Managing childhood asthma: challenge of preventing exacerbations.

Acute episodes of airway obstruction followed by periods of apparent wellness are the main clinical manifestations of the disease for many children with persistent asthma. Although currently available asthma controllers decrease the risk for acute asthma exacerbations, 30% of children taking these medicines still have >or=1 episode requiring oral corticosteroid treatment per year. There is increasing evidence that neutrophilic inflammation, against which inhaled corticosteroids are not very effective, plays a major role in the pathogenesis of asthma exacerbations. New therapeutic approaches are needed for this frequent cause of consultation in pediatric practice. One approach could be the development of drugs that target neutrophilic inflammation specifically. Studies in adults have shown that use of inhaled corticosteroids every time a bronchodilator is needed may decrease the frequency of asthma exacerbations. This strategy is currently being tested in a large clinical trial involving children with mild persistent asthma.