Continuing Medical Education

Asthma treatment in children: A pragmatic approach

R Masekela, A Jeevanathrum, S Kling, T C Gray, J Morrison, A Vanker, A S Puterman, D Rhode, E W Zöllner, P de Waal, A Manjra, M Levin, H Zar, R J Green, F E Kritzinger; on behalf of the South African Childhood Asthma Working Group (SACAWG)

Abstract


Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life.

Objectives. To provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.

Methods. The South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.

Conclusions. To ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.


Authors' affiliations

R Masekela, Inkosi Albert Luthuli Central Hospital and Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

A Jeevanathrum, Steve Biko Academic Hospital and Department of Paediatrics and Child Health, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

S Kling, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

T C Gray, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

J Morrison, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

A Vanker, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa

A S Puterman, Private practice, Life Kingsbury Hospital, Cape Town, South Africa

D Rhode, Private practice, Melomed Private Hospital, Cape Town, South Africa

E W Zöllner, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

P de Waal, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

A Manjra, Private practice, Life Westville Hospital, Durban, South Africa

M Levin, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa

H Zar, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa

R J Green, Steve Biko Academic Hospital and Department of Paediatrics and Child Health, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

F E Kritzinger; on behalf of the South African Childhood Asthma Working Group (SACAWG), Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town; and Netcare Christiaan Barnard Memorial Hospital, Cape Town, South Africa

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Keywords

Asthma; Children

Cite this article

South African Medical Journal 2018;108(8):612-618. DOI:10.7196/SAMJ.2018.v108i8.13164

Article History

Date submitted: 2018-07-25
Date published: 2018-07-25

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