Balancing safety and efficacy in the treatment of pediatric asthma.

The treatment of pediatric asthma requires balancing the efficacy and safety of various asthma medications, facilitating patient and family education, and developing a supportive treatment network. The efficacy and safety of the major asthma controllers--cromolyn, long-acting beta(2)-agonists, inhaled corticosteroids, and leukotriene receptor antagonists-are well tolerated overall when used appropriately. Cromolyn is used often as first-line therapy in treating pediatric asthma, but the inhaled corticosteroids remain the cornerstone of pediatric asthma control. Long-acting beta(2)-agonists are most beneficial when used intermittently or in combination with other asthma medications. The most recent class of drugs, the leukotriene receptor antagonists are effective in controlling asthma and are well tolerated in children as young as 2 years of age. In moderate-to-severe pediatric asthma, combination therapy is often required to achieve optimal asthma control. Leukotriene receptor antagonists combined with inhaled corticosteroids reduce the need for steroid rescue, the rate of serious exacerbations, and the level of inflammation. The treatment of asthma requires the ability to diagnose and treat asthma effectively. In subpopulations with special needs such as very young or inner-city minority children, treating asthma requires a comprehensive approach that includes a supportive patient-physician relationship and the involvement of schools, churches, and neighborhood outreach programs that will identify children with asthma and promote quality care.