From the Guidelines
Mild asthma is still a relevant consideration in children under 6 years of age, and its management should be guided by the presence of specific symptoms and risk factors, as outlined in the expert panel report 3 (EPR-3) guidelines 1.
Key Considerations for Diagnosis
When evaluating children under 6 for mild asthma, it's crucial to consider the frequency and severity of wheezing episodes, the presence of a positive asthma predictive index (which includes factors such as parental history of asthma, atopic dermatitis, or sensitization to aeroallergens), and the impact of symptoms on daily life and sleep 1.
- The EPR-3 guidelines suggest that long-term control therapy should be considered for infants and young children who have had four or more episodes of wheezing in the past year that lasted more than one day and affected sleep, and who have a positive asthma predictive index 1.
- For children who consistently require symptomatic treatment more than two days a week for over four weeks, or those who have two exacerbations requiring systemic corticosteroids within six months, long-term control therapy should also be considered 1.
Treatment Approach
The preferred initial treatment for mild asthma in young children is a low-dose inhaled corticosteroid (ICS), with the goal of reducing impairment and the risk of exacerbations while minimizing potential side effects 1.
- Medications such as budesonide (Pulmicort) via nebulizer or fluticasone (Flovent) via dry powder inhaler are options, depending on the child's age and ability to use the delivery device effectively 1.
- For quick relief during symptoms, albuterol (Proventil, Ventolin) via nebulizer or metered-dose inhaler with a spacer can be used as needed 1.
- It's essential to monitor response to therapy closely and adjust treatment as necessary, considering the potential for spontaneous remission of symptoms in this age group 1.
From the Research
Definition and Diagnosis of Mild Asthma in Children Under 6
- Mild asthma is a common chronic condition in children, and its diagnosis can be challenging, especially in toddlers with recurrent wheezing 2
- The diagnosis of asthma in children under 6 is often based on symptoms, triggers, and response to therapy, but there is no uniformly agreed-upon definition for mild asthma 3
Treatment of Mild Asthma in Children Under 6
- Inhaled corticosteroids (ICS) are recommended for the treatment of mild asthma in children, and regular ICS use may be the most effective treatment for preventing exacerbation and increasing FEV1 in children with mild asthma 4, 5
- The Canadian Thoracic Society's 2021 guideline update recommends daily inhaled corticosteroids to manage mild asthma in children, and advises against intermittent short courses of inhaled corticosteroids 6
- As-needed budesonide/formoterol (bud/form) may be an option for children ≥12 years old who are unable to take daily inhaled corticosteroids despite extensive asthma education and support 6
Management of Mild Asthma in Children Under 6
- The management of mild asthma in children under 6 requires a step-wise approach, with treatment usually reducing symptom frequency and improving asthma control 2
- Assessing for risk of asthma exacerbation and not using as-needed short-acting beta-agonists alone in patients at higher risk for exacerbation are important considerations in the management of mild asthma in children 6