Treatment Options for Childhood Asthma

Childhood Asthma Guidelines

In 2002, an expert panel from the National Asthma Education and Prevention Program (NAEPP) issued updated guidelines for the diagnosis and management of asthma in both adults and children. The NAEPP expert panel established four severity classification categories of asthma based upon the severity of symptoms, frequency of night awakenings due to asthma symptoms, and lung function. Severity classification of asthma helps doctors devise an optimal treament plan for each category of patients. These categories are:

  • Mild intermittent asthma
  • Mild persistent asthma
  • Moderate persistent asthma
  • Severe persistent asthma

The NAEPP guidelines recommend a stepwise approach for the management of asthma for two categories of patients:

  • Infants and young children 5 years of age and younger
  • Adults and children older than 5 years of age

Mild Intermittent Asthma

  • Symptoms:

    • symptoms occur 2 times a week or less with only brief episodes of acute exacerbations and no limitations on physical activity
    • night awakenings due to asthma symptoms occur 2 times or less per month
    • mild lung function impairment

  • Treatment guidelines:

    • Infants and children 5 years of age and younger:

      • no daily medications required

    • Adults and children older than 5 years of age:

      • no daily medications required
      • a course of treatment with systemic corticosteroids is recommended for episodes of severe asthma attacks should they occur.

Mild Persistent Asthma

  • Symptoms:

    • symptoms occur 2 times a week or less with episodes of acute exacerbations that may limit physical activity
    • night awakenings due to asthma symptoms occur 2 or more times per month
    • mild to moderate lung function impairment

  • Treatment guidelines:

    • Infants and children 5 years of age and younger:

      • Preferred treatment: low-dose inhaled corticosteroids administered with a nebulizer or metered dose inhaler
      • Alternative treatment: cromolyn OR a leukotriene receptor antagonist

    • Adults and children older than 5 years of age:

      • Preferred treatment: low-dose corticosteroids
      • Alternative treatment: cromolyn; leukotriene receptor antagonist; nedocromil; OR sustained-release theophylline

Moderate Persistent Asthma

  • Symptoms

    • symptoms occur daily that require the use of inhaled bronchodilators; acute exacerbations of asthma affect physical activity
    • night awakenings due to asthma symptoms occur at least once a week
    • moderate lung function impairment

  • Treatment guidelines:

    • Infants and children 5 years of age and younger:

      • Preferred treatment: low-dose inhaled corticosteroids and long-acting inhaled Beta-adrenergic bronchodilator OR medium-dose inhaled corticosteroids
      • Alternative treatment: low-dose inhaled corticosteroids and EITHER a leukotriene receptor antagonist OR theophylline

    • Adults and children older than 5 years of age:

      • Preferred treatment: low-to-medium dose inhaled corticosteroids and long-acting inhaled Beta-adrenergic bronchodilator
      • Alternative treatment: medium-dose inhaled corticosteroids OR low-to-medium dose inhaled corticosteroids and EITHER a leukotriene receptor antagonist OR theophylline

Severe Persistent Asthma

  • Symptoms:

    • symptoms occur continously with frequent acute exacerbations that significantly limit physical activity
    • night awakenings due to asthma symptoms occur frequently
    • severe lung function impairment

  • Treatment guidelines:

    • Infants and children 5 years of age and younger:

      • Preferred treatment: high-dose inhaled corticosteroids and long-acting inhaled Beta-adrenergic bronchodilator.
      • Systemic corticosteroids (tablet or syrup) at a dose of 2 mg/kg/day (not to exceed 60 mg per day) should be added if needed.

    • Adults and children older than 5 years of age:

      • Preferred treatment: high-dose inhaled corticosteroids and long-acting inhaled Beta-adrenergic bronchodilator.
      • Systemic corticosteroids (tablet or syrup) at a dose of 2 mg/kg/day (not to exceed 60 mg per day) should be added if needed.