Asthma is the most prevalent chronic disease in children.1 In the United States, asthma affects approximately 1.4 million children younger than 5 years2 and causes frequent activity limitations3 and hospitalizations.1,4 Unfortunately, a substantial number of children in this age-group have suboptimal asthma control, demonstrated by the higher rates of emergency department (ED) visits and hospitalizations in preschool-aged children than in older children.4
In the United States, mothers of children aged 1 to 5 years with persistent weekly asthma-like symptoms (ie, cough, wheeze, breathlessness) have reported that 22% of the children had an ED visit and 11% had been hospitalized within the past 6 months.5 In 2007, approximately 851,000 children younger than 5 years had an asthma attack in the past year, which represents 61% of the children with asthma in this agegroup. 2 These findings suggest that the treatment goals of asthma are not currently being met in preschoolaged children.
The goal of asthma therapy, detailed in the 2007 National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program's Expert Panel Report 3 (EPR-3),6 is to control asthma by reducing both the impairment and risk domains. Impairment addresses the daily impact of asthma on traditional clinical indices and quality of life. Risk refers to the negative consequences of the disease or pharmacotherapy.
Impairment is reduced by preventing chronic and troublesome symptoms, minimizing short-acting β2-adrenergic agonist (SABA) use to 2 or fewer days a week, maintaining near-normal pulmonary function, maintaining normal activity levels, and meeting patients' and families' expectation of and satisfaction with asthma care. Risk is reduced by preventing recurrent exacerbations of asthma and minimizing the need for ED visits or hospitalizations, preventing reduced lung growth, and providing optimal pharmacotherapy with minimal or no adverse events. Both domains may respond differently to treatment. Treatments are selected and adjusted on the basis of the patient's level of asthma control, which is determined by assessments made by the health care provider (HCP) and caregiver.
This review provides an overview on how to assess and achieve asthma control in children younger than 5 years and presents answers based on current asthma guidelines to the following questions that arise during clinic visits:
- Is the diagnosis asthma?
- Can a child outgrow asthma?
- How severe is the child's asthma?
- What are the current recommendations for initial controller or step-up therapy?
- What is the preferred therapy when initiating daily controller medications?
- Are the child's respiratory symptoms controlled?
- What is the Test for Respiratory and Asthma Control in Kids (TRACKTM)?7
- What are the next steps for a child with uncontrolled respiratory symptoms?
- How can caregivers help children achieve asthma control?