Bernstein Jonathan A, Mansfield Lyndon
a University of Cincinnati, College of Medicine , Cincinnati , OH , USA.
b Clinical Research for the Division of Immunology , Cincinnati , Ohio , USA.
J Asthma. 2019 Jul;56(7):758-770. doi: 10.1080/02770903.2018.1490752. Epub 2018 Sep 12.
To review therapeutic options for stepwise management of pediatric asthma in the context of this population's unique needs such as potential effects of asthma, treatments, or both on growth and psychosocial development, and caregiver involvement.
We conducted PubMed searches to identify relevant articles then reviewed resultant articles, guidelines for asthma management in children, and articles from personal files.
Stepwise management of asthma, similar to adults, is recommended for children in current global and US guidelines. Treatment may be stepped up or stepped down temporarily or long-term based on response over time. Inhaled corticosteroids remain the recommended treatment for persistent childhood asthma and any potential small effects on growth are considered relatively minor compared with their benefit. Controller medication options for patients <18 years old are limited, especially for Global Initiative for Asthma Steps 2-5. The long-acting antimuscarinic antagonist tiotropium (Steps 4/5, patients aged ≥12 years) and in certain circumstances (Step 5), anti-immunoglobulin E (aged ≥6 years) and interleukin-5 antibodies (aged ≥12 years) are newer treatment options. Tiotropium is indicated in the United States and Europe for patients ≥6 years old. Stepping down treatment, which is recommended but infrequently practiced, can maintain symptom control and minimize adverse events while substantially reducing costs. Patient education and better monitoring remain important for self-management and optimum outcomes.
A need exists to target individual treatment goals for children with asthma by using step-up and step-down approaches to maximize treatment benefits and minimize potential adverse effects.
鉴于儿童群体的独特需求，如哮喘、治疗方法或两者对生长发育及心理社会发展的潜在影响，以及照顾者的参与情况，综述儿童哮喘逐步管理的治疗选择。
我们进行了PubMed检索以识别相关文章，随后对检索结果文章、儿童哮喘管理指南以及个人文件中的文章进行了综述。
当前全球和美国指南建议，儿童哮喘的管理与成人相似，采用逐步管理方法。治疗可根据一段时间内的反应临时或长期上调或下调。吸入性糖皮质激素仍然是持续性儿童哮喘的推荐治疗方法，与它们带来的益处相比，对生长的任何潜在微小影响被认为相对较小。18岁以下患者的控制药物选择有限，尤其是对于全球哮喘防治创议第2 - 5步。长效抗毒蕈碱拮抗剂噻托溴铵（第4/5步，年龄≥12岁患者）以及在某些情况下（第5步），抗免疫球蛋白E（年龄≥6岁）和白细胞介素-5抗体（年龄≥12岁）是较新的治疗选择。噻托溴铵在美国和欧洲适用于≥6岁的患者。虽然推荐但很少实施的逐步减少治疗，可以维持症状控制并将不良事件降至最低，同时大幅降低成本。患者教育和更好的监测对于自我管理和实现最佳治疗效果仍然很重要。
需要通过采用上调和下调方法来针对哮喘儿童的个体治疗目标，以最大化治疗益处并最小化潜在不良反应。
