MANAGING SYMPTOMS AND EXACERBATIONS IN PEDIATRIC ASTHMA

International guidelines indicate that the primary goals of asthma tre atment are minimizing symptoms and preventing exacerbations. Symptoms last for short periods of time (minutes or hours) and usually disappea r either spontaneously or with the use of bronchodilator therapy. Exac erbations last for 1 or more days and need more extensive bronchodilat or therapy with the possible addition of a course of oral corticostero ids. Particularly in children, because of their active life style, exe rcise-induced symptoms may interfere with normal daily life, and noctu rnal symptoms may cause severe sleep disturbance. Although the avoidan ce of triggers that provoke symptoms and exacerbations is advocated in the guidelines, this is not a practical option as it is extremely dif ficult for asthmatic children to lead a normal life and yet avoid exer cise. Long-term use of medication is therefore necessary to achieve th e treatment goals. Inhaled corticosteroids have been shown to be the m ost effective drugs for reducing asthma symptoms and exacerbations. Ho wever, most children will not be free of symptoms during corticosteroi d therapy and intermittent use of bronchodilator therapy is required. Cessation of inhaled corticosteroid therapy, even after several years of use, is likely to result in a reoccurrence of asthma symptoms. Long -acting beta(2)-agonists, such as salmeterol and formoterol, are now a vailable as additional therapy to inhaled corticosteroids in patients who remain symptomatic despite at least a moderate dose of inhaled cor ticosteroid. Two recent studies in adults revealed addition of salmete rol superior to increasing inhaled corticosteroid dose. So far, no dat a in children are available, but theoretically it might be attractive to add a long-acting beta(2)-agonist to on-going therapy for children who remain symptomatic, especially at nighttime, despite the use of in haled corticosteroids. There is no place for the use of long-acting be ta(2)-agonists as monotherapy in pediatric patients. (C) 1997 Wiley-Li ss, Inc.