The MJA has just released a review of the management of asthma in kids the review looks mainly at chronic / outpatient management and there are a few changes. They also looked at acute management of asthma and have created a divide between young (< 5 yrs) and older children with regards to oral steroid treatment.
The guidelines are based on the division of asthmatic children into 3 groups: mild / infrequent intermittent, frequent intermittent and chronic / persistent asthma. I use this strategy in my practice and find it useful. The commonest errors that I see in my part of the world is over-prescription of inhaled to corticosteroids to the mild / infrequent group, and the use of combination ICS/long-acting B-agonist as 1st line (hence the title of this post).
The algorithm in the article shows the suggested guidelines for the children with indications for ongoing preventer therapy. The leukotriene blockers get a bit of an upgrade and the older agent Intal get a guernsey…
In terms of acute therapy – the gurus have looked at the stats and feel the younger kids – they have queried the use of oral steroids in acute management of the viral-induced wheeze. They should probably be reserved for the more severe end of the spectrum / those requiring admission. In terms of dose – they recommend 2mg/kg of oral prednisolone on day 1 then a few more days of 1mg/kg.
Asthma is one of the bread and butter diseases of GP, however it is one where the evidence is often not well applied. Let me know, will this change our management?