New Canadian Paediatric Asthma Guidelines
Reported by Mary Allen, AAIA CEO
Canada's asthma guidelines were originally published in 1999. At that time there was little focus on childhood asthma. In the most recent update, paediatric asthma was addressed and the guidelines for children have recently been published in the Canadian Medical Association Journal (CMAJ September 2005; 173(suppl):S1-S56).
Some of the topics reviewed in the development of the guidelines include diagnosis of asthma in the young child, prevention, asthma education, and therapy. All recommendations were evidence based with the level of evidence specified.
Most asthma begins very early in childhood and the earlier the diagnosis, the better our ability to prevent deterioration of lung function and to achieve a good level of control. In diagnosing asthma two of the key elements to be looked at are family history and the presence of atopy (allergy). The most important major risk factors for the development of asthma are parental asthma and the presence of eczema. Other factors such as allergic rhinitis and wheezing without colds also increase risk. Atopy is a predictor of persistent asthma. In those children who are unresponsive to therapy, the physician should be alert for the existence of other conditions.
In terms of primary prevention of asthma, the authors noted that the data on early life exposure to pets is conflicting but they did recommend that families where both parents are allergic should avoid having cats and dogs in the home. Breastfeeding was recommended because of its numerous benefits but there was conflicting or insufficient evidence to support the claim that breastfeeding would aid in preventing asthma. In terms of secondary preventative measures, cigarette smoke is to be avoided and appropriate environmental control is encouraged. Allergy testing and reduction of allergen exposure are also recommended.
As in adult asthma, the continuum of care for children should include:
- Education, environmental control, written action plan and follow-up
- Fast acting bronchodilator used appropriately
- Inhaled corticosteroids as the first line medication to combat inflammation
- Add-on therapies for moderate to severe asthma
- * Prednisone may be used in severe cases or situations.
Physicians should regularly assess control; triggers; compliance; inhaler techniques; and any co-existing conditions. Immunotherapy could be considered if asthma is well documented and control is inadequate. Education is an essential component of asthma therapy and should be offered to parents and patients of all ages.
To read more about the guidelines go to www.cmaj.ca/content/vol173/6_suppl/index.shtml
Dr. Allan Becker of Winnipeg's University of Manitoba has played a leading role in the development of these guidelines and deserves much credit. Having been involved in the committee I can attest that he and many other experts have devoted many volunteer hours to this undertaking because they believe that asthma care and control can be improved. Health Canada statistics in recent years show a significant decline in asthma mortality, so progress is indeed being made. But we know that asthma control is not optimal. We as patients can do our part - we have access to excellent asthma treatment in Canada and need to work in partnership with our children's physicians to ensure that they are receiving the best possible care, education and regular follow-up. (This also holds true for adult asthma!)
from Allergy & Asthma News, Issue 4 2005