Presentation of new GINA guidelines for paediatrics

The Global Initiative on Asthma (GINA) has provided guidelines for the mana gement of children with asthma. For a step-wise approach to therapy, asthma is divided into four categories based on severity of symptoms: intermitten t, mild persistent, moderate persistent, and severe persistent asthma. Long -term preventive therapy is distinguished from quick relief therapy in each group. Although these guidelines are clear and simple there have been few studies on asthma therapy for infants. Moreover, the existence of different wheezing phenotypes with varying pathogenic mechanisms hampers the interpr etation of these studies. Transient wheezers have stopped wheezing by the a ge of 3 years and there is no relationship to atopy or a family history of asthma. Tn contrast, persistent wheezers continue to wheeze from the first year of life throughout school-age and have a high risk of atopy. Although they have normal lung function at birth, persistent wheezers develop signif icant decrements in lung function by the age of 6 years. Whether these impa irments are amenable to prevention by early initiation of antiinflammatory therapy remains to be seen. At present, there are no disease markers to ide ntify the different wheezing phenotypes in infancy, although eosinophil cou nts and measurements of eosinophil cationic protein in serum may prove to b e helpful in distinguishing these conditions.