[Dutch College of General Practitioners' practice guideline 'Asthma in children']

Abstract

In children < 6 years characteristic asthma patterns are often lacking and the diagnosis cannot be objectified. For this reason 'episodic expiratory wheezing' is the preferred diagnosis. In children ≥ 6 years asthma is diagnosed on the basis of symptoms; if there is doubt spirometry may be helpful. The treatment goal is complete asthma control, i.e. daytime symptoms < 2/week, no nocturnal symptoms, no limitation of activities, rescue treatment ≤ 2/week, normal spirometry. Smoking by children or relatives is strongly discouraged. In children < 1 year, a monitored trial with short-acting beta-agonist (SABA) is recommended. Controller medication (inhaled corticosteroids (ICS)) is not recommended. In children aged 1 to 6 years, a SABA is recommended, with additional ICS if symptoms persist. Incompletely controlled asthma is an indication for referral. In children ≥ 6 years ICS are recommended in incomplete asthma control. If the normal daily dosage of ICS and adequate coping fail to achieve complete control of the asthma, then referral is recommended. Patients on ICS should be monitored regularly.