Management of childhood asthma [State of the Art Series. Asthma in high- and low-income countries, Edited by M. Chan-Yeung. Number 5 in the series]

The guidelines for the management of childhood asthma have evolved from recommendations by experts to being evidence-based as a result of better understanding of the pathophysiology of asthma, awareness of the heterogeneity and early onset of childhood asthma and a new approach to the pharmacological management. While there are reasonably good evidence-based guidelines for the treatment of asthma in children aged over 5 years, there is a paucity of data for preschool children for the most appropriate management. Most guidelines include recommendations on diagnosis of asthma in children and pharmacological treatment according to the severity of the asthma. Environmental control is an important cornerstone of care, and allergen avoidance should be recommended for children with asthma who are known to be sensitised to the allergen. Environmental tobacco smoke remains an important trigger for worsening asthma in all children, and their parents must be encouraged to give up the habit. Educating children with asthma and their care givers on the disease and proper treatment is another vital element in the management of asthma. There remains a major problem with ensuring the implementation of guidelines in most countries. A care gap thus exists between best practice and common practice. The impact on asthma morbidity of developing and implementing guidelines requires appropriate study.