Permanent childhood asthma: inhaled corticosteroids, based DMARD

Inhaled corticosteroids are the mainstay of treatment for the bottom of the persistent asthma in children, said Dr. Francis Amsallem (CHU Montpellier), in an oral session of Pediatrics, held in Paris as part of the interviews Bichat.

Asthma: a common disease in children

Asthma is the most common chronic disease in children, affecting about 10% of them and growing in almost all industrialized countries, he says. "Two reports, one after the GINA (Global INitiative for Asthma), the other PRACTALL group for launching base treatment recommendations, knowing that if the beta2-agonist short action is the only treatment necessary when asthma is intermittent, the transition to inhaled corticosteroids is required for persistent asthma, "informs the pediatrician.

If, however, asthma affects 30 to 50% less than 3 years, more than half of them do not whistle at the age of 6 years, predictors of persistent asthma are family history of asthma or allergy, atopy (eczema) and the severity of the condition.

"In infants and young children, the priority is to eliminate false asthma (malformations, cystic fibrosis, bronchial dyskinesia, foreign body, immune deficiency, ciliopathy). Should then look for markers of atopy and aggravating factors associated often entangled (gastroesophageal reflux disease, passive smoking, iron deficiency), then make a allergy tests (IgE, skin tests), and a chest X-ray, "said Dr. Amsallem. Other further exploration should be considered in the presence of signs of severity or failure of the treatment, he added.

Different phenotypes of asthma are described in terms of triggers, he observes: virus-induced asthma, asthma induced by exercise, or non-allergic asthma.

Observe doses and equivalences based on corticosteroid selected

In infants, said Dr. Amsallem, treatment with inhaled corticosteroids is recommended at a dose of 100 to 400 micrograms of fluticasone or equivalent, thus respecting the difference of doses depending on the chosen (100 micrograms of fluticasone product correspond to the same dose of beclomethasone, budesonide 200 mcg + spray inhalation chamber and 500 mg of nebulized budesonide). "In addition, leukotriene antagonists may be useful in the treatment of virus-induced asthma," he points out.

In children over 2 years, it is proposed to start with low doses of inhaled corticosteroids (200 mcg of beclomethasone or equivalent) and in case of lack of control, doubling the dose (400 micrograms) or associate a leukotriene (200 mcg of beclomethasone + ALT). In the next step, says the specialist, is administered a higher dose of inhaled corticosteroid (800 mcg of beclomethasone) or added is a leukotriene (with 400 mcg of beclomethasone) or a beta2 agonist long duration of action ( with 800 mcg of beclomethasone) to book the big kid, he warns.

"Beyond that, there are more options but only recommendations: increasing doses of corticosteroids, the addition of theophylline, temporary use of oral corticosteroids, anti-IgE in the more than 12 years," explains the specialist in insisting that before intensify treatment background, where poor control of the disease, it is essential to eliminate incorrect inhalation technique, a lack of compliance or the occurrence of related aggravating factors.

Asthma is considered controlled when there is more diurnal or nocturnal symptoms, no truancy, no use of a beta2-mimetic action more rapid processing of background, no occurrence of exacerbation as well as PFT (pulmonary function tests) and normal physical activities.