The management of asthma in children in Papua New Guinea.

In the last decade advances in knowledge of the aetiology and pathogenesis of asthma, and the availability of metered-dose inhalers and nebulisers, has led to a change in emphasis in both the preventive and curative aspects of the management of children with asthma. Metered-dose inhalers are available in Papua New Guinea, and can be used successfully, with spacing devices, even in children less than 2 years of age. Inhaled beta-sympathomimetics, now widely available and relatively inexpensive, may be all that is required for the majority of children with infrequent episodic asthma. For those with frequent episodic and chronic asthma, preventive therapy with inhaled steroids is available and should be given wherever practicable. In the management of acute severe asthma inhaled beta-sympathomimetics should be combined with a short course of oral or parenteral steroids (covered with isoniazid in areas where tuberculosis is prevalent). Whilst asthma classically presents with wheeze, medical personnel should be aware of its other presentations. It is possible, and should be the aim, to achieve a very high level of control for the majority of asthmatic children using currently available therapy.