Management of childhood and adolescent asthma. 1994 consensus. South African Childhood Asthma Working Group.

OBJECTIVE

To make recommendations regarding the treatment of chronic asthma to achieve effective control; to emphasise that asthma is a clinical diagnosis; to stress the central role of inflammation in asthma; to recommend alternative agents for practice where certain drugs are not available; and to address new agents that have been introduced for the treatment of asthma.

OPTIONS

A new severity grading of mild, moderate and severe asthma is proposed to aid in the selection of medication. This severity assessment uses four features; attack frequency, nocturnal symptom frequency, hospital admissions and peak flow. Since asthma can vary with time, regular reassessment with a view to reassignment of individual grading is necessary.

OUTCOMES

Goals of effective control strive to ensure that the asthmatic leads a normal life free from symptoms with regular school attendance, restful sleep, normal growth and development, minimal acute attacks and avoidance of hospital admissions.

EVIDENCE

Previous local and international consensus statements.

BENEFITS, HARMS, COSTS: Early diagnosis, accurate grading and effective control reduce morbidity and mortality and will be cost-saving. Pharmaco-economic evaluations of the cost of asthma show that medications per se represent a small percentage of the overall cost of asthma.

RECOMMENDATIONS

Inhaled therapy is preferred, even in young children, as aerosol devices for all ages are available. Mild asthma is treated with intermittent short-acting beta-agonists, moderate asthma with regular cromoglycate and severe asthma with regular inhaled steroids. Environmental control, specialist referral and hazardous and unnecessary therapy are also addressed.