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Childhood asthma has been with us for many years, and prevalence has been increasing. Asthma is the fifth most common killer in our country, and although it may not kill as many people as infectious diseases, the quality of life of an asthmatic may be seriously impaired, leaving a child or adult with compromised lung health that never goes away. The diagnosis of asthma, which is characterised by variable expiratory airflow limitation, is primarily based on recurrent cough and wheeze. Asthma management should be personalised, and long-term asthma management involves assessing, adjusting and reviewing treatment response. Medication should be titrated up or down for individual patient needs. [ABSTRACT FROM AUTHOR]

Summary: Asthma is a complex disease with a significant inflammatory component characterized by repeated episodes of exacerbation and inflammatory changes in both large and peripheral airways. The clinical course of childhood asthma varies substantially among individuals. The reasons why the clinical course of asthma displays persistence and even progression in some children but is intermittent in others remains unclear. Children with asthma are different from adults with asthma. Inflammatory involvement in children with asthma appears to be localised more in peripheral than central airways, and the inflammatory phenotype displays differences from adults. Children with acute asthma display a dominant eosinophilic inflammatory phenotype instead of the neutrophilic phenotype that is seen in adults with acute asthma. Corticosteroids do not alter the natural history of the disease and may not prevent progressive decline of lung function in the subset of severe asthma. The underlying inflammatory mechanisms involved in the decline of lung function remains to be elucidated. Non-invasive biomarkers for monitoring lung function and inflammation are needed in children to track and monitor pathological changes in the distal airways, as is the development of therapeutic strategies that effective to peripheral airway in this vulnerable population. This review summarises our present understanding of airway inflammatory phenotypes in children with asthma and factors determining disease severity in exacerbations of asthma, and focuses on studies evaluating relationships between clinical features and the dominant inflammatory phenotypes in disease prognosis in a variety of asthma populations. This presents the crucial steps for describing the strategies associated with improvements for paediatric asthma care. [ABSTRACT FROM AUTHOR]

Summary: Objective: To evaluate the efficacy and safety of three doses of ciclesonide (with or without spacer) in children with persistent asthma. Patients and methods: This was a multicentre, double-blind, placebo-controlled, 12-week study of ciclesonide 40, 80 or 160 μg (once daily pm). Children (6–11 years) were randomised 1:1 to treatment via a metered dose inhaler (MDI) or MDI plus spacer. The primary variable was change from baseline in mean morning peak expiratory flow (PEF). Secondary variables included: time to first lack of efficacy (LOE), asthma control, forced expiratory volume in 1 s (FEV1), asthma symptom score and quality of life (QoL). Safety assessments included: adverse events (AEs), urinary cortisol excretion and body height. Results: In total, 1073 children received treatment. At endpoint, mean morning PEF significantly improved with all doses of ciclesonide vs. placebo. There was no difference over placebo in time to first LOE, but ciclesonide was superior to placebo on asthma control, symptom score, FEV1 and QoL. There were no differences between the spacer or non-spacer subgroups. The incidences of AEs were comparable between treatment groups (approximately 35%) and there were no between-group differences in body height or urinary cortisol. Conclusions: Ciclesonide 40–160 μg once daily is effective and well tolerated in children with persistent asthma; its efficacy and safety are unaffected by the use of a spacer. clinicaltrials.gov registration number: NCT00384189. [ABSTRACT FROM AUTHOR]

Summary: ‘Paediatric asthma: everything that seemed to be certain no longer is’, holds the promise of leaving you with more questions than answers at the end of this review of paediatric asthma 2008–2009. This has often been true for asthma research, in particular over the past few years. Research with direct consequences for a clinician managing children with wheezing or asthma is discussed such as limitations in the characterisation of asthma phenotypes and the influence of early viral infections on asthma and the development of atopic sensitisation. It appears that wheezing in preschool children with specific viral pathogens confers differential rates of asthma risk. Viruses and day-care shift respiratory morbidity to an early age when it is more troublesome than at a later age but are not protective for sensitisation or asthma. What needs to be further explored is the relationship between viruses and recurrent wheeze or asthma in studies with stringently defined phenotypes including personal atopic status, timing of infection, and severity of infection. A modification of preschool wheeze phenotypes or replacement by other phenotypes that have been defined with the application of different methods is needed. Oral corticosteroids should not be prescribed in preschool children with acute mild to moderate viral wheeze, unless a severe outcome is anticipated or if the child has a classic atopic phenotype. Despite initial high expectations, FeNO was proven not to be beneficial for routine monitoring of asthma treatment. [ABSTRACT FROM AUTHOR]

Asthma is one of the most common childhood illnesses with which patients will present to general practitioners. Despite this, the associated mortality and morbidity remain high, particularly in South Africa. This is largely due to the diagnostic and therapeutic challenges that are associated with asthma in childhood. This results in under-diagnosis of asthma and poor control of known patients who are on treatment. Creating awareness among patients and health practitioners, as well as including the allied healthcare providers in the management of childhood asthma, can help improve the diagnosis and care of patients with asthma. Specifically, community pharmacists can play a major role in improving the outcomes of patients with asthma [ABSTRACT FROM AUTHOR]