Issues in pediatric asthma

Different wheezing syndromes can carry the diagnostic label of "asthma," es pecially in very young children, and an accurate differential diagnosis is essential for improving outcomes, Because presenting symptoms are similar, making a rapid, accurate differential diagnosis is often daunting. Asthma c an, eventually, be distinguished from other wheezing disorders based on dif ferences in symptomatology, pathophysiology, and disease evolution. Once di agnosed, inhaled corticosteroids (ICS) remain the cornerstone of treatment in persistent pediatric asthma. Compelling evidence supports the benefits o f these agents in reducing asthma-related morbidity and mortality and in pr eventing airway remodeling. As a result, ICS use in young children with ast hma has grown substantially in recent years. Questions are being raised abo ut the appropriateness of early and long-term use of ICS in young children, and whether ICS are overused in this population. Because of the challenges faced by clinicians in differentiating asthma from the other childhood whe ezing disorders often present in young children, it may be best to delay th e use of regular ICS therapy until a definitive diagnosis can be establishe d. Alternatives to ICS (such as the leukotriene receptor antagonists) shoul d also be considered to avoid the growth-suppressing potential of steroids in the management of mild asthma. (C) 2001 Wiley-Liss. Inc.