Asthma in South African children: Guidelines, obstacles and solutions

摘要

In this issue of CME, we continue the theme of paediatric asthma management that was commenced in the last edition. The prior articles, comprising the summary of the childhood asthma guidelines[1] and the prevention of viral exacerbations of asthma,[2] are followed here by articles on the diagnosis and management of asthma[3] and the management of asthma exacerbations.[4] The need for this update stems from recent major changes in the approach to the diagnosis and management of asthma.[5,6] The most major of these changes stems from a renewed emphasis on the need to treat underlying asthma, in all grades of severity, with the 2019 Global Initiative for Asthma (GINA) guidelines[5] that recommend that an inhaled corticosteroid (ICS) always be used in conjunction with a bronchodilator. This has led to an increasingly prominent role for ICS-formoterol single maintenance and reliever therapy. Data on safety and efficacy in children 12 years of age are still lacking, and therefore in children aged 6 - 11 years, regular low-dose ICS, or an ICS taken together with each dose of as-needed inhaled short-acting beta-2 agonist (SABA), is recommended as the first step in the revised GINA guidelines.[5] The other major change has been the addition of ICS-tiotropium combination therapy as an option for the treatment of difficult-to-control asthma. This is recommended as a possible option for patients ≥6 years at step 4 of the GINA guideline.