About treatment?
Treatment should follow a stepwise process as established by BTS/SIGN guidelines (2014) and parents should be reassured that asthma medications are generally safe when prescribed and administered correctly. Many parents will have concerns regarding medications, so time should be spent on this area ensuring that parents are given a good understanding of how each prescribed medication works to control symptoms. Careful explanation should be given about the use of bronchodilators and parents should be made aware that a need for bronchodilators more than three times a week should indicate a need for preventer therapy or an increase in the current inhaled corticosteroid dose as per the personalized asthma action plan (PAAP).
Concerns regarding the use of corticosteroids are common due to the term ‘steroid’, which is often portrayed in the media negatively. These concerns should be addressed and reassurance should be given the nature of corticosteroids and how they differ from ‘muscle building’ anabolic steroids. The prescribing of corticosteroids should be in accordance with national guidelines and the choice of inhaler device should not be underestimated, as poor inhaler technique is a primary cause of poor asthma control. Common side effects associated with the use of inhaled corticosteroids such as oral candidiasis can be reduced or avoided with the use of spacer devices. Spacers can help keep the dose of corticosteroids needed at a minimum, as they increase the deposition of the drug in the lungs and therefore improve efficacy. Parents and children will need to be taught how to use these pieces of equipment.
It is important that clinicians are aware of the differing potency and appropriate dosages of the different inhaled steroids and inhaler types when discussing and deciding on treatment. In children with difficult asthma or for those who do not respond to the upper limit of 400 ug a day beclometasone or equivalent-despite adherence, correct inhaler technique and the addition of a leukotriene receptor antagonist-referral to a respiratory paediatrician is advised.
Regular oral steroids should only be instigated by a specialist (BTS/SIGN,2014).