[Treatment of asthma in children; revised guidelines by pediatric pneumologists. Section of Pediatric Lung Diseases of the Dutch Association of Pediatric Medicine].

The diagnosis of 'asthma' is still based on anamnesis, physical examination and lung function tests. Supplementary examinations (laboratory or roentgen) are carried out only if indicated. Most young children with recurrent periods of wheezing and coughing prove not to develop asthma in the long run. Oral medication no longer has a place in the treatment of asthma, since inhalation medication is now possible at all ages, among other things because of the current availability of new nozzle attachments. Every child with asthma should have a short-acting beta 2-agonist at hand. Furthermore, inhaled corticosteroids are the maintenance drug of choice in children with moderate or severe asthma. Systemic effects may occur with every inhaled corticosteroid, even with dosages usual for children, but these are rarely relevant. Cromones nowadays play a very limited part. Long-acting beta 2-agonists are indicated in children whose asthma cannot be controlled with standard doses of inhaled corticosteroids. In the prevention of allergic asthma of childhood, prescription of the allergen-tight mattress cover plays a main part. The physician has an important task in discouraging (passive) smoking. Young children who, in spite of treatment with inhaled corticosteroids, have recurrent episodes of wheezing and coughing. and children requiring high doses of inhaled corticosteroids (over 400 micrograms beclomethasone/budesonide or 250 micrograms fluticasone) should be referred to a paediatrician. The asthma nurse has an important task in instructing and advising the asthmatic child and its parents. Self-management programmes may be of great psychological value for the patient and his environment.