New guidelines issued recently insist that children aged
five and under should be treated with oral corticosteroids for asthma only if
their wheeze is severe enough to require hospital admission, especially those
with intermittent viral-induced wheezing.
The Thoracic Society of Australia and New Zealand (TSANZ)
updated its position statement on corticosteroid use in childhood asthma after
reviewing recently published clinical research.
The understanding of childhood asthma and recognition of the
need for separate management guidelines for children aged five and under has
increased since the TSANZ published its previous position statement in 2002,
Professor Peter Van Asperen, Head of the Department of Respiratory Medicine at
The Children's Hospital at Westmead said in an editorial published in the
latest Medical Journal of Australia.
"If control is not achieved using initial preventer
therapy, it is important to review the diagnosis of asthma - particularly in
children aged five years or younger - as many children with recurrent cough are
mislabelled as having asthma," Prof Van Asperen said.
"Oral corticosteroids improve outcomes in children
presenting to hospital with acute asthma, but the efficacy of oral
corticosteroids for children aged five years or younger with acute, mild-moderate,
viral-induced wheezing has been questioned.
"In children aged five years or younger (particularly
those with intermittent, viral-induced wheezing) the use of oral
corticosteroids should be limited to those with severe wheeze who require
The revised position statement also provides updated
recommendations on the roles of inhaled corticosteroids, leukotriene receptor
antagonists and combination medications in childhood asthma management. It
highlights the role of leukotriene receptor antagonists as an alternative to
long-acting beta-agonists as add on therapy in children not adequately
controlled on inhaled corticosteroids and also recommends that long-acting
beta-agonists not be used in children aged five years or younger.