The Paediatric Asthma Yardstick, a new guideline from the American College of Allergy, Asthma and Immunology (ACAAI), offers a user-friendly “operational document.” It helps health care professionals understand which controller treatments are right for which age groups and identifies when a step up is needed.
“There is nothing like the Paediatric Asthma Yardstick in the current literature,” says allergist Dr Bradley Chipps, ACAAI president and lead author of the paper. “We created the yardstick because there are many options for treating paediatric asthma. It’s a roadmap for how to move forward with kids whose asthma is not under control. The yardstick describes controller treatments at different levels of severity for all ages, the choices available for parents for their child and how to step up therapy.”
The diagnosis and management of asthma in children differs from that in adults. Differences also exist between the three age groups addressed in the yardstick – adolescents, 12-18 years old; school-age children, 6-11 years old; infants and young children, 5 years old and under.
“Differences in diagnosis and management of asthma in children reflect differences in development of their respiratory systems, particularly for younger children,” says Dr Leonard Bacharier, co-author of the yardstick. “Other factors include challenges related to daily activities and emotional and social concerns, particularly for adolescents. Comorbid conditions and non-adherence with treatment (due to the stigma of having a chronic condition and taking medicine) can affect outcomes for older children.”
Although asthma often begins in early childhood, diagnosing asthma in the very young child is challenging because it is based largely on symptoms and is not easily confirmed by objective testing, such as lung function. Additionally, symptoms, notably wheezing and coughing, often are related to, or occur with, common viral infections. Paediatric data for medicines are limited and robust clinical studies attesting to efficacy and safety of asthma medications are few.
“The Paediatric Asthma Yardstick is a practical resource for identifying children with uncontrolled asthma who need a step-up in controller medicine,” says Chipps. “It describes how to start and/or adjust controller therapy based on the options that are currently available for children, from infants to 18 years of age. The recommendations are presented around patient profiles, by severity and age, and are based on current best practice strategies according to the most recent data and the authors’ clinical experience.”
Current asthma guidelines recommend a control-based approach to management involving assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient’s needs and preferences. However, for children with asthma, achieving control can be elusive. Although tools are available to help children (and families) track and manage day-to-day symptoms, when and how to implement a longer-term step-up in care is less clear. Furthermore, treatment is challenged by the 3 age groups of childhood—adolescence (12–18 years old), school age (6–11 years old), and young children (≤5 years old)—and what works for 1 age group might not be the best approach for another. The Pediatric Asthma Yardstick provides an in-depth assessment of when and how to step-up therapy for the child with not well or poorly controlled asthma. Development of this tool follows others in the Yardstick series, presenting patient profiles and step-up strategies based on current guidance documents, but modified according to newer data and the authors’ combined clinical experience. The objective is to provide clinicians who treat children with asthma practical and clinically relevant recommendations for each step-up and each intervention, with the intent of helping practitioners better treat their pediatric patients with asthma, particularly those who do not always respond to recommended therapies.
Bradley E Chipps, Leonard B Bacharier, Judith R Farrar, Daniel J Jackson, Kevin R Murphy, Wanda Phipatanakul, Stanley J Szefler, W Gerald Teague, Robert S Zeiger