Feature Article

Paediatric asthma: update on the stepwise management approach

Stuart Haggie, Paul D. Robinson

Figures

© andrey deryabin/ istockphoto.com model used for illustrative purposes only
© andrey deryabin/ istockphoto.com model used for illustrative purposes only

Abstract

The 2019 and 2020 updates to the Australian Asthma Handbook (versions 2.0 and 2.1) included a major update to evidence and advice on managing asthma in infants and children. Enhanced adherence to these guidelines is crucial for efforts to address the ongoing concern about preventable asthma deaths in Australia.

Key Points

  • The stepwise approach to management of childhood asthma differs by age group (0 to 12 months, 1 to 5 years, 6 to 11 years and 12 years and over).
  • Before any stepwise increase in asthma preventer treatment, clinicians should reconsider the diagnosis of asthma, check the parents’ and child’s understanding of asthma management and treatment adherence, and minimise exposure to triggers and environmental tobacco smoke.
  • Asthma should be considered as a chronic remitting and relapsing condition, with any hospital presentation representing evidence of inadequate disease control.
  • Asthma exacerbations should be considered as a red flag and prompt review of current management.
  • Children should be referred for specialist paediatric assessment if they have:
    – continued poor symptom control or airflow limitation on spirometry despite appropriate asthma preventer management
    – more than two courses of systemic corticosteroids per year or more than one hospital presentation per year
    – limitations on school attendance or participation in activities
    – any life-threatening episode of asthma.

Figures

© andrey deryabin/ istockphoto.com model used for illustrative purposes only
© andrey deryabin/ istockphoto.com model used for illustrative purposes only