dis. Child. 1989; 143:938.PubMedGoogle Scholar
  71. 71.
    Goldenhersh MJ, Rachelefsky GS, Dudley J, et al. The microbiology of chronic sinus disease in children with respiratory allergy. J. Allergy Clin. Immunol. 1990; 85:1030.PubMedCrossRefGoogle Scholar
  72. 72.
    Rachelefsky GS, Katz RM, and Siegel SC. Chronic sinus disease with associated reactive airway disease in children. Pediatrics 1984; 73:526–529.PubMedGoogle Scholar
  73. 73.
    Virant FS. Increasing rate of asthma mortality. Clin. Adv. Asthma 1990; 1(4):4–11.Google Scholar
  74. 74.
    Wilson AF. Aerosol dynamics and delivery systems, in Drug Therapy for Asthma (Jenne JW and Murphy S, eds.), Marcel Dekker, New York, 1987; pp. 389–412.Google Scholar
  75. 75.
    Shim C and Williams MH. The adequacy of inhalation of aerosol from the canister nebulizers. Am. J. Med. 1980; 69:891–894.PubMedCrossRefGoogle Scholar
  76. 76.
    Newman SP, Pavia D, and Clarke SW. Simple instructions for using pressurized aerosol bronchodilators. J. R. Soc. Med. 1980; 73:776–779.PubMedGoogle Scholar
  77. 77.
    McNabb WL, Wilson-Pessano SR, Hughes GW, and Scamagas P. Self-management education of children with asthma. Am. J. Public Health 1985; 75(10): 1219–1220.PubMedCrossRefGoogle Scholar
  78. 78.
    Lewis CE, Rachelefsky GS, Lewis MA, de la Sota A, and Kaplan M. A randomized trial of A.C.T. (asthma care training) for kids. Pediatrics 1984; 74:478–486.PubMedGoogle Scholar
  79. 79.
    Hindi-Alexander MC and Croop GJA. Evaluation of a family asthma program. J. Allergy Clin. Immunol. 1984; 74:505–510.PubMedCrossRefGoogle Scholar
  80. 80.
    Virant FS and Shapiro GG. Current asthma pharmacotherapy. Hosp. Formul. 1991; 26:379–395.Google Scholar
  81. 81.
    National Heart, Lung, and Blood Institute. Air wise: self management of asthma through individual education. NIH publication No. 85-2363. Bethesda, MD, 1984.Google Scholar
  82. 82.
    National Heart, Lung, and Blood Institute. Living with asthma: Part 1: Manual for teaching parents the self-management of childhood asthma: Part 2: Manual for teaching children the self-management of asthma. NIH publication No. 85-2364. Bethesda, MD, 1984Google Scholar

Copyright information

© The Humana Press Inc. 1994

Authors and Affiliations

  • Frank S. Virant
    • 1
  • Gail G. Shapiro
    • 1
  1. 1.University of Washington School of MedicineSeattleUSA

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