Paediatric asthma best practice not only includes prescribing the correct therapeutic mix based on consensus guidelines, but also reducing therapy once control has been achieved. Clinicians should also be aware that asthma in young children is a heterogeneous entity, and a beneficial response to bronchodilators and/or inhaled steroids is not inevitable. In general, preschool children and infants should not be prescribed inhaled corticosteroids above 200 μg beclometasone dipropionate equivalent twice a day, or regular oral steroids, or long acting β2-adrenoceptor agonists. New therapies such as anti-IgE antibodies are on the horizon, but these are unlikely to replace the established drug combinations. More likely is that the delivery of established drugs will become more convenient (for example, once a day inhaled corticosteroids, or season dependent prophylactic therapy).
- BDP, beclometasone dipropionate
- FEV1, forced expiratory volume in one second
- LABA, long acting β2-adrenoceptor agonist
- pMDI, pressurised metered dose inhaler
- PEF, peak expiratory flow
- RSV, respiratory syncytial virus
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I have received financial support to attend conferences from Astra, 3M, Merck (UK), Glaxo-Wellcome, and payment for lectures given at educational meetings from Astra, Merck (UK), and Glaxo-Wellcome. I have also been a co-investigator on a asthma genetics study funded by Glaxo-Wellcome.
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