Updates in Pediatric Asthma

Asthma is the most common chronic condition in children in the US, with an incidence of 9% (6.8 million individuals under the age of 18). It is more common in children from families living below the poverty threshold (13%) than families with higher incomes (8%). African-American children are more likely to have asthma (16%) than Hispanic (9%) or non-Hispanic white (8%) children. Asthma cannot be cured, but illness and deaths can be prevented with appropriate drug therapy.

The National Asthma Education and Prevention Program (NAEPP) Expert Panel Report (EPR-3) guidelines for the Diagnosis and Management of Asthma are currently used as the standard of practice in the US, but have not been updated since 2007. An international guideline -- the Global Initiative for Asthma (GINA) global strategy for asthma management and prevention – was extensively revised in 2014, and was updated in 2015 to include current literature. GINA provides a comprehensive, integrated approach that is widely used to guide asthma management. Both the EPR-3 and GINA guidelines endorse the involvement of pharmacists and nurse practitioners in comprehensive asthma management strategies. GINA separates asthma patients into 2 age groups: 1) children 5 years of age and younger, and 2) adults, adolescents, and children age 6 and older. This article is focused solely on pediatric asthma, using the GINA age groupings and related recommendations. Children less than 6 years old are considered “young children” and those 6 to 17 years old will be referred to as “older children.” The outpatient management of pediatric asthma based on GINA strategies will be reviewed including the medications most commonly used for pediatric asthma.

The role of community providers in pediatric asthma management is multi-faceted and may include education, monitoring drug therapy, and equipping patients/families for self-management. The educational needs of patients and family include information about the disease and medications, regular review of proper inhaler and spacer technique, instruction about the use of peak flow meters, and recognition of triggers and symptoms. Drug therapy may be monitored through inquiries about effectiveness, side effects, and adherence to treatment. Self-management skills may include adopting asthma action plans, setting goals, avoiding triggers, and home management of exacerbations.