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Pediatric asthma management remains challenging for physicians
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Asthma in young children presents a unique set of challenges for physicians when diagnosing and considering treatment options, according to speakers.
One major hurdle in treating pediatric asthma is making a diagnosis in young children, especially in 2- to 3-year-olds, because only 40% of children with wheezing will develop asthma, Michelle M. Cloutier, MD, of the Connecticut Children’s Medical Center in Hartford, said during the discussion. If physicians could distinguish between children who will develop asthma and those who experience wheezing early in life, then settling on an appropriate therapy would be easier, she said.
Cloutier also said that the asthma predictive index — which has gained popularity in the past decade — has reasonably good capacity (61%) as a diagnostic tool. However, the index requires several wheezing episodes before initiating therapy, and Cloutier noted that most physicians will not always wait to start daily therapy.
Another issue is response to treatment. Peyton Eggleston, MD, of the Johns Hopkins Children’s Center, cited the Prevention of Early Asthma in Kids (PEAK) trial to illustrate the nature of this problem: When children in the PEAK trial underwent asthma therapy, they responded similar to those with asthma. He posed the question of whether or not initiating treatment for asthma may alter morbidity.
Questions also arose about dosing amounts. Although a few studies exist on doubling or quadrupling doses in adults during an acute asthma exacerbation, not much data address the issue in children, making it difficult to determine whether it is beneficial, according to Cloutier.
Parental concerns also contribute to the dilemma. Some worry about growth problems related to therapy; others think about cost; and others do not feel their child needs treatment if symptoms are not present. Therefore, parents often stop treatment or only treat intermittently without consulting physicians. Cloutier and Eggleston said they often assure parents that reduction of height is minimal, but factoring in other parental concerns can create problems with asthma management. – by Melissa Foster
Cloutier M. #2002. Presented at: 2010 Annual Meeting of the American Academy of Asthma, Allergy and Immunology; Feb. 26-March 2, 2010; New Orleans.