Childhood asthma: A best-practice strategy for diagnosis and assessment of control in South Africa

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Abstract

The South African (SA) Childhood Asthma Working Group of the Allergy Society of SA (ALLSA) advises on best-practice strategy for childhood asthma management. The strategy is in accordance with current evidence and consensus. The aim of this review is to inform on a best-practice strategy for asthma diagnosis and the assessment of asthma control in SA children who attend public and private healthcare services. The diagnosis of asthma is more difficult in preschool-aged than school-aged children. This review proposes a four-step diagnostic approach in both groups, with an added obligation to objectively measure variable expiratory airflow limitation in school-aged children. Asthma control refers to the degree to which the effects of asthma can be seen in patients, or to which these have been reduced by treatment. After initiation of treatment, it is essential to assess asthma control at regular follow-up visits, and to adjust treatment accordingly. Patient education is key to attaining control.

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Long-term inhaled corticosteroids in preschool children at high risk for asthma.

Theresa W. Guilbert, Wayne J. Morgan, Robert Zeiger … (2006)

It is unknown whether inhaled corticosteroids can modify the subsequent development of asthma in preschool children at high risk for asthma. We randomly assigned 285 participants two or three years of age with a positive asthma predictive index to treatment with fluticasone propionate (at a dose of 88 mug twice daily) or masked placebo for two years, followed by a one-year period without study medication. The primary outcome was the proportion of episode-free days during the observation year. During the observation year, no significant differences were seen between the two groups in the proportion of episode-free days, the number of exacerbations, or lung function. During the treatment period, as compared with placebo use, use of the inhaled corticosteroid was associated with a greater proportion of episode-free days (P=0.006) and a lower rate of exacerbations (P<0.001) and of supplementary use of controller medication (P<0.001). In the inhaled-corticosteroid group, as compared with the placebo group, the mean increase in height was 1.1 cm less at 24 months (P<0.001), but by the end of the trial, the height increase was 0.7 cm less (P=0.008). During treatment, the inhaled corticosteroid reduced symptoms and exacerbations but slowed growth, albeit temporarily and not progressively. In preschool children at high risk for asthma, two years of inhaled-corticosteroid therapy did not change the development of asthma symptoms or lung function during a third, treatment-free year. These findings do not provide support for a subsequent disease-modifying effect of inhaled corticosteroids after the treatment is discontinued. (ClinicalTrials.gov number, NCT00272441.). Copyright 2006 Massachusetts Medical Society.

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Childhood asthma after bacterial colonization of the airway in neonates.

Hans Bisgaard, Mette Northman Hermansen, Frederik Buchvald … (2007)

Pathological features of the airway in young children with severe recurrent wheeze suggest an association between bacterial colonization and the initiating events of early asthma. We conducted a study to investigate a possible association between bacterial colonization of the hypopharynx in asymptomatic neonates and later development of recurrent wheeze, asthma, and allergy during the first 5 years of life. The subjects were children from the Copenhagen Prospective Study on Asthma in Childhood birth cohort who were born to mothers with asthma. Aspirates from the hypopharyngeal region of asymptomatic 1-month-old infants were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Wheeze was monitored prospectively on diary cards during the first 5 years of life. Blood eosinophil count and total IgE and specific IgE were measured at 4 years of age. Lung function was measured and asthma was diagnosed at 5 years of age. Hypopharyngeal samples were cultured from 321 neonates at 1 month of age. Twenty-one percent of the infants were colonized with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms; colonization with one or more of these organisms, but not colonization with S. aureus, was significantly associated with persistent wheeze (hazard ratio, 2.40; 95% confidence interval [CI], 1.45 to 3.99), acute severe exacerbation of wheeze (hazard ratio, 2.99; 95% CI, 1.66 to 5.39), and hospitalization for wheeze (hazard ratio, 3.85; 95% CI, 1.90 to 7.79). Blood eosinophil counts and total IgE at 4 years of age were significantly increased in children colonized neonatally with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms, but specific IgE was not significantly affected. The prevalence of asthma and the reversibility of airway resistance after beta2-agonist administration at 5 years of age were significantly increased in the children colonized neonatally with these organisms as compared with the children without such colonization (33% vs. 10% and 23% vs. 18%, respectively). Neonates colonized in the hypopharyngeal region with S. pneumoniae, H. influenzae, or M. catarrhalis, or with a combination of these organisms, are at increased risk for recurrent wheeze and asthma early in life. Copyright 2007 Massachusetts Medical Society.

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Intermittent inhaled corticosteroids in infants with episodic wheezing.

Hans Bisgaard, Mette Northman Hermansen, Lotte Loland … (2006)

We hypothesized that asthma is preceded by a stage of recurrent episodes of wheezing during the first years of life and that inhaled corticosteroid therapy during symptomatic episodes in this early phase may delay progression to persistent wheezing. We assigned one-month-old infants to treatment with two-week courses of inhaled budesonide (400 mug per day) or placebo, initiated after a three-day episode of wheezing, in this single-center, randomized, double-blind, prospective study of three years' duration. The primary outcome was the number of symptom-free days; key secondary outcomes were the time to discontinuation due to persistent wheezing and safety, as evaluated by height and bone mineral density at the end of the study. We enrolled 411 infants and randomly assigned 294 to receive budesonide at a first episode of wheezing. The proportion of symptom-free days was 83 percent in the budesonide group and 82 percent in the placebo group (absolute difference, 1 percent; 95 percent confidence interval, -4.8 to 6.9 percent). Twenty-four percent of children in the budesonide group had persistent wheezing, as compared with 21 percent in the placebo group (hazard ratio, 1.22; 95 percent confidence interval, 0.71 to 2.13)--a finding that was unaffected by the presence or absence of atopic dermatitis. The mean duration of the acute episodes was 10 days in both groups and was independent of respiratory viral status. Height and bone mineral density were not affected by treatment. Intermittent inhaled corticosteroid therapy had no effect on the progression from episodic to persistent wheezing and no short-term benefit during episodes of wheezing in the first three years of life. (ClinicalTrials.gov number, NCT00234390.). Copyright 2006 Massachusetts Medical Society.

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Journal ID (publisher-id): samj

Title: SAMJ: South African Medical Journal

Abbreviated Title: SAMJ, S. Afr. med. j.

Publisher: South African Medical Association (Pretoria, Gauteng, South Africa )

ISSN (Print): 0256-9574

ISSN (Electronic): 2078-5135

Publication date (Print and electronic): August 2021

Volume: 111

Issue: 8

Pages: 705-709

Affiliations

[03] Cape Town orgnameStellenbosch University orgdiv1Faculty of Health Sciences orgdiv2Department of Paediatrics and Child Health South Africa

[04] orgnameUniversity of Limpopo orgdiv1Faculty of Health Sciences orgdiv2Department of Paediatrics and Child Health South Africa

[02] orgnameUniversity of the Witwatersrand orgdiv1Faculty of Health Sciences orgdiv2Department of Paediatrics and Child Health South Africa

[01] Pretoria orgnameUniversity of Pretoria orgdiv1Faculty of Health Sciences orgdiv2School of Medicine South Africa

Article

Publisher ID: S0256-95742021000800010 Publisher ID: S0256-9574(21)11100800010

DOI: 10.7196/samj.2021.v111i5.15851

SO-VID: feee586b-5f07-4293-93bd-599fe3b8e05b

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Childhood asthma: A best-practice strategy for diagnosis and assessment of control in South Africa

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Most cited references 15

Long-term inhaled corticosteroids in preschool children at high risk for asthma.

Childhood asthma after bacterial colonization of the airway in neonates.

Intermittent inhaled corticosteroids in infants with episodic wheezing.

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