[Guideline "Treatment of asthma in children": 3 controversial approaches to treatment]. / Richtlijn 'Behandeling van astma bij kinderen': 3 controversiële behandelopties.

ABSTRACT

In context of the development of evidence-based guidelines by the Dutch Paediatric Society, the three most important controversies in asthma treatment in children were investigated by systematic literature review and assessed based on the quality of evidence according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Although the quality of evidence was low, this method did result in clear, although weak, recommendations, in which the considerations playing a role are made clear. In young children with severe and/or recurrent wheezing, maintenance treatment using an inhalation corticosteroid (ICS) is initially recommended. When inhalation technique is poor, a leukotriene receptor antagonist (LTRA) can be given instead. Inhalation corticosteroids with ultrafine particles are not specifically recommended as first line treatment in young children. If asthma is not controlled despite use of ICS, it is advised to double the dose of ICS after unfavourable environmental factors have been excluded. If the result is insufficient, a combination of ICS and a long acting bronchodilator is prescribed in children older than 4- 6 years of age.