Asthma an update of the guideline for Dutch Youth Health Care: abstract

Background and aims Asthma is a chronic respiratory disease affecting 12% of children > 6 years in the Netherlands. Asthma is characterized by variable symptoms of wheeze, shortness of breath, chest tightness an cough, and by variable expiratory airflow limitation. Atopy is present in the majority of children with asthma. Youth Health Care (YHC) professionals have an important role in the prevention of (symptoms of) asthma and in case-finding. The aim of the project was to develop an update of the web-based clinical guideline on the subject for YHC professionals. Methods A working group of various disciplines involved in the screening and treatment of asthma, patients’ representatives, researchers and guideline developers updated the guideline according to the principles of evidence-based medicine. Results The guideline provides YHC professionals with background information on asthma and its treatment, and recommendations regarding case-finding and non-pharmacological strategies to control symptoms. Asthma often begins in early childhood. However wheezing in young children is a heterogeneous condition and not all wheezing children will develop asthma. Some viral infections are associated with recurrent wheezing during childhood. Asthma is more likely if wheezing occurs in the absence of a viral infection, or when it is related to an allergic trigger. A major risk factor is a family history of asthma or allergic disease (eczema or allergic rhinitis). Primary prevention of asthma consists of allergen avoidance (multifaceted) and avoidance of pre- and postnatal exposure to environmental tobacco smoke. Breastfeeding is advised for its general health benefits, not necessarily for asthma prevention. Exposure to outdoor pollutants is also associated with an increased risk of asthma. The guideline is based on a literature review, together with experiences of professionals (YHC, GPs, pediatricians) and of youth and their caregivers. Conclusions An updated, web-based guideline for early detection and prevention of asthma symptoms was developed. This guideline will contribute to better quality of healthcare, as it supports evidence-based practice. Statement or main question Prevention of asthma by YHC professionals requires case-finding according to the clinical guideline and appropriate advice (avoidance of pre- and postnatal exposure to environmental tobacco smoke!) towards youth and their caregivers.